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Sample records for stroke caregiving outcomes

  1. Caregiver-mediated exercises for improving outcomes after stroke

    NARCIS (Netherlands)

    Vloothuis, Judith D.M.; Mulder, Marijn; Veerbeek, Janne M.; Konijnenbelt, Manin; Visser-Meily, Johanna M.A.; Ket, Johannes C.F.; Kwakkel, Gert; van Wegen, Erwin E.H.

    2016-01-01

    Background: Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are

  2. Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity.

    Science.gov (United States)

    Denno, Melissa S; Gillard, Patrick J; Graham, Glenn D; DiBonaventura, Marco D; Goren, Amir; Varon, Sepi F; Zorowitz, Richard

    2013-09-01

    To investigate the relationship between anxiety/depression and caregiver burden in informal caregivers of stroke survivors with spasticity. Data were collected via online surveys from informal caregivers 18 years or older who cared for stroke survivors. Internet-based survey. 2007 through 2009 U.S. National Health and Wellness Survey database or Lightspeed Research general panel respondents (N=153). Not applicable. Anxiety and depression were self-reported by the caregiver as a physician diagnosis. Depression severity was measured by the Patient Health Questionnaire-9 (PHQ-9). Caregiver burden was measured by the Oberst Caregiving Burden Scale (OCBS) and the Bakas Caregiving Outcomes Scale (BCOS). Logistic regression analyses were conducted with anxiety, depression, and the PHQ-9 depression severity categories as a result of each caregiver burden scale. Data were analyzed for 153 informal caregivers; they were mostly women (70.6%) and white (78.4%), with a mean age of 51.6 years. For every 1-point increase in the OCBS Difficulty Scale, the odds of anxiety or depression were 2.57 times as great (Pcaregiver burden increases, caregivers are more likely to have anxiety and depression. Depression severity also increases. Providing treatment to stroke survivors with spasticity that lessens the time and more importantly, the difficulty of caregiving may lead to a reduction in caregiver anxiety and depression. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Does caregiver well-being predict stroke survivor depressive symptoms? A mediation analysis.

    Science.gov (United States)

    Grant, Joan S; Clay, Olivio J; Keltner, Norman L; Haley, William E; Wadley, Virginia G; Perkins, Martinique M; Roth, David L

    2013-01-01

    Studies suggest that family caregiver well-being (ie, depressive symptoms and life satisfaction) may affect stroke survivor depressive symptoms. We used mediation analysis to assess whether caregiver well-being might be a factor explaining stroke survivor depressive symptoms, after controlling for demographic factors and stroke survivor impairments and problems. Caregiver/stroke participant dyads (N = 146) completed measures of stroke survivor impairments and problems and depressive symptoms and caregiver depressive symptoms and life satisfaction. Mediation analysis was used to examine whether caregiver well-being mediated the relationship between stroke survivor impairments and problems and stroke survivor depressive symptoms. As expected, more stroke survivor problems and impairments were associated with higher levels of stroke survivor depressive symptoms (P mediated by caregiver life satisfaction (29.29%) and caregiver depressive symptoms (32.95%). Although these measures combined to account for 40.50% of the relationship between survivor problems and impairments and depressive symptoms, the direct effect remained significant. Findings indicate that stroke survivor impairments and problems may affect family caregivers and stroke survivors and a high level of caregiver distress may result in poorer outcomes for stroke survivors. Results highlight the likely importance of intervening with both stroke survivors and family caregivers to optimize recovery after stroke.

  4. Combined life satisfaction of persons with stroke and their caregivers: associations with caregiver burden and the impact of stroke

    Directory of Open Access Journals (Sweden)

    von Koch Lena

    2011-01-01

    Full Text Available Abstract Background Little is known about the life satisfaction of the person with stroke combined with their caregiver, i.e. the dyad, despite the fact that life satisfaction is an important rehabilitation outcome. The aim of this study was to describe the dyads combined life satisfaction and to understand this in relationship to the perceived impact of stroke in everyday life and caregiver burden. Methods In this cross-sectional study, the life satisfaction of persons and their informal caregivers was measured in 81 dyads one year post stroke. Their global life satisfaction, measured with LiSat-11, was combined to a dyad score and the dyads were then categorized as satisfied, dissatisfied or discordant. The groups were compared and analyzed regarding levels of caregiver burden, measured with the Caregiver Burden scale, and the perceived impact of stroke in everyday life, measured with the Stroke Impact Scale (SIS. Results The satisfied dyads comprised 40%, dissatisfied 26% and those that were discordant 34%. The satisfied dyads reported a significantly lower impact of the stroke in everyday life compared with the dyads that were not satisfied. As expected, dyads that were not satisfied reported a significantly greater caregiver burden compared with the satisfied dyads. The discordant group was further broken down into a group of dissatisfied and satisfied caregivers. The caregivers that were not satisfied in the discordant group perceived a significantly greater level of caregiver burden compared with the satisfied group. Even caregivers who were satisfied with life but whose care recipients were not satisfied reported caregiver burden. Conclusions Measuring combined life satisfaction provides a unique focus and appears to be a feasible way of attaining the dyads' perspective. The findings suggest that those dyads with a discordant life satisfaction could be vulnerable because of the caregivers' reported caregiver burden. These findings

  5. Combined life satisfaction of persons with stroke and their caregivers: associations with caregiver burden and the impact of stroke.

    Science.gov (United States)

    Bergström, Aileen L; Eriksson, Gunilla; von Koch, Lena; Tham, Kerstin

    2011-01-11

    Little is known about the life satisfaction of the person with stroke combined with their caregiver, i.e. the dyad, despite the fact that life satisfaction is an important rehabilitation outcome. The aim of this study was to describe the dyads combined life satisfaction and to understand this in relationship to the perceived impact of stroke in everyday life and caregiver burden. In this cross-sectional study, the life satisfaction of persons and their informal caregivers was measured in 81 dyads one year post stroke. Their global life satisfaction, measured with LiSat-11, was combined to a dyad score and the dyads were then categorized as satisfied, dissatisfied or discordant. The groups were compared and analyzed regarding levels of caregiver burden, measured with the Caregiver Burden scale, and the perceived impact of stroke in everyday life, measured with the Stroke Impact Scale (SIS). The satisfied dyads comprised 40%, dissatisfied 26% and those that were discordant 34%. The satisfied dyads reported a significantly lower impact of the stroke in everyday life compared with the dyads that were not satisfied. As expected, dyads that were not satisfied reported a significantly greater caregiver burden compared with the satisfied dyads. The discordant group was further broken down into a group of dissatisfied and satisfied caregivers. The caregivers that were not satisfied in the discordant group perceived a significantly greater level of caregiver burden compared with the satisfied group. Even caregivers who were satisfied with life but whose care recipients were not satisfied reported caregiver burden. Measuring combined life satisfaction provides a unique focus and appears to be a feasible way of attaining the dyads' perspective. The findings suggest that those dyads with a discordant life satisfaction could be vulnerable because of the caregivers' reported caregiver burden. These findings support the importance of a dyadic perspective and add to the

  6. Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke.

    Science.gov (United States)

    Kamel, Andaleeb Abu; Bond, A Elaine; Froelicher, Erika Sivarajan

    2012-04-01

    Many stroke survivors will be cared for at home, primarily by their relatives. Providing care to a family member with a chronic disabling disease can be both emotionally and physically distressing for the caregivers. The purpose of this study was to investigate the relationship between patients' characteristics, duration of caregiving, daily caregiving time, caregiver's characteristics, caregiver depression and burden in caregivers of patients with stroke. A cross-sectional design was used with a convenience sample of 116 subjects. The Center of Epidemiologic Studies of Depression and the Caregiver Strain Index were used to identify caregiver depression and burden, respectively. Logistic regression analysis identified the influence of independent variables on caregiver depression and caregiver burden. Caregivers had high scores for depression and burden indices. Caregivers' health, receiving professional home health care and caregivers' burden were related to caregiver depression. Functional disabilities of patients with stroke and depression of caregivers were related to caregiver burden. To decrease caregiver depression and burden, nurses must provide caregivers with instructions for home management of patients with stroke. Development of specialized stroke home health services in Jordan that targets patients with stroke and their caregivers are recommended. © 2012 Blackwell Publishing Asia Pty Ltd.

  7. Caregiver experiences and perceptions of stroke

    Directory of Open Access Journals (Sweden)

    Mary Thomas

    2008-11-01

    Full Text Available With the increasing prevalence of people in developing countries who suffer strokes, the long-term care of people who have had a stroke and who are living with disabilities has substantial consequences for caregivers and their respective families. As the caregiver plays a pivotal role in the rehabilitation of the people who have had a stroke, the objectives of this study constitute an investigation into the complexities of caregiving, including both perceptions and experiences of the healthcare system. Semi-structured interviews were utilised to elicit post-stroke experiences of six caregivers. The challenge the South African context adds to these experiences was probed. The data were analysed qualitatively by thematic and content analysis. Prominent themes associated with caregiving included: role changes and relationship disruptions within the family, occupational and social implications, fatigue, anxiety, depression, loneliness, frustration as well as financial problems. Caregiver experiences were exacerbated by the inadequate support structures available. The results are interpreted within a biopsychosocial approach, concluding with the concerns raised by caregivers on the support they require from the healthcare system in order to provide home-based care. Opsomming Met die toenemende voorkoms van beroerte in ontwikkelende lande bring die langdurige versorging van pasiënte met gestremdheid beduidende gevolge vir sorggewers en hulle onderskeie gesinne mee. Aangesien die sorggewer ‘n sleutelrol in die rehabilitasie van die beroertepasiënt speel, behels die doelstellings van hierdie studie ‘n ondersoek na die verwikkeldhede van versorging, wat sowel persepsies as ondervinding van die gesondheidsorgstelsel insluit. Semi- gestruktureerde onderhoude is aangewend om die na-beroerte ondervindings van ses sorggewers te peil. Die uitdaging wat die Suid- Afrikaanse konteks tot hierdie ondervindings meebring is ondersoek. Die data is kwalitatief

  8. Addressing the burden of stroke caregivers: a literature review.

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    Camak, Deborah Jacks

    2015-09-01

    To examine the empirical literature regarding the risk of burden experienced by the older adult caregiver of the stroke survivor. The scope of this review was limited to older adult family members caring for older adult stroke survivors as evidenced in the literature written between the years of 2009-2014. This article will explore published research within the past five years (2009-2014) that addresses the issue of burden among older adult caregivers of stroke survivors in addition to the implication for the changes needed within the nursing profession to mitigating the burden experienced by the caregiver. Many stroke survivors are in their 6th decade of life or older, with caregivers approximately the same age. This literature review specifically focuses on the role of nursing and the issue of caregiver burden. Literature Review. A review of the literature published between 2009-2014 related to the lived experience of caregivers of stroke survivors and the role of nursing related to mitigating caregiver burden. Numerous factors impact the lived experience of caregivers providing care for the stroke survivor. Assuming the role of caregiver has an inherent risk which can result in health compromises for the caregiver. It is the responsibility of the nurse to assess, design interventions and provide education to prepare the caregiver for the demands of the role. The literature review has shown that research regarding the risk of caregiver burden and the resulting health compromise is scarce. In addition, there is a lack of evidence-based nursing interventions aimed at assuaging the risk of caregiver burden. Caregiver stress culminating in burden is commonly a reason for the eventual institutionalisation of the stroke survivor. Critically assessing and providing for the physical, psychosocial and educational support needs of stroke caregivers will assist in mitigating the daily burden experienced by the caregiver. Caregiver burden often results in psychological and

  9. Changes in caregiver burden among informal caregivers of stroke patients in Mongolia.

    Science.gov (United States)

    Chuluunbaatar, Enkhzaya; Pu, Christy; Chou, Yiing-Jenq

    2017-05-01

    Modern therapeutics and health care improvements prolong stroke patients' survival; however, the degree of disability remains high. Stroke survivors often require caregivers, particularly in the first year after the onset of the stroke. Longitudinal assessment of and factors associated with caregiver burden (CGB) among caregivers of stroke patients has been scarcely discussed. This study aimed to define the changes in CGB in the first year of caregiving among the caregivers of stroke patients and to identify associated factors. A prospective, multi-centered observational study was conducted in nine public hospitals in Mongolia. We used the Montgomery CGB Scale for assessing CGB, and repeated the assessment after 1 year. Stroke patient characteristics were included in the analyses. Multinomial logistic regressions were conducted to analyze changes in CGB. A paired t-test analysis revealed that demand burden increased (from 12.61 to 11.50, p = 0.034), whereas stress burden decreased (from 10.69 to 11.60, p = 0.016). Although objective burden decreased, the difference was not significant. Factors associated with these changes in CGB were the caregiver's marital status, the caregiver's relationship with the patient, financial difficulties, and the patient's sex and dependency. The information on factors predicting changes in CGB in the first year of caregiving provided in this study suggests that social or financial support can assist in reducing CGB among the caregivers of post-stroke patients.

  10. Stroke management: Informal caregivers' burdens and strians of caring for stroke survivors.

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    Gbiri, Caleb Ademola; Olawale, Olajide Ayinla; Isaac, Sarah Oghenekewe

    2015-04-01

    Stroke survivors live with varied degrees of disabilities and cares are provided largely by the informal caregivers. This study investigated informal caregivers' burden and strains of caring for stroke patients. This study involved 157 (81 males and 76 females) informal caregivers of stroke survivors receiving care in all secondary and tertiary health institutions with physiotherapy services in Lagos State, Nigeria. Information was collected through self-administered questionnaire during clinic-hours. Data was analyzed using Spearman's Rank Correlation Coefficient. The patients' age ranged between 20 and 79 (mean=59.6 ± 14.6 years). Sixty-one had haemorrhagic stroke while 96 had ischaemic stroke. The informal caregivers' age was 39.2 ± 12.8 years (range: 17-36 years). More (60.8%) participants reported moderate objective while 79.2% had mild subjective burdens. The following factors significantly increased (Pbeings of the informal caregivers. Caring for stroke survivors put social, emotional, health and financial burdens and strains on the informal caregivers. These burdens and strains increase with duration of stroke, intimacy, smaller number of caregivers and length of daily caregiving. Therefore, informal caregivers should be involved in the rehabilitation plan for stroke patients and their well-being should also be given adequate attention. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Psychometric properties of the Caregiver Preparedness Scale in caregivers of stroke survivors.

    Science.gov (United States)

    Pucciarelli, Gianluca; Savini, Serenella; Byun, Eeeseung; Simeone, Silvio; Barbaranelli, Claudio; Vela, Raúl Juárez; Alvaro, Rosaria; Vellone, Ercole

    2014-01-01

    To evaluate the psychometric characteristics of the Caregiver Preparedness Scale (CPS) in caregivers of stroke survivors. Caregiver preparedness can have an important impact on both the caregiver and the stroke survivor. The validity and reliability of the CPS has not been tested for the stroke-caregiver population. We used a cross-sectional design to study a sample of 156 caregivers of stroke survivors. Construct validity of the CPS was evaluated by confirmatory factor analysis (CFA). Internal consistency and test-retest reliability were also evaluated. Caregivers were, on average, 54 year old (SD = 13.2) and most were women (64.7%). CFA supported the unidimensionality of the scale (comparative fit index = 0.98). Reliability was also supported: item-reliability index and item-total correlations above 0.30; composite reliability index = 0.93; Cronbach's alpha = 0.94; factor score determinacy = 0.97; and test-retest reliability = 0.92. The CPS is valid and reliable in caregivers of stroke survivors. Scores on this scale may assist health-care providers in identifying caregivers with less preparedness to provide specific interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Female Caregivers and Stroke Severity Determines Caregiver Stress in Stroke Patients.

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    Menon, Bindu; Salini, P; Habeeba, K; Conjeevaram, Jyoti; Munisusmitha, K

    2017-01-01

    Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs) stress in stroke survivors. A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] 75) according to patient's BI, according to gender (male and female CG) and relation; spouses (wife, husband), daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws). Data were analyzed using SPSS software version-21. Data were analyzed to determine which variables of the patient effects the CG stress. Majority of the CGs (74.62%) were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4 th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patient's bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patient's bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ 2 = 15.199, P = 0.002) than males (χ 2 = 11.931, P = 0.018); wives and daughters than other relations (χ 2 = 32.184, P = 0.000), (χ 2 = 35.162, P = 0.019). Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic burden. The burden was more evident in female CGs and in

  13. Female caregivers and stroke severity determines caregiver stress in stroke patients

    Directory of Open Access Journals (Sweden)

    Bindu Menon

    2017-01-01

    Full Text Available Background: Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs stress in stroke survivors. Materials and Methods: A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] 75 according to patient's BI, according to gender (male and female CG and relation; spouses (wife, husband, daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws. Data were analyzed using SPSS software version–21. Data were analyzed to determine which variables of the patient effects the CG stress. Results: Majority of the CGs (74.62% were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patient's bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patient's bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ2 = 15.199, P = 0.002 than males (χ2 = 11.931, P = 0.018; wives and daughters than other relations (χ2 = 32.184, P = 0.000, (χ2 = 35.162, P = 0.019. Conclusion: Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic

  14. Burden of informal caregiving for stroke patients: Identification of caregivers at risk of adverse health effects

    NARCIS (Netherlands)

    Exel, N.J.A. van; Koopmanschap, M.A.; Berg, B. van den; Brouwer, W.B.F.; Bos, G.A.M. van den

    2005-01-01

    Background: We assessed the objective and subjective burden of caregiving for stroke patients and investigated which characteristics of the patient, the informal caregiver and the objective burden contribute most to subjective burden and to the condition of feeling substantially burdened. Methods:

  15. Nursing home care educational intervention for family caregivers of older adults post stroke (SHARE): study protocol for a randomised trial.

    Science.gov (United States)

    Day, Carolina Baltar; Bierhals, Carla Cristiane Becker Kottwitz; Santos, Naiana Oliveira Dos; Mocellin, Duane; Predebon, Mariane Lurdes; Dal Pizzol, Fernanda Laís Fengler; Paskulin, Lisiane Manganelli Girardi

    2018-02-09

    Family caregivers of aged stroke survivors face challenging difficulties such as the lack of support and the knowledge and skills to practice home care. These aspects negatively influence the caregivers' burden and quality of life, the use of health services, and hospital readmissions of the stroke survivor. The aim of this research is to describe an educational intervention focused on family caregivers of stroke survivors for the development of home care in the south of Brazil. A randomized clinical trial with 48 family caregivers of stroke survivors will be recruited and divided into two groups: 24 in the intervention group and 24 in the control group. The intervention will consist of the systematic follow-up by nurses who will perform three home visits over a period of 1 month. The control group will not receive the visits and will have the usual care guidelines of the health services. Primary outcomes: burden and quality of life of the caregiver. functional capacity and readmissions of the stroke survivors; the use of health services of the stroke survivors and their family caregivers. Outcomes will be measured 2 months after discharge. The project was approved in April 2016. This research offers information for conducting educational intervention with family caregivers of stroke survivors, presenting knowledge so that nurses can structure and plan the actions aimed at the education of the family caregiver. It is expected that the educational intervention will contribute to reducing caregiver burden and improving their quality of life, as well as avoiding readmissions and inadequate use of health services by stroke survivors. ClinicalTrials.gov, ID: NCT02807012 . Registered on 3 June 2016. Name: Nursing Home Care Intervention Post Stroke (SHARE).

  16. ACUTE STROKE: FUNCTIONAL OUTCOME PREDICTORS

    OpenAIRE

    Sujatha; Ramalingam; Vinodkumar; Vasumathi; Valarmathi; Anu

    2016-01-01

    BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess fu...

  17. Infections and Ischemic Stroke Outcome

    OpenAIRE

    Grabska, Katarzyna; Gromadzka, Grażyna; Członkowska, Anna

    2011-01-01

    Background. Infections increase the risk of ischemic stroke (IS) and may worsen IS prognosis. Adverse effects of in-hospital infections on stroke outcome were also reported. We aimed to study the prevalence of pre- and poststroke infections and their impact on IS outcome. Methods. We analysed clinical data of 2066 IS patients to assess the effect of pre-stroke and post-stroke infections on IS severity, as well as short-term (up to 30 days) and long-term (90 days) outcome. The independent i...

  18. Caregivers of Alzheimer's Disease and Stroke Patients: Immunological and Psychological Considerations.

    Science.gov (United States)

    Reese, Dawn R.; And Others

    1994-01-01

    Examined psychological and immunological changes among 25 caregivers of Alzheimer's disease (AD) patients, 25 caregivers of stroke patients, and 25 noncaregivers. Found that AD caregiving group was more psychologically distressed than stroke group, and both caregiving groups were more psychologically distressed than controls. Found no differences…

  19. The modifying role of caregiver burden on predictors of quality of life of caregivers of hospitalized chronic stroke patients.

    Science.gov (United States)

    Jeong, Yeon-Gyu; Myong, Jun-Pyo; Koo, Jung-Wan

    2015-10-01

    Caregiver burden is an important predictor of quality of life (QoL) among caregivers of stroke patients. While caregiver burden and QoL might be closely related, caregiver burden seems also to be a potential modifier of the associations between patients' and caregivers' characteristics and caregivers' QoL. The purpose of this study was to investigate the effect of caregiver burden in caregivers of hospitalized chronic stroke patients and the predictors of caregivers' QoL by level of caregiver burden. A total of 238 patients and their caregivers were interviewed using questionnaires consisting of the Zarit Burden Interview and the Korean-version of the World Health Organization Quality of Life-BREF. Multiple hierarchical regression analyses were performed to determine the predictors of caregivers' QoL among caregivers stratified by median caregiver burden score (high/low). Caregiver burden had a modifying effect on caregivers' QoL. In caregivers with high burden, the patient characteristics of being unemployed and the caregiver characteristics of poor health status, lower income, and being a spouse were negative predictors of caregivers' QoL. In caregivers with low burden, the patient characteristics of being hospitalized for a longer duration and the caregiver characteristics of poor health status were negative predictors of caregivers' QoL (all ps < 0.05). This study found that in South Korea, more attention should be paid to spouses who are caring for hospitalized chronic stroke patients, particularly with regard to their health status and financial problems. Further studies are needed to examine the impact of factors not examined in the Korean cultural context. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Focus on relationship between the caregivers unmet needs and other caregiving outcomes in cancer palliative care

    OpenAIRE

    Buscemi, Valérie

    2010-01-01

    Objetive: Study the relationships between caregivers unmet needs and others caregiving outcomes in palliative care and cancer, which is a first and necessary step to offer adequate supporting intervention. Methods: 59 caregivers participated in a research that examined the caregiving outcomes using an Unmet Needs Questionnaire, the Hospital Anxiety and Depression Scale, and the Bakas Caregiving Outcomes Scale. Results and conclusions: Results showed a high average of unmet needs, especially e...

  1. Long-term effects of a group support program and an individual support program for informal caregivers of stroke patients : which caregivers benefit the most?

    NARCIS (Netherlands)

    van den Heuvel, ETP; de Witte, LP; Stewart, RE; Schure, LM; Sanderman, R; Meyboom-de Jong, B

    In this article, we report the long-term outcomes of an intervention for informal caregivers who are the main provider of stroke survivors' emotional and physical support. Based on the stress-coping theory of Lazarus and Folkman two intervention designs were developed: a group support program and

  2. Validation of the Caregivers' Satisfaction with Stroke Care Questionnaire: C-SASC hospital scale

    NARCIS (Netherlands)

    J.M. Cramm (Jane); M.M.H. Strating (Mathilde); A.P. Nieboer (Anna)

    2011-01-01

    textabstractTo date, researchers have lacked a validated instrument to measure stroke caregivers' satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers' satisfaction with hospital care

  3. [Impact on quality of life in caregivers of stroke survivors].

    Science.gov (United States)

    López-Espuela, Fidel; González-Gil, Teresa; Jiménez-Gracia, María Antonia; Bravo-Fernández, Sherezade; Amarilla-Donoso, Javier

    2015-01-01

    Stroke is the first cause of disability in adults. Often, the care falls on the family and can affect their quality of life. To determine the health-related quality of life and the level of caregiver burden of a patient after a stroke. Descriptive and cross-sectional study. Caregivers, who had cared for a patient for more than six months and without pay, were included. This study had been approved by the Ethics Committee. Variables collected: sociodemographic, EuroQol-5D questionnaire, Zarit scale, mood and sleep problems. Forty-eight caregivers were included, with a mean age of 55.63 (SD: 13.48) and the majority were women (70.8%). The mean time of the care was 28.8 months (SD: 28.68), with 58% stated having a depressed mood, 31% had burden, and 89.6% had sleep problems. The dimensions that presented problems (moderate and severe) in the EQ-5D were pain-discomfort (66.7%) and anxiety-depression (68.8%). The score on the visual analog scale rating of quality of life was associated with a worse mood (75.5 vs. 32, p=0.0028), with the pain (81.94 vs. 38, p<0.001), and Zarit scale (r:<0.334, p=0.020). The role of caregivers of stroke patients often falls on women. To be a caregiver affects the quality of life, mainly in the pain-discomfort and anxiety-depression dimensions, regardless of the functional status of the patient. Nurses must identify the psychopathological needs and develop strategies on the prevention of the risk of burnout. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  4. Validation of a model of family caregiver communication types and related caregiver outcomes.

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    Wittenberg, Elaine; Kravits, Kate; Goldsmith, Joy; Ferrell, Betty; Fujinami, Rebecca

    2017-02-01

    Caring for the family is included as one of the eight domains of quality palliative care, calling attention to the importance of the family system and family communications about cancer during care and treatment of the disease. Previously, a model of family caregiver communication defined four caregiver communication types-Manager, Carrier, Partner, Lone-each with a unique communication pattern. The purpose of the present study was to extend the model of family caregiver communication in cancer care to further understand the impact of family communication burden on caregiving outcomes. This mixed-method study employed fieldnotes from a family caregiver intervention focused on quality of life and self-reported caregiver communication items to identify a specific family caregiver type. Caregiver types were then analyzed using outcome measures on psychological distress, skills preparedness, family inventory of needs, and quality-of-life domains. Corroboration between fieldnotes and self-reported communication for caregivers (n = 21, 16 women, mean age of 53 years) revealed a definitive classification of the four caregiver types (Manager = 6, Carrier = 5, Partner = 6, Lone = 4). Mean scores on self-reported communication items documented different communication patterns congruent with the theoretical framework of the model. Variation in caregiver outcomes measures confirmed the model of family caregiver communication types. Partner and Lone caregivers reported the lowest psychological distress, with Carrier caregivers feeling least prepared and Manager caregivers reporting the lowest physical quality of life. This study illustrates the impact of family communication on caregiving and increases our knowledge and understanding about the role of communication in caregiver burden. The research provides the first evidence-based validation for a family caregiver communication typology and its relationship to caregiver outcomes. Future research is needed to develop and test

  5. Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention

    NARCIS (Netherlands)

    van den Heuvel, ETP; de Witte, LP; Schure, LM; Sanderman, R; Meyboom-de Jong, B

    2001-01-01

    Objective: To identify which caregivers of stroke patients living at home experience the highest levels of strain and are at risk of burn-out, and to investigate how support for caregivers of stroke patients could best be organized, and when this support should be offered. Design and setting:

  6. Using a complex adaptive system lens to understand family caregiving experiences navigating the stroke rehabilitation system.

    Science.gov (United States)

    Ghazzawi, Andrea; Kuziemsky, Craig; O'Sullivan, Tracey

    2016-10-01

    Family caregivers provide the stroke survivor with social support and continuity during the transition home from a rehabilitation facility. In this exploratory study we examined family caregivers' perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity of care and complex adaptive systems were integrated to examine the transition from a stroke rehabilitation facility to the patient's home. This study provides an understanding of the interacting complexities at the macro and micro levels. A convenient sample of family caregivers (n = 14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient's discharge from a stroke rehabilitation facility in Ontario, Canada. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed and inductive content analysis and the theory of Complex Adaptive Systems were used to interpret the perceptions of family caregivers. Health system policies and procedures at the macro-level determined the types and timing of information being provided to caregivers, and impacted continuity of care and access to supports and services at the micro-level. Supports and services in the community, such as outpatient physiotherapy services, were limited or did not meet the specific needs of the stroke survivors or family caregivers. Relationships with health providers, informational support, and continuity in case management all influence the family caregiving experience and ultimately the quality of care for the stroke survivor, during the transition home from a rehabilitation facility.

  7. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster

    2014-01-01

    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  8. The Impact of Technology-Based Interventions on Informal Caregivers of Stroke Survivors: A Systematic Review.

    Science.gov (United States)

    Aldehaim, Abdulkarim Yousef; Alotaibi, Faisal F; Uphold, Constance R; Dang, Stuti

    2016-03-01

    This article is a systematic review of the impact of technology-based intervention on outcomes related to care providers for those who survived a stroke. Literature was identified in the PubMed, PsycINFO, Scopus, and Cochrane databases for evidence on technology-based interventions for stroke survivors' caregivers. The search was restricted for all English-language articles from 1970 to February 2015 that implied technology-based interventions. This review included studies that measured the impact of these types of approaches on one or more of the following: depression and any of the following-problem-solving ability, burden, health status, social support, preparedness, and healthcare utilization by care recipient-as secondary outcomes. Telephone or face-to-face counseling sessions were not of interest for this review. The search strategy yielded five studies that met inclusion criteria: two randomized clinical trials and three pilot/preliminary studies, with diverse approaches and designs. Four studies have assessed the primary outcome, two of which reported significant decreases in caregivers' depressive symptoms. Two studies had measured each of the following outcomes-burden, problem-solving ability, health status, and social support-and they revealed no significant differences following the intervention. Only one study assessed caregivers' preparedness and showed improved posttest scores. Healthcare services use by the care recipient was assessed by one study, and the results indicated significant reduction in emergency department visits and hospital re-admissions. Despite various study designs and small sample sizes, available data suggest that an intervention that incorporates a theoretical-based model and is designed to target caregivers as early as possible is a promising strategy. Furthermore, there is a need to incorporate a cost-benefit analysis in future studies.

  9. Correlates of Perceived Social Support in Chinese Adult Child Caregivers of Parent Stroke Survivors.

    Science.gov (United States)

    Pan, Yuqin; Jones, Patricia S

    2017-10-01

    Prevalence of stroke and traditional filial responsibility involve adult children in caregiving to their parent stroke survivors in China. Support resources are insufficient because of the shrinking size of family and the underdeveloped support system. The aim of this study was to identify the correlates of perceived social support among adult child caregivers of parent stroke survivors in China. A cross-sectional correlational design was used in this study. A nonproportional quota sample of 126 adult child caregivers was recruited from Zhejiang Province, China. Data were collected at either the hospital stroke units or the respondents' homes using structured questionnaires of caregiving dyadic demographics and caregiving characteristics, 14-item Activities of Daily Living, 15-item Mutuality Scale, and 12-item Multidimensional Scale of Perceived Social Support. SPSS 17.0 was used for analysis. Caregivers' mutuality, education, full employment or being retired, monthly income, having a co-carer, and having a father as the care receiver were significantly positively associated with caregivers' perceived social support. However, mutuality was not significantly associated with caregivers' perceived social support after the other factors were adjusted. Adult child caregivers with higher levels of mutuality, education, or monthly income; who are fully employed or are retired; who have a co-carer; or who are caring for a father perceived more social support. Nursing strategies and social policies need to be directed to enhance caregiver mutuality and support caregiving efforts.

  10. EFFECTS OF REHABILITATION SERVICES ON ANXIETY, DEPRESSION, CARE-GIVING BURDEN AND PERCEIVED SOCIAL SUPPORT OF STROKE CAREGIVERS

    Directory of Open Access Journals (Sweden)

    Ali Yavuz Karahan

    2014-01-01

    Full Text Available Background: Few data are available on the specific care giving-related problems of stroke patient’s caregivers and factors that influence the burden of these caregivers. Aim: To study the influences of the active rehabilitation process on anxiety, depression, care burden and perceived social support level of stroke patients caregivers. Design: A prospective clinical trial. Setting: Patients and caregivers entering a rehabilitation program at a university hospital in Turkey. Populations: Ninety patients with a first episode of stroke and 90 caregivers responsible for their care were recruited for our study. Methods: Patients and caregivers were assessed before and after the active rehabilitation process. The functional disability level of the patients was assessed by Functional Independence Measure (FIM. The Beck Anxiety Scale (BAS and the Beck Depression Scale (BDS were used for anxiety and depression assessment, the Zarit Care Burden Scale (ZCBS for care burden assessment and the Multi-Dimensional Scale of Perceived Social Support (MDSPSS for perceived social support assessment. Results: A statistically significant rise is observed in the special person sub-assessment of MDSPSS in both female and male caregivers. Also, a significant decrease in care burden, anxiety and depression levels of caregivers was noted after the rehabilitation program (p < 0.05. Conclusion: Caregivers accept the rehabilitation period as important social support in addition to the support provided by family and friends. Also, our positive results were associated with an improvement in the patients’ functional level and an increase in the acquisition of knowledge and skill required of caregivers in order to provide care during rehabilitation. Clinical Rehabilitation Impact: The rehabilitation team should be aware of the fact that the perceived care burden may be greater due to the lack of knowledge concerning available resources and due to the inability to cope with

  11. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

    2017-10-23

    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. A Qualitative Study of Family Caregiver Experiences of Managing Incontinence in Stroke Survivors.

    Directory of Open Access Journals (Sweden)

    Chien-Ning Tseng

    Full Text Available Incontinence is a common problem faced by family caregivers that is recognized as a major burden and predictor of institutionalization. However, few studies have evaluated the experiences of family caregivers caring for stroke survivors with incontinence.To describe experiences of caregivers managing incontinence in stroke survivors.This qualitative descriptive study employed a grounded-theory approach.Semi-structured in-depth interviews with ten family caregivers of stroke survivors with incontinence were conducted during 2011. Audiotaped interviews were transcribed and analyzed using content analysis.Data analysis identified four themes: chaos, hypervigilance, exhaustion, and creating a new life. There were nine related subcategories: fluster, dirtiness, urgency, fear of potential health-hazard, physically demanding and time-consuming, mentally draining, financial burden, learning by doing, and attitude adjustment. Together, these described a process of struggling to cope with the care of stroke survivors with urinary/fecal incontinence. Of the four categories, "creating a new life" developed gradually over time to orient caregivers to their new life, while the other three categories occurred in a chronological order.The research highlighted unique caring experiences of family caregivers of stroke patients, which focused solely on the 'incontinence issue'. Understanding these experiences may help nurses provide better support and resources for family caregivers when caring for stroke survivors with incontinence.

  13. Stroke scale score and early prediction of outcome after stroke

    International Nuclear Information System (INIS)

    Ahmed, R.; Zuberi, F.Z.; Afsar, S.

    2004-01-01

    Objective: To evaluate the baseline National Institute of Health Stroke Scale (NIHSS) score as a predictor of functional outcome after ischemic stroke. Subjects and Methods: The study included 50 patients who presented to Civil Hospital, Karachi, during the study period with acute stroke and were evaluated with CT scan of brain. Only those patients were enrolled in the study that had acute ischemic stroke. The enrolled subjects were then evaluated for the neurological impairment using National Institute of Health Stroke Scale (NIHSS). The subjects were followed-up and their functional outcome was assessed using Barthel index (BI) on the 7th day of their admission. Results: Of the fifty patients enrolled in the study, 31 (62%) were males and 19 (38%) were females, with age ranging from 45 years to 95 years and a mean age of 59.9 years. Neurological impairment at presentation was assessed by NIHSS. The score ranged between 2 and 28. The functional outcome was evaluated on the 7th day using Barthel index (BI), which ranged from 0 to 80. NIHSS score was found to be a good predictor of functional outcome in patients with ischemic stroke (p<0.001). Other factors like gender, hypertension and heart disease did not affect the functional recovery in such patients. Various factors were found to be significant for early prediction of stroke recovery. The NIHSS score was the strongest predictor of outcome after ischemic stroke. Age at the time of the event was also found to be an important predictor for stroke recovery. Conclusion: The NIHSS score is a good predictor of patient's recovery after stroke. Assessing the patient's neurological impairment at first presentation of ischemic stroke can guide the physician regarding the prognosis and management plan. (author)

  14. Effects of rehabilitation services on anxiety, depression, care-giving burden and perceived social support of stroke caregivers.

    Science.gov (United States)

    Karahan, Ali Yavuz; Kucuksen, Sami; Yilmaz, Halim; Salli, Ali; Gungor, Tayfun; Sahin, Muhammed

    2014-01-01

    Few data are available on the specific care giving-related problems of stroke patient's caregivers and factors that influence the burden of these caregivers. To study the influences of the active rehabilitation process on anxiety, depression, care burden and perceived social support level of stroke patients caregivers. A prospective clinical trial. Patients and caregivers entering a rehabilitation program at a university hospital in Turkey. Ninety patients with a first episode of stroke and 90 caregivers responsible for their care were recruited for our study. Patients and caregivers were assessed before and after the active rehabilitation process. The functional disability level of the patients was assessed by Functional Independence Measure (FIM). The Beck Anxiety Scale (BAS) and the Beck Depression Scale (BDS) were used for anxiety and depression assessment, the Zarit Care Burden Scale (ZCBS) for care burden assessment and the Multi-Dimensional Scale of Perceived Social Support (MDSPSS) for perceived social support assessment. A statistically significant rise is observed in the special person sub-assessment of MDSPSS in both female and male caregivers. Also, a significant decrease in care burden, anxiety and depression levels of caregivers was noted after the rehabilitation program (p social support in addition to the support provided by family and friends. Also, our positive results were associated with an improvement in the patients' functional level and an increase in the acquisition of knowledge and skill required of caregivers in order to provide care during rehabilitation. The rehabilitation team should be aware of the fact that the perceived care burden may be greater due to the lack of knowledge concerning available resources and due to the inability to cope with stress effectively.

  15. Aphasia As a Predictor of Stroke Outcome.

    Science.gov (United States)

    Lazar, Ronald M; Boehme, Amelia K

    2017-09-19

    Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.

  16. FACTORS ASSOCIATED WITH STROKE SURVIVOR BEHAVIORS AS IDENTIFIED BY FAMILY CAREGIVERS

    Science.gov (United States)

    Gonzalez, Carmanny; Bakas, Tamilyn

    2013-01-01

    Stroke survivor behaviors that caregivers identify as bothersome can lead to family caregiver stress, which can result in premature institutionalization of the survivor. The purpose of this study was to explore demographic and theory-based factors associated with survivor bothersome behaviors as identified by family caregivers. A secondary analysis of a combined sample of 96 family caregivers of stroke survivors was conducted using baseline data from 2 existing studies. Bothersome behaviors were measured using the Revised Memory and Behavior Problems Checklist (RMBPC). Theory-based factors were measured using well-validated scales. Male stroke survivors exhibited more bothersome behaviors (t = 3.53, p nursing interventions designed to reduce bothersome behaviors as identified by family caregivers. PMID:23686515

  17. An organizing framework for informal caregiver interventions: detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts

    Directory of Open Access Journals (Sweden)

    Van Houtven Courtney

    2011-11-01

    Full Text Available Abstract Background Caregiver interventions may help improve the quality of informal care. Yet the lack of a systematic framework specifying the targets and outcomes of caregiver interventions hampers our ability to understand what has been studied, to evaluate existing programs, and to inform the design of future programs. Our goal was to develop an organizing framework detailing the components of the caregiving activities and the caregiver and care recipient outcomes that should be affected by an intervention. In so doing, we characterize what has been measured in the published literature to date and what should be measured in future studies to enable comparisons across interventions and across time. Methods Our data set comprises 121 reports of caregiver interventions conducted in the United States and published between 2000 and 2009. We extracted information on variables that have been examined as primary and secondary outcomes. These variables were grouped into categories, which then informed the organizing framework. We calculated the frequency with which the interventions examined each framework component to identify areas about which we have the most knowledge and under-studied areas that deserve attention in future research. Results The framework stipulates that caregiver interventions seek to change caregiving activities, which in turn affect caregiver and care recipient outcomes. The most frequently assessed variables have been caregiver psychological outcomes (especially depression and burden and care recipient physical and health care use outcomes. Conclusions Based on the organizing framework, we make three key recommendations to guide interventions and inform research and policy. First, all intervention studies should assess quality and/or quantity of caregiving activities to help understand to what extent and how well the intervention worked. Second, intervention studies should assess a broad range of caregiver and care recipient

  18. Clinimetrics & determinants of outcome after stroke

    NARCIS (Netherlands)

    Schepers, V.P.M.

    2006-01-01

    This thesis is based on findings of the Functional Prognostication and disability study on stroke, which had two main objectives: (1) to examine which outcome measures are most appropriate, and especially most responsive, for the assessment of functional outcome in stroke patients and (2) to study

  19. Impact of Noncaregiving-Related Stressors on Informal Caregiver Outcomes.

    Science.gov (United States)

    Austrom, Mary Guerriero; Lu, Yvonne Yueh-Feng; Perkins, Anthony J; Boustani, Malaz; Callahan, Christopher M; Hendrie, Hugh C

    2014-08-01

    Caregivers of persons with dementia are stressed. Stressors not related to care recipients' needs impact caregiver outcomes, yet are seldom reported. The purpose of this study was to report the most stressful events experienced by spouse caregivers of older adults with Alzheimer s disease during a 6-month period. 31 caregivers completed the Most Stressful Event form, Patient Health Questionnaire (PHQ-9) and the Revised Memory Behavioral Problem Checklist (R-MBPC). Fisher's exact test and two-sample t-test were used to compare Most Stressful Events between caregivers. ANOVA model tested whether the PHQ-9 and R-MBPC subscales differed by stressor. Caregivers reported no stressors 21.5% of the time, 1-2 stressors 25% of the time, and 3 stressors 53% of the time with 318 stressors reported in total. Care recipient needs (30.2%), caregiver needs (26.7%), and decision-making (16.7%) were the most frequently reported stressors. Using a mixed effects model, there were associations between the Most Stressful Events and depression (p = 0.016), mobility (p = 0.024) and caregiver issues (p = 0.009) subscales of R-MBPC. Results can be used to develop targeted intervention and support strategies for spouse caregivers experiencing non-caregiving related stressorsas well as the traditional challenges with caregiving related issues. © The Author(s) 2014.

  20. Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation.

    Science.gov (United States)

    Mirkowski, Magdalena; Pereira, Shelialah; Janzen, Shannon; Mehta, Swati; Meyer, Matthew; McClure, Andrew; Speechley, Mark; Teasell, Robert

    2018-02-01

    To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke. A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates. Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8 ± 23.6 versus 72.9 ± 20.3; p availability explained 1.3% of additional variance, with the final model explaining 41.3% of total variance for functional ability at discharge (F (5,174) = 26.21, p availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke. The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.

  1. Impact of Non-caregiving Related Stressors on Informal Caregiver Outcomes

    Science.gov (United States)

    Lu, Yvonne Yueh-Feng; Perkins, Anthony J.; Boustani, Malaz; Callahan, Christopher M.; Hendrie, Hugh C.

    2014-01-01

    Background Caregivers of persons with dementia are stressed. Stressors not related to care recipients’ needs impact caregiver outcomes, yet are seldom reported. Methods 31 caregivers completed the Most Stressful Event form, Patient Health Questionnaire (PHQ-9) and the Revised Memory Behavioral Problem Checklist (R-MBPC). Fisher’s exact test and two-sample t-test were used to compare Most Stressful Events between caregivers. ANOVA model tested whether the PHQ-9 and R-MBPC subscales differed by stressor. Results Caregivers reported no stressors 21.5%, 1–2 stressors 25%, and 3 stressors 53% of the time with 318 stressors total. Care recipient needs (30.2%), caregiver needs (26.7%), and decision-making (16.7%) were the most frequently reported stressors. Using a mixed effects model, there were associations between Most Stressful Events and depression (p=0.016), mobility (p=0.024) and caregiver issues (p=0.009) subscales of R-MBPC. Conclusion Results can be used to develop intervention and support strategies for caregivers experiencing non-caregiving related stressors. PMID:24413541

  2. Proteinuria and clinical outcomes after ischemic stroke.

    Science.gov (United States)

    Kumai, Y; Kamouchi, M; Hata, J; Ago, T; Kitayama, J; Nakane, H; Sugimori, H; Kitazono, T

    2012-06-12

    The impact of chronic kidney disease (CKD) on clinical outcomes after acute ischemic stroke is still not fully understood. The aim of the present study was to elucidate how CKD and its components, proteinuria and low estimated glomerular filtration rate (eGFR), affect the clinical outcomes after ischemic stroke. The study subjects consisted of 3,778 patients with first-ever ischemic stroke within 24 hours of onset from the Fukuoka Stroke Registry. CKD was defined as proteinuria or low eGFR (Stroke Scale during hospitalization), in-hospital mortality, and poor functional outcome (modified Rankin Scale score at discharge of 2 to 6). The effects of CKD, proteinuria, and eGFR on these outcomes were evaluated using a multiple logistic regression analysis. CKD was diagnosed in 1,320 patients (34.9%). In the multivariate analyses after adjusting for confounding factors, patients with CKD had significantly higher risks of neurologic deterioration, in-hospital mortality, and poor functional outcome (p relationship between the eGFR level and each outcome was found. CKD is an important predictor of poor clinical outcomes after acute ischemic stroke. Proteinuria independently contributes to the increased risks of neurologic deterioration, mortality, and poor functional outcome, but the eGFR may not be relevant to these outcomes.

  3. Caregiver experiences and perceptions of stroke | Thomas | Health ...

    African Journals Online (AJOL)

    Prominent themes associated with caregiving included: role changes and relationship disruptions within the family, occupational and social implications, fatigue, anxiety, depression, loneliness, frustration as well as financial problems. Caregiver experiences were exacerbated by the inadequate support structures available.

  4. Neurodevelopmental outcome after neonatal perforator stroke

    NARCIS (Netherlands)

    Ecury-Goossen, Ginette M; van der Haer, Marit; Smit, Liesbeth S; Feijen-Roon, Monique; Lequin, Maarten; de Jonge, Rogier C J; Govaert, Paul; Dudink, Jeroen

    AIM: To assess outcome after neonatal perforator stroke in the largest cohort to date. METHOD: Survivors from a cohort of children diagnosed with neonatal perforator stroke using cranial ultrasound or magnetic resonance imaging were eligible for inclusion. Recovery and Recurrence Questionnaire

  5. The longitudinal and dyadic effects of mutuality on perceived stress for stroke survivors and their spousal caregivers.

    Science.gov (United States)

    Godwin, Kyler M; Swank, Paul R; Vaeth, Patrice; Ostwald, Sharon K

    2013-01-01

    Functional impairment resulting from a stroke frequently requires the care of a family caregiver, often the spouse. This change in the relationship can be stressful for the couple. Thus, this study examined the longitudinal, dyadic relationship between caregivers' and stroke survivors' mutuality and caregivers' and stroke survivors' perceived stress. This secondary data analysis of 159 stroke survivors and their spousal caregivers utilized a cross-lagged, mixed models analysis with the actor-partner interdependence model to examine the dyadic relationship between mutuality and perceived stress over the first year post-discharge from inpatient rehabilitation. Caregivers' mutuality showed an actor effect (β = -3.82, p perceived stress but not the stroke survivors' perceived stress. Stroke survivors' perceived stress showed a partner effect and affected caregivers' perceived stress (β = 0.13, p = 0.047). Caregivers' perceived stress did not show a partner effect and did not significantly affect stroke survivors' perceived stress. These findings highlight the interpersonal nature of stress in the context of caregiving for a spouse. Caregivers are especially influenced by perceived stress in the spousal relationship. Couples should be encouraged to focus on positive aspects of the caregiving relationship to mitigate stress.

  6. National data on stroke outcomes in Thailand.

    Science.gov (United States)

    Kongbunkiat, Kannikar; Kasemsap, Narongrit; Thepsuthammarat, Kaewjai; Tiamkao, Somsak; Sawanyawisuth, Kittisak

    2015-03-01

    Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼$USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Measures of psychological stress and physical health in family caregivers of stroke survivors: a literature review.

    Science.gov (United States)

    Saban, Karen L; Sherwood, Paula R; DeVon, Holli A; Hynes, Denise M

    2010-06-01

    Studies have demonstrated that the stress of family caregiving places caregivers at risk for developing depression, poor quality of life, and health problems. The purpose of this review was to identify the ways in which variables are operationalized in studies addressing psychological stressors and physical health of family caregivers of stroke survivors. The adapted Pittsburgh Mind-Body Center model provides the organizing conceptual framework for this literature review. A literature search for relevant articles was conducted using Ovid Medline, PsycINFO, and Ovid Nursing Database for the period of July 1999 through June 2009 using the following search terms: caregiver (or family caregiver), stroke, stress, and health. Articles were included if they met the following inclusionary criteria: (a) written in English, (b) published in peer-reviewed journal, (c) focused on adults who were caring for an adult who experienced stroke, (d) included measures of stress and physical health or health-related quality of life, and (e) primarily used quantitative research methods. Twenty-four articles were identified that met the inclusion criteria. Findings related to the variables included in the adapted Pittsburgh Mind-Body Center model are discussed. Variables were not well defined, a wide array of measurement instruments were used, and measures were taken at broadly divergent time frames following stroke. Future research guided by a theoretical framework, consistent measures of variables, and standardized measurement time points would allow for better comparison of findings across studies, thus enabling clinicians to better understand the health risks of family caregivers.

  8. Men Lacking a Caregiver Have Greater Risk of Long-Term Nursing Home Placement After Stroke.

    Science.gov (United States)

    Blackburn, Justin; Albright, Karen C; Haley, William E; Howard, Virginia J; Roth, David L; Safford, Monika M; Kilgore, Meredith L

    2018-01-01

    Social support can prevent or delay long-term nursing home placement (NHP). The purpose of our study was to understand how the availability of a caregiver can affect NHP after ischemic stroke and how this affects different subgroups differently. Nested cohort study. Nationally based REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke survivors aged 65 to 100 (256 men, 304 women). Data were from Medicare claims from January 2003 to December 2013 and REGARDS baseline interviews conducted from January 2003 to October 2007. Caregiver support was measured by asking, "If you had a serious illness or became disabled, do you have someone who would be able to provide care for you on an on-going basis?" Diagnosis of ischemic stroke was derived from inpatient claims. NHP was determined using a validated claims algorithm for stays of 100 days and longer. Risk was estimated using Cox regression. Within 5 years of stroke, 119 (21.3%) participants had been placed in a nursing home. Risk of NHP was greater in those lacking available caregivers (log-rank P = .006). After adjustment for covariates, lacking an available caregiver increased the risk of NHP after stroke within 1 year by 70% (hazard ratio (HR) = 1.70, 95% confidence interval (CI) = 0.97-2.99) and within 5 years by 68% (HR = 1.68, 95% CI = 1.10-2.58). The effect of caregiver availability on NHP within 5 years was limited to men (HR = 3.15, 95% CI = 1.49-6.67). In men aged 65 and older who have survived an ischemic stroke, the lack of an available caregiver is associated with triple the risk of NHP within 5 years. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  9. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was

  10. Psychological health of caregivers and association with functional status of stroke patients.

    Science.gov (United States)

    Em, Serda; Bozkurt, Mehtap; Caglayan, Mehmet; Ceylan Cevik, Figen; Kaya, Cemal; Oktayoglu, Pelin; Nas, Kemal

    2017-07-01

    Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients. This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey. The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores. Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.

  11. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R

    2015-01-01

    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  12. Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer's disease.

    Science.gov (United States)

    Huang, Chiung-Yu; Sousa, Valmi D; Perng, Shao-Jen; Hwang, Mei-Yi; Tsai, Chun-Ching; Huang, Mei-Huang; Yao, Shu-Ying

    2009-02-01

    This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers' health. While research on caregiving in Taiwan has examined caregivers' characteristics, caregivers' need and caregivers' burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Cross-sectional, descriptive correlation design. Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson's correlations, multiple and hierarchical regressions and t-tests. Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms. Caregivers of persons with Alzheimer's disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms. The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan.

  13. Participation in everyday life and life satisfaction in persons with stroke and their caregivers 3-6 months after onset.

    Science.gov (United States)

    Bergström, Aileen L; von Koch, Lena; Andersson, Magnus; Tham, Kerstin; Eriksson, Gunilla

    2015-06-01

    To explore and describe persons with stroke and their caregivers' restrictions in participation in everyday occupations, i.e. occupational gaps, 3-6 months post-stroke, in relation to life satisfaction, combined life satisfaction, care-giver burden, perceived impact of stroke, and activities of daily living. Cross-sectional study. Persons with stroke and their caregivers (105 dyads). The Occupational Gaps Questionnaire, Life Satisfaction Checklist, Caregiver Burden Scale, Stroke Impact Scale and Barthel Index were used. Correlations were analysed with Spearman's rank, and regression analyses used life satisfaction as the dependent variable. At least one person in 86% of the dyads perceived restrictions in participation, with the most common gap in travelling for pleasure. Correlations were low between the numbers of occupational gaps and life satisfaction (R = -0.33, R = -0.31); however, life satisfaction accounted for occupational gaps both for persons with stroke and for caregivers. A greater number of occupational gaps were perceived in the dyads with combined low levels of life satisfaction compared with those with combined high levels of life satisfaction. Participation in everyday occupations is related to life satisfaction even for caregivers of persons with stroke. The results of this study add to our knowledge about the stroke-caregiver dyad and will help to inform family-centred approaches within stroke rehabilitation.

  14. Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives.

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    Xu, Tianma; O'Loughlin, Kate; Clemson, Lindy; Lannin, Natasha A; Dean, Catherine; Koh, Gerald

    2017-12-25

    Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants' experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor's safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Implications for rehabilitation Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke

  15. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: analysis of survivors and caregivers views from an online stroke forum.

    Science.gov (United States)

    Jamison, James; Sutton, Stephen; Mant, Jonathan; De Simoni, Anna

    2017-07-16

    To identify barriers and facilitators of medication adherence in patients with stroke along with their caregivers. Qualitative thematic analysis of posts about secondary prevention medications, informed by Perceptions and Practicalities Approach. Posts written by the UK stroke survivors and their family members taking part in the online forum of the Stroke Association, between 2004 and 2011. 84 participants: 49 stroke survivors, 33 caregivers, 2 not stated, identified using the keywords 'taking medication', 'pills', 'size', 'side-effects', 'routine', 'blister' as well as secondary prevention medication terms. Perceptions reducing the motivation to adhere included dealing with medication side effects, questioning doctors' prescribing practices and negative publicity about medications, especially in regard to statins. Caregivers faced difficulties with ensuring medications were taken while respecting the patient's decisions not to take tablets. They struggled in their role as advocates of patient's needs with healthcare professionals. Not experiencing side effects, attributing importance to medications, positive personal experiences of taking tablets and obtaining modification of treatment to manage side effects were facilitators of adherence. Key practical barriers included difficulties with swallowing tablets, dealing with the burden of treatment and drug cost. Using medication storage devices, following routines and getting help with medications from caregivers were important facilitators of adherence. An online stroke forum is a novel and valuable resource to investigate use of secondary prevention medications. Analysis of this forum highlighted significant barriers and facilitators of medication adherence faced by stroke survivors and their caregivers. Addressing perceptual and practical barriers highlighted here can inform the development of future interventions aimed at improving adherence to secondary prevention medication after stroke. © Article author

  16. Positive caregiving experiences are associated with life satisfaction in spouses of stroke survivors.

    Science.gov (United States)

    Kruithof, Willeke J; Visser-Meily, Johanna M A; Post, Marcel W M

    2012-11-01

    Studies into caregivers usually have been focused on negative caregiving experiences. This study is based on the hypotheses that positive caregiving experiences (i.e., self-esteem derived from caregiving) of spouses of stroke patients also need to be taken into account, and that these are related to life satisfaction in 2 ways: first, by a direct association with life satisfaction, and second, indirectly by way of a buffer effect (i.e., by compensating for the impact of negative caregiving experiences on life satisfaction). In this cross-sectional study (n = 121) 3 years poststroke, the Caregiver Reaction Assessment was used to assess caregiver burden (Burden) and self-esteem derived from caregiving (Self-esteem scale). Life satisfaction was measured with the Life Satisfaction Questionnaire (LiSat-9). Spearman correlations and regression analyses were performed. Both Self-esteem and Burden scores were associated with life satisfaction (correlation coefficients 0.35 and -0.74, respectively). An interaction effect was also found (P = .006); spouses who perceived both high Burden and high Self-esteem reported significantly higher life satisfaction scores (mean 4.2, standard deviation [SD] 0.5) than spouses who perceived high Burden but low Self-esteem (mean 3.6, SD 0.7). Positive caregiving experiences are related to spouses' life satisfaction 3 years poststroke and mediate the impact of burden on life satisfaction. Positive caregiving experiences should get more attention in rehabilitation research and practice. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Informal caregivers and racial/ethnic variation in health service use of stroke survivors.

    Science.gov (United States)

    Hinojosa, Melanie Sberna; Rittman, Maude; Hinojosa, Ramon

    2009-01-01

    We investigated the racial and ethnic variation in health service use among stroke survivors with informal caregivers in a number of Department of Veterans Affairs Medical Centers in one Veterans Integrated Service Network in the southeastern United States. We focused on the role of caregivers as an enabling factor in the use of health services. One hundred twenty-five veterans who had been hospitalized after an acute stroke, been released home, and identified an informal caregiver were enrolled in the study. Veterans and caregivers were surveyed at four time points over 12 months. Poisson multivariate regression analyses were used to model the relative risk (RR) of health service use. African Americans and Puerto Ricans were half as likely as Caucasians to use inpatient therapy services (RR = 0.522 and 0.494, respectively; p < 0.01), Puerto Ricans were less likely to be admitted to the hospital (RR = 0.689, p < 0.05), and Puerto Ricans were more likely to use outpatient services than Caucasians (RR = 1.230, p < 0.01). Stroke survivors that received more hours of informal care were associated with a higher likelihood of outpatient service use (RR = 1.01, p < 0.01). Stroke survivors living with their caregiver had a lower likelihood of inpatient therapy use (RR = 0.791, p < 0.01) and a higher likelihood of outpatient service use (RR = 1.17, p < 0.01). Greater likelihood of inpatient therapy (RR = 1.340, p < 0.01) and outpatient services (RR = 1.160, p < 0.05) was related to caregivers who received outside help. This study provides insight into the role of informal care in health service use for stroke survivors.

  18. Quality of life in stroke survivor-caregiver dyads: a new conceptual framework and longitudinal study protocol.

    Science.gov (United States)

    Savini, Serenella; Buck, Harleah G; Dickson, Victoria Vaughan; Simeone, Silvio; Pucciarelli, Gianluca; Fida, Roberta; Matarese, Maria; Alvaro, Rosaria; Vellone, Ercole

    2015-03-01

    To describe a new conceptual framework and the research protocol of a study designed to examine the quality of life in stroke survivor-caregiver dyads. Stroke has a significant impact on the patient-caregiver dyad. Few studies have been guided by a specific conceptual framework which considers the interactions among pre-existing situations prior to stroke, the new situation caused by the stroke and the moderating effects of environmental and caregiver-related variables. Longitudinal study. A sample of stroke survivor-caregiver dyads will be enrolled at patient discharge from rehabilitation hospitals and will be surveyed every 3 months for 1-year. Hypotheses generated from the conceptual framework will test predictors, mediators and moderators of stroke survivor and caregiver quality of life from the pre-existing situation prior to the stroke, the new situation mediation poststroke and situation moderators. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, December 2013. This study seeks to identify variables in the pre-existing situation prior to the stroke (e.g. living condition), the new situation mediation poststroke (e.g. type of stroke and caregiver burden) as well as situation moderators (e.g. social support) that influence stroke survivor-caregiver dyad's quality of life across the stroke trajectory. Also, the study will inform clinical practice and research by identifying variables that are potentially modifiable and therefore amenable to intervention. The proposed framework will also be helpful for future research focused on stroke survivor-caregiver dyads. © 2014 John Wiley & Sons Ltd.

  19. A STUDY ON CARDIOVASCULAR AUTONOMIC FUNCTIONS IN CAREGIVERS OF STROKE PATIENTS

    Directory of Open Access Journals (Sweden)

    Ghouse Mubarak

    2017-08-01

    Full Text Available BACKGROUND Stroke (cerebrovascular accident is an important cause of disability in countries like India and longterm care of these bedridden patients is usually undertaken by the family members. A caregiver is a person who takes responsibility for those who cannot completely care for themselves. Taking care of a chronically ill member in the family usually causes stress to the caregiver causing disturbances in the autonomic function. Thus, the present study is undertaken to find out the effect of longterm caregiving on cardiovascular autonomic functions in a caregiver. MATERIALS AND METHODS 57 caregivers of post-stroke bedridden patients, both male and female, were included in this longitudinal study. Parasympathetic activity was assessed by observing the heart rate changes to immediate standing from lying down position, heart rate changes during deep breathing and heart rate changes during Valsalva manoeuvre. Sympathetic activity was assessed by observing blood pressure changes on immediate standing from lying down position and blood pressure changes during sustained hand grip. RESULTS The results of the present study showed statistically significant decrease in Valsalva ratio, decrease in the heart rate following deep breathing and statistically significant increase in systolic blood pressure in response to immediate standing suggestive of autonomic imbalance. CONCLUSION Our findings suggest that longterm caregiving is accompanied by dysfunction of the cardiac autonomic nervous system, and these individuals are more prone to autonomic neuropathy.

  20. Seeking harmony in the provision of care to the stroke-impaired: views of Chinese family caregivers.

    Science.gov (United States)

    Lee, Regina L T; Mok, Esther S B

    2011-05-01

    To explore the coping strategies of Chinese family caregivers of stroke-impaired older relatives. Many stroke-impaired patients rely heavily on support from their families, and the daily lives of such family caregivers are severely impacted. However, services and support for family caregivers of stroke-impaired relatives in the home setting have received little attention. Appropriate and relevant information and support to family caregivers are important in facilitating the care-giving task. It is, therefore, necessary to understand the nature and demands of care-giving before planning specific educational and support programmes. Grounded theory. Fifteen Chinese family caregivers of stroke-impaired older relatives were recruited and interviewed in 2003 and 2004. Theoretical sampling and constant comparative analysis were used to recruit the sample and perform data analysis. Seeking harmony to provide care for the stroke-impaired was the core category for describing and guiding the family care-giving process, with five main stages: (1) living with ambiguity, (2) monitoring the recovery progress, (3) accepting the downfalls, (4) meeting family obligations and (5) reconciling with harmony. These issues were seldom discussed openly with health professionals. The findings indicated that Chinese family caregivers determine their own needs by seeking harmony to continue to provide care without thinking about getting help from others or their own health problems. These findings help to define some of the complex dynamics that have an impact on the development of partnership care and might challenge nurses practising in the community. Community nurses should assess and understand the coping strategies of family caregivers and assist them to engage in stress-reducing practices. This is an important partnership to be formed in stroke care for family caregivers in the community. The study findings will guide further development of family care-giving aspects in nursing practice

  1. Auckland Stroke Outcomes Study. Part 1: Gender, stroke types, ethnicity, and functional outcomes 5 years poststroke.

    Science.gov (United States)

    Feigin, V L; Barker-Collo, S; Parag, V; Senior, H; Lawes, C M M; Ratnasabapathy, Y; Glen, E

    2010-11-02

    Studying long-term stroke outcomes including body functioning (neurologic and neuropsychological impairments) and activity limitations and participation is essential for long-term evidence-based rehabilitation and service planning, resource allocation, and improving health outcomes in stroke. However, reliable data to address these issues is lacking. This study (February 2007-December 2008) sourced its participants from the population-based incidence study conducted in Auckland in 2002-2003. Participants completed structured self-administered questionnaires, and a face-to-face interview including a battery of neuropsychological tests. Logistic regression analysis was used to analyze associations between and within functional outcomes and their potential predictors. Of 418 5-year stroke survivors, two-thirds had good functional outcome in terms of neurologic impairment and disability (defined as modified Rankin Score <3), 22.5% had cognitive impairment indicative of dementia, 20% had experienced a recurrent stroke, almost 15% were institutionalized, and 29.6% had symptoms suggesting depression. Highly significant correlations were found between and within various measurements of body functioning (especially neuropsychological impairments), activity, and participation. Age, dependency, and depression were independently associated with most outcomes analyzed. The strong associations between neuropsychological impairment and other functional outcomes and across various measurements of body functioning, activity, and participation justify utilizing a multidisciplinary approach to studying and managing long-term stroke outcomes. Observed gender and ethnic differences in some important stroke outcomes warrant further investigations.

  2. Factors affecting burden on caregivers of stroke survivors: Population-based study in Mumbai (India

    Directory of Open Access Journals (Sweden)

    Madhumita Bhattacharjee

    2012-01-01

    Full Text Available Background: Caring for stroke patients leads to caregiver (CG strain. The aims of this study are to identify factors related to increased CG burden in stroke survivors in a census-defined population and to assess the relationship between patient characteristics and CG stress. Materials and Methods: In a prospective population-based study, 223 first ever stroke (FES were identified over a 1-year period. At 28 days, 127 (56.9% were alive and 79 (35% died, and 17 were lost to follow-up. One hundred and eleven CGs of 127 FES survivors agreed to participate. The level of stress was assessed by two scales: Oberst Caregiving Burden Scale (OCBS and the Caregivers Strain Index (CSI in CGs of survivors with mild stroke Modified Rankin Scale (MRS 1-2 and in those with significant disability (MRS 3-5. Results: The mean age of CGs was 45.6 years, approximately 22 years younger than that of the patients (67.5 years. Eighty-nine (80% of the CGs were females and only 22 (20% were males. Urinary incontinence (P=0.000008, morbidity at 28 days by MRS (P=0.0051, female gender (P=0.0183 and moderate to severe neurological deficit by National Institute of Health Stroke Scale (NIHSS on admission (P=0.0254 were factors in FES cases leading to major CGs stress. CG factors responsible for major stress were long caregiving hours (P≤0.000001, anxiety (P≤0.000001, disturbed night sleep ( P≤0.000001, financial stress (P=0.0000108, younger age (P=0.0021 and CGs being daughter-in-laws (P=0.012. Conclusion: Similar studies using uniform methodologies would help to identify factors responsible for major CG stress. Integrated stroke rehabilitation services should address CG issues to local situations and include practical training in simple nursing skills and counseling sessions to help reduce CG burden.

  3. Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care.

    Science.gov (United States)

    Xian, Ying; O'Brien, Emily C; Fonarow, Gregg C; Olson, DaiWai M; Schwamm, Lee H; Hannah, Deidre; Lindholm, Brianna; Maisch, Lesley; Lytle, Barbara L; Greiner, Melissa A; Wu, Jingjing; Peterson, Eric D; Pencina, Michael J; Hernandez, Adrian F

    2015-07-01

    Stroke is common and costly, annually depriving the lives and well-being of 800,000 Americans. Despite demonstrated efficacy in clinical trials, questions remain about the safety and clinical effectiveness of various treatment options given patient characteristics, conditions, preferences, and their desired outcomes. The Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-sponsored project designed to help patients, physicians, and other stakeholders make informed decisions regarding stroke care and improve outcomes through patient-centered comparative effectiveness research. The primary outcomes identified and prioritized by stroke patients are "home time" (time spent alive and outside a hospital) and major adverse cardiovascular events. With inputs from stroke patients themselves, a series of comparative safety and effectiveness analyses will be performed across 3 prioritized therapeutic areas identified as important by stroke survivors: oral anticoagulants, statin therapy, and antidepressants. We obtained data from Get With the Guidelines-Stroke linked with Medicare claims and follow-up telephone interviews. Our combined retrospective and prospective research strategy allows the evaluation of the safety and effectiveness of various treatment options and patient-centered longitudinal outcomes. To ensure the rapid translation of findings into clinical practice, results will be disseminated to stroke survivors, caregivers, and health care providers through traditional and social media, including an online decision aid tool. PROSPER is a patient-centered outcome research study guided by patients, caregivers, and the broader health care community. By addressing knowledge gaps in treatment uncertainties through comparative effectiveness research, PROSPER has the potential to improve decision making in stroke care and patient outcomes reflecting individual patient

  4. Effect of aphasia on acute stroke outcomes

    Science.gov (United States)

    Boehme, Amelia K.; Martin-Schild, Sheryl; Marshall, Randolph S.

    2016-01-01

    Objective: To determine the independent effects of aphasia on outcomes during acute stroke admission, controlling for total NIH Stroke Scale (NIHSS) scores and loss of consciousness. Methods: Data from the Tulane Stroke Registry were used from July 2008 to December 2014 for patient demographics, NIHSS scores, length of stay (LOS), complications (sepsis, deep vein thrombosis), and discharge modified Rankin Scale (mRS) score. Aphasia was defined as a score >1 on question 9 on the NIHSS on admission and hemiparesis as >1 on questions 5 or 6. Results: Among 1,847 patients, 866 (46%) had aphasia on admission. Adjusting for NIHSS score and inpatient complications, those with aphasia had a 1.22 day longer LOS than those without aphasia, whereas those with hemiparesis (n = 1,225) did not have any increased LOS compared to those without hemiparesis. Those with aphasia had greater odds of having a complication (odds ratio [OR] 1.44, confidence interval [CI] 1.07–1.93, p = 0.0174) than those without aphasia, which was equivalent to those having hemiparesis (OR 1.47, CI 1.09–1.99, p = 0.0137). Controlling for NIHSS scores, aphasia patients had higher odds of discharge mRS 3–6 (OR 1.42 vs 1.15). Conclusion: Aphasia is independently associated with increased LOS and complications during the acute stroke admission, adding $2.16 billion annually to US acute stroke care. The presence of aphasia was more likely to produce a poor functional outcome than hemiparesis. These data suggest that further research is necessary to determine whether establishing adaptive communication skills can mitigate its consequences in the acute stroke setting. PMID:27765864

  5. Effects of art therapy using color on purpose in life in patients with stroke and their caregivers.

    Science.gov (United States)

    Kim, Mi Kyoung; Kang, Sung Don

    2013-01-01

    Patients with stroke suffer from physical disabilities, followed by mental instability. Their caregivers also suffer from mental instability. The present study attempted to address the degree and the change of the level of Purpose in Life (PIL) in patients with stroke and caregivers by applying art therapy using colors. Twenty-eight stroke patients with a good functional recovery or a moderate disability and their 28 caregivers were selected and evaluated. The period of the study between the stroke and color therapy was more than 6 months. Patients and caregivers were divided into the color therapy (28) and control groups (28). A questionnaire, which measures the level of PIL was conducted separately for patients and caregivers prior to the first session of color therapy (2 hours per week, total 16 sessions). The final examination was performed 5 months after the last color therapy session. There was significant difference between before and after color therapy when the level of PIL was measured both in patients and caregivers (plife of the patients with stroke and their caregivers.

  6. Burden and Quality of Life of Family Caregivers of Stroke Patients.

    Science.gov (United States)

    Caro, Camila Caminha; Costa, Jacqueline Denubila; Da Cruz, Daniel Marinho Cezar

    2018-03-26

    The purpose of this study was to identify the level of burden and quality of life of family caregivers of stroke patients and to investigate the correlation between burden, quality of life (including physical, social, psychological, and environmental domains), age of caregivers, and the care period. A descriptive correlational cross-sectional study was performed, with a convenience sample of family caregivers (n = 30) of stroke patients in São Paulo, Brazil. Data were collected using a questionnaire on participants' characteristics, the Zarit Burden Interview Scale (ZBIS), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument. A descriptive analysis was performed, and correlations between variables were analyzed using Pearson's product-moment correlation coefficient. The average burden score on the ZBIS was 29.6, representing a moderate burden, and the average overall quality of life score on the WHOQOL-BREF was 62.06%, which indicates moderate quality of life. A significant weak negative correlation was observed between burden and environmental domains (r = -0.470; p =.009), quality of life (r = -0.414; p =.023), and physical domains (r = -0.394; p =.031). No significant correlations were found between burden and quality of life, and variables in the psychological and social domains, age of caregivers, or care period. Caregivers for stroke patients presented with moderate levels of burden and reduction in quality of life. Levels of burden correlated negatively with environmental domains, quality of life levels, and physical domains; however, these correlations were weak, indicating the possible interference of other factors.

  7. Contemporary outcome measures in acute stroke research: choice of primary outcome measure.

    Science.gov (United States)

    Lees, Kennedy R; Bath, Philip M W; Schellinger, Peter D; Kerr, Daniel M; Fulton, Rachael; Hacke, Werner; Matchar, David; Sehra, Ruchir; Toni, Danilo

    2012-04-01

    The diversity of available outcome measures for acute stroke trials is challenging and implies that the scales may be imperfect. To assist researchers planning trials and to aid interpretation, this article reviews and makes recommendations on the available choices of scales. The aim is to identify an approach that will be universally accepted and that should be included in most acute trials, without seeking to restrict options for special circumstances. The article considers outcome measures that have been widely used or are currently advised. It examines desirable properties for outcome measures such as validity, relevance, responsiveness, statistical properties, availability of training, cultural and language issues, resistance to comorbidity, as well as potential weaknesses. Tracking and agreement among outcomes are covered. Typical ranges of scores for the common scales are described, along with their statistical properties, which in turn influence optimal analytic techniques. The timing of recovery on scores and usual practice in trial design are considered. The preferred outcome measure for acute trials is the modified Rankin Scale, assessed at 3 months after stroke onset or later. The interview should be conducted by a certified rater and should involve both the patient and any relevant caregiver. Incremental benefits at any level of the modified Rankin Scale may be acceptable. The modified Rankin Scale is imperfect but should be retained in its present form for comparability with existing treatment comparisons. No second measure should be required, but correlations with supporting scales may be used to confirm consistency in direction of effects on other measures.

  8. Assessment of the needs of caregivers of stroke patients at state-owned acute-care hospitals in southern Vietnam, 2011.

    Science.gov (United States)

    Hayashi, Yumiko; Hai, Hoang Hoa; Tai, Nguyen Anh

    2013-08-22

    Care for stroke patients has improved steadily in southern Vietnam. Medical treatments such as thrombolytic therapy have been implemented at several hospitals, and stroke-care units composed of a team of various health professionals have been created. However, little attention has been focused on providing support to caregivers of stroke patients. This study aimed to characterize the caregivers of stroke patients who were treated in state-owned acute-care hospitals and to learn about their needs when patients are discharged. Such information can be used to enhance the caregiver's support system. We used questionnaires to conduct a descriptive study in 2011 at a state-owned acute-care hospital in southern Vietnam. We recruited study participants from among caregivers of stroke patients who had been informed of their hospital discharge date. We assessed 8 caregiver characteristics, and caregiver participants selected their needs from the survey's list of 15 possible needs. We analyzed the data by using the independent sample t test and logistic regression. Of the 93 caregivers who consented to participate, 86 (92.5%) completed the survey and indicated their concerns at discharge. The most frequently cited need was information on how to prevent stroke recurrence (72, 83.7%), followed by which drugs are most effective in preventing a relapse (62, 72.1%), how long recovery would take (61, 70.9%), and availability of hospitals in the patient's hometown (60, 69.8%). A little over half of caregivers indicated financial concerns. A caregiver's need for information on diet for a stroke survivor increased with the caregiver's education level. This study revealed several needs among caregivers of stroke survivors in southern Vietnam that are similar to those found by studies of caregivers of stroke survivors in high-income countries. Our findings suggest that comprehensive stroke care that includes caregiver education about healthful diets and prevention of stroke recurrence

  9. Social support, coping strategies and health-related quality of life among primary caregivers of stroke survivors in China.

    Science.gov (United States)

    Yu, Yunhong; Hu, Jie; Efird, Jimmy T; McCoy, Thomas P

    2013-08-01

    To examine the relationships of social support and coping strategies to health-related quality of life among primary caregivers of stroke survivors in China. Caring for a stroke survivor is highly stressful, which can negatively affect a caregiver's physical and psychological well-being. Stroke caregivers generally report more somatic symptoms, depressive symptoms, sleep disorders and social isolation. They generally have poorer quality of life than the general population. A cross-sectional, descriptive, correlational study. A quasi-random, point of reference sample of 121 survivor-caregiver dyads was recruited from three community health centres and six health service stations in a city in central China. Data were collected in face-to-face interviews at participants' homes using structured questionnaires. Higher educational levels, planning and active coping were positively associated with health-related quality of life. The number of chronic conditions, hours of care per day and functional dependence of the survivor were negatively related to quality of life. Active coping strategies predicted better health-related quality of life. Findings suggest that intervention programmes should be developed to enhance caregivers of stroke survivors' coping skills and improve social support for these caregivers in China. Community healthcare providers may need to help caregivers strengthen strategies that are effective (planning, active coping, seeking instrumental and emotional support) and change those that are not helpful (venting, denial and self-blame). © 2013 John Wiley & Sons Ltd.

  10. Exploring factors and caregiver outcomes associated with feelings of preparedness for caregiving in family caregivers in palliative care: a correlational, cross-sectional study.

    Science.gov (United States)

    Henriksson, Anette; Årestedt, Kristofer

    2013-07-01

    Family caregivers in palliative care often report feeling insufficiently prepared to handle the caregiver role. Preparedness has been confirmed as a variable that may actually protect family caregiver well-being. Preparedness refers to how ready family caregivers perceive they are for the tasks and demands in the caregiving role. The aim of this study was to explore factors associated with preparedness and to further investigate whether preparedness is associated with caregiver outcomes. This was a correlational study using a cross-sectional design. The study took place in three specialist palliative care units and one haematology unit. A total of 125 family caregivers of patients with life-threatening illness participated. Preparedness was significantly associated with higher levels of hope and reward and with a lower level of anxiety. In contrast, preparedness was not associated with depression or health. Being female and cohabiting with the patient were significantly associated with a higher level of preparedness. The relationship to the patient was significantly associated with preparedness, while social support, place of care, time since diagnosis and age of the patients showed no association. Feelings of preparedness seem to be important for how family caregivers experience the unique situation when caring for a patient who is severely ill and close to death. Our findings support the inclusion of preparedness in support models for family caregivers in palliative care. Psycho-educational interventions could preferably be designed aiming to increase family caregiver's preparedness to care, including practical care, communication and emotional support.

  11. Independence and cognition post-stroke and its relationship to burden and quality of life of family caregivers.

    Science.gov (United States)

    Caro, Camila Caminha; Mendes, Paulo Vinicius Braga; Costa, Jacqueline Denubila; Nock, Lauren Jane; Cruz, Daniel Marinho Cezar da

    2017-04-01

    Stroke is a chronic disease responsible for changes in the functional capacity of the patients. Patient care is usually provided by family caregivers, but with great burden and negative impact on their quality of life. (1) To investigate whether a correlation existed between the levels of independence and cognition in stroke patients and the burden and quality of life of their caregivers; (2) to assess whether periods of injury, rehabilitation and care, and age of the stroke patients interfered with these correlations. This was a cross-sectional and correlational study that included 60 participants, of which 30 were post-stroke patients and 30 were their caregivers. The data collection instruments were the Mini Mental State Examination and the Functional Independence Measure for the post-stroke participants, and the Zarit Burden Interview Scale and the World Health Organization Quality of Life-BREF, for the caregivers. The Pearson's product-moment correlation was used for the data analysis. Independence and cognition showed no correlation with the burden and quality of life of the caregivers. We identified a strong positive correlation between independence and cognition (r = 0.882), and a moderate negative correlation between independence and rehabilitation period (r = -0.398) and between burden and quality of life of the caregivers (r = -0.414). Our data suggest the need for health interventions aimed not only at stroke patients, but also at their family caregivers, given the association between the burden and the low levels of quality of life of the caregivers.

  12. Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin Population Stroke Study.

    LENUS (Irish Health Repository)

    2011-04-01

    Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study.

  13. Predicting outcome after stroke: the role of basic activities of daily living predicting outcome after stroke.

    Science.gov (United States)

    Gialanella, B; Santoro, R; Ferlucci, C

    2013-10-01

    Very few studies have investigated the influence of single activities of daily living (ADL) at admission as possible predictors of functional outcome after rehabilitation. The aim of the current study was to investigate admission functional status and performance of basic ADLs as assessed by Functional Independence Measure (FIM) scale as possible predictors of motor and functional outcome after stroke during inpatient rehabilitation. This is a prospective and observational study. Inpatients of our Department of Physical Medicine and Rehabilitation. Two hundred sixty consecutive patients with primary diagnosis of stroke were enrolled and 241 patients were used in the final analyses. Two backward stepwise regression analyses were applied to predict outcome. The first backward stepwise regression had age, gender, stroke type, stroke-lesion size, aphasia, neglect, onset to admission interval, Cumulative Illness Rating Scale, National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Scale, Trunk Control Test, and FIM (total, motor and cognitive scores) as independent variables. The second analyses included the above variables plus FIM items as an independent variable. The dependent variables were the discharge scores and effectiveness in total and motor-FIM, and discharge destination. The first multivariate analysis showed that admission Fugl-Meyer, neglect, total, motor and cognitive FIM scores were the most important predictors of FIM outcomes, while admission NIHSS score was the only predictor of discharge destination. Conversely, when admission single FIM items were included in the statistical model, admission Fugl-Meyer, neglect, grooming, dressing upper body, and social interaction scores were the most important predictors of FIM outcomes, while admission memory and bowel control scores were the only predictors of discharge destination. Our study indicates that performances of basic ADLs are important stroke outcome predictors and among which social

  14. Stroke Location Is an Independent Predictor of Cognitive Outcome.

    Science.gov (United States)

    Munsch, Fanny; Sagnier, Sharmila; Asselineau, Julien; Bigourdan, Antoine; Guttmann, Charles R; Debruxelles, Sabrina; Poli, Mathilde; Renou, Pauline; Perez, Paul; Dousset, Vincent; Sibon, Igor; Tourdias, Thomas

    2016-01-01

    On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes. Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample. In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample. Stroke location is an independent predictor of cognitive outcome (MoCA) at 3

  15. Caregivers

    Science.gov (United States)

    Caregivers provide help to another person in need. The person receiving care may be an adult - often ... or a child with special medical needs. Some caregivers are family members. Others are paid. They do ...

  16. Outcome of stroke in Saudi children

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Al-Jarallah; Al-Jarallah, Ahmed A.; Kentab, Amal Y.; Abdel-Gader, Abdel-Galil M.

    2006-01-01

    Objective was to report on the prognosis, neurologic outcome, and recurrence of stroke in Saudi children. We evaluated a cohort of 104 Saudi children with stroke at the Division of Pediatric Neurology at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia from July 1992 to February 2001 (retrospective study) and February2001 to March 2003 (prospective study). We analyzed the salient clinical, neuroimaging, neurophysiological, neuropsychological and laboratory data following retrieval from a specially designed comprehensive protocol. Of the 104 children in the cohort (aged one month to 12 years), 5 (4.8%) died during the study period and 9(8.7%) were lost to follow-up. The mean duration of follow-up for the remaining 90 children was 40 months (median 33 months). Recovery was judged complete in 6(6.7%) of these 90 children. We detected residual hemiparesis (irrespective of its effect on daily functions) in 73 (81%) and this was combined with other motor deficits in 45 children (50%). Forty-one children (46%) had residual dysphasia or language deficits, whereas 45 (50%) were judged to have had cognitive deficit. Psychometry revealed an abnormal intelligence quotient test (70) in 19 of 26 (73%) children. Other neurologic sequelae included epilepsy in 52 (58%), recurrent headaches in 13 (14%) and hydrocephalus in 4 (4.4%) patients, Six of the 95 (6.3%) children, who were ascertained to have died or kept their follow-up, had one or more occurrences, one month to 5 years after initial stroke (median 23 months). Patients who had recurrent strokes were significantly more likely to be the product of consanguineous marriages (p=0.04). Regarding the group of 23 children with perinatal stroke, neither deaths nor recurrences occurred during the follow-up period. However, 20 (87%) of them had significant delays in their developmental milestones. The toll of stroke in Saudi children is demanding, with most children demonstrating

  17. Stroke outcome in clinical trial patients deriving from different countries.

    Science.gov (United States)

    Ali, Myzoon; Atula, Sari; Bath, Philip M W; Grotta, James; Hacke, Werner; Lyden, Patrick; Marler, John R; Sacco, Ralph L; Lees, Kennedy R

    2009-01-01

    Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix. We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment. Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days (P<0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days (P=0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998. We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.

  18. Peripheral glucose levels and cognitive outcome after ischemic stroke : Results from the Munich Stroke Cohort

    NARCIS (Netherlands)

    Zietemann, Vera; Wollenweber, Frank Arne; Bayer-Karpinska, Anna; Biessels, Geert Jan; Dichgans, Martin

    2016-01-01

    Introduction: The relationship between glucose metabolism and stroke outcome is likely to be complex. We examined whether there is a linear or non-linear relationship between glucose measures in the acute phase of stroke and post-stroke cognition, and whether altered glucose metabolism at different

  19. The Role of Coping Strategies in Psychological Outcomes for Frontotemporal Dementia Caregivers.

    Science.gov (United States)

    Roche DClinPsy, Lauren; Croot, Karen; MacCann, Carolyn; Cramer, Barbara; Diehl-Schmid, Janine

    2015-09-01

    Caregiving for a person with frontotemporal dementia (FTD) is related to poor caregiver outcomes. Coping strategies adopted by caregivers are known to influence psychological outcomes in other dementia caregiver populations, however, their influence on psychological outcomes in FTD caregivers is poorly understood at present. Questionnaire data for 94 German primary caregivers (mean [M] 59.11 years, 68 females) of FTD care-recipients living in the community (M 63.94, 30 females) were investigated. Standardized measures completed by the caregiver included the Caregiver Strain Index (CSI), Beck Depression Inventory II (BDI-II), Quality of Life-Alzheimer's Disease (QoL-AD), and the Brief Coping Orientations to Problems Experienced (COPE). Care-recipients' nursing care level was collected as a measure of the intensity of their care needs. Mediation analyses showed that the effect of the intensity of care-recipients' care needs on caregiver well-being depended on caregivers' experience of strain. High levels of caregiver strain did not predict depression (-0.22, 95% confidence interval CI: [0.16 to 2.04]) but predicted reduced QoL (-0.44, CI: [-1.15 to -.16]). Moreover, caregivers' experience of strain was exacerbated by their use of dysfunctional coping (β = .21; p = .04), care-recipients' intensity of care needs (β = .25; p = .01), and fewer financial resources (β = .23; p = .02). In turn, caregivers' use of dysfunctional coping as a response to their strain increased the levels of depression (0.46, CI: [0.19-0.82]). By contrast, use of problem-focused coping strategies increased caregivers' QoL (0.10, CI: [0.00 to 0.31]). This study identifies variables amenable to clinical interventions that can improve caregivers' well-being: specifically, caregiver strain and coping strategies. For a disease without cure yet increasing prevalence and cost, ameliorating the caregiver experience through targeted interventions is essential. © The Author(s) 2015.

  20. Multidisciplinary rehabilitation outcomes of stroke patients in the ...

    African Journals Online (AJOL)

    Multidisciplinary rehabilitation can be implemented to address disability post stroke. The aim of this study was to determine outcomes of stroke patients managed by a multidisciplinary team at a step-down facility in the Western Cape. A longitudinal observational study was used to measure outcomes at baseline and ...

  1. Outcome in hyperglycemic stroke with ultrasound-augmented thrombolytic therapy.

    Science.gov (United States)

    Martini, S R; Hill, M D; Alexandrov, A V; Molina, C A; Kent, T A

    2006-08-22

    Hyperglycemia independently predicts poor outcome after acute ischemic stroke. CLOTBUST (Combined Lysis Of Thrombus in Brain ischemia using transcranial Ultrasound and Systemic tPA) demonstrated that ultrasound-augmented thrombolysis improves recanalization and 24-hour outcome in patients with acute ischemic stroke. We hypothesized that ultrasound would preferentially benefit hyperglycemic patients, and reviewed CLOTBUST with respect to admission glucose and good outcome. We found that ultrasound's benefit on 90-day outcome was primarily apparent at higher glucose levels, suggesting that ultrasound therapy may improve outcome following hyperglycemic stroke.

  2. White matter changes in stroke patients. Relationship with stroke subtype and outcome

    DEFF Research Database (Denmark)

    Leys, D; Englund, E; Del Ser, T

    1999-01-01

    or white matter lesions or leukoencephalopathy or leukoaraiosis' and 'stroke or cerebral infarct or cerebral hemorrhage or cerebrovascular disease or transient ischemic attack (TIA)'. WMC, as defined radiologically, are present in up to 44% of patients with stroke or TIA and in 50% of patients...... of death or dependency, recurrent stroke of any type, cerebral bleeding under anticoagulation, myocardial infarction, and poststroke dementia. WMC in stroke patients are often associated with small-vessel disease and lead to a higher risk of death, and poor cardiac and neurological outcome. However......White matter changes (WMC), detected by imaging techniques, are frequent in stroke patients. The aim of the study was to determine how WMC relate to stroke subtypes and to stroke outcome. We made a systematic Medline search for articles appearing with two of the following key words: either 'WMC...

  3. Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome

    Science.gov (United States)

    2012-01-01

    Background Pyrexia after stroke (temperature ≥37.5°C) is associated with poor prognosis, but information on timing of body temperature changes and relationship to stroke severity and subtypes varies. Methods We recruited patients with acute ischemic stroke, measured stroke severity, stroke subtype and recorded four-hourly tympanic (body) temperature readings from admission to 120 hours after stroke. We sought causes of pyrexia and measured functional outcome at 90 days. We systematically summarised all relevant previous studies. Results Amongst 44 patients (21 males, mean age 72 years SD 11) with median National Institute of Health Stroke Score (NIHSS) 7 (range 0–28), 14 had total anterior circulation strokes (TACS). On admission all patients, both TACS and non-TACS, were normothermic (median 36.3°C vs 36.5°C, p=0.382 respectively) at median 4 hours (interquartile range, IQR, 2–8) after stroke; admission temperature and NIHSS were not associated (r2=0.0, p=0.353). Peak temperature, occurring at 35.5 (IQR 19.0 to 53.8) hours after stroke, was higher in TACS (37.7°C) than non-TACS (37.1°C, ptemperatures. Sixteen (36%) patients became pyrexial, in seven (44%) of whom we found no cause other than the stroke. Conclusions Normothermia is usual within the first 4 hours of stroke. Peak temperature occurs at 1.5 to 2 days after stroke, and is related to stroke severity/subtype and more closely associated with poor outcome than admission temperature. Temperature-outcome associations after stroke are complex, but normothermia on admission should not preclude randomisation of patients into trials of therapeutic hypothermia. PMID:23075282

  4. Effects of primary caregiver participation in vestibular rehabilitation for unilateral neglect patients with right hemispheric stroke: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Dai CY

    2013-04-01

    Full Text Available Chin-Ying Dai,1,2 Yu-Hui Huang,3,4 Li-Wei Chou,5,6 Shiao-Chi Wu,7 Ray-Yau Wang,8 Li-Chan Lin9 1School of Nursing, National Yang Ming University, Taipei, Taiwan; 2Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan; 4School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 5Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 6School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 7Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; 8Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; 9Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan, Republic of China Introduction: The current study aims to investigate the effects of primary caregiver participation in vestibular rehabilitation (VR on improving the measures of neglect, activities of daily living (ADL, balance, and falls of unilateral neglect (UN patients. Methods: This study is a single-blind randomized controlled trial. Both experimental (n = 24 and control groups (n = 24 received conventional rehabilitation. The experimental group undertook VR for a month. During the first and second weeks, a registered nurse trained the experimental group in VR. The primary caregivers in the experimental group supervised and guided their patients in VR during the third and fourth weeks. The outcome measures were neglect, ADL, balance, and falls. Results: The two groups of UN patients showed a significant improvement in neglect, ADL, and balance over time. Based on the generalized estimating equations model, an interaction was observed between groups and times. Significant interactions were observed between the VR group

  5. Rising statin use and effect on ischemic stroke outcome

    Directory of Open Access Journals (Sweden)

    Haymore Joseph

    2004-03-01

    Full Text Available Abstract Background Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have neuroprotective effects in experimental stroke models and are commonly prescribed in clinical practice. The aim of this study was to determine if patients taking statins before hospital admission for stroke had an improved clinical outcome. Methods This was an observational study of 436 patients admitted to the National Institutes of Health Suburban Hospital Stroke Program between July 2000 and December 2002. Self-reported risk factors for stroke were obtained on admission. Stroke severity was determined by the admission National Institutes of Health Stroke Scale score. Good outcome was defined as a Rankin score Results There were 436 patients with a final diagnosis of ischemic stroke; statin data were available for 433 of them. A total of 95/433 (22% of patients were taking a statin when they were admitted, rising from 16% in 2000 to 26% in 2002. Fifty-one percent of patients taking statins had a good outcome compared to 38% of patients not taking statins (p = 0.03. After adjustment for confounding factors, statin pretreatment was associated with a 2.9 odds (95% CI: 1.2–6.7 of a good outcome at the time of hospital discharge. Conclusions The proportion of patients taking statins when they are admitted with stroke is rising rapidly. Statin pretreatment was significantly associated with an improved functional outcome at discharge. This finding could support the early initiation of statin therapy after stroke.

  6. Differences in Caregiving Outcomes and Experiences by Sexual Orientation and Gender Identity.

    Science.gov (United States)

    Boehmer, Ulrike; Clark, Melissa A; Heeren, Timothy C; Showalter, Elizabeth Ann; Fredman, Lisa

    The purpose of this study was to determine whether caregiving experiences and their health-related outcomes differ by sexual orientation and gender identity in a representative U.S. caregiver sample. A secondary data analysis was performed of the cross-sectional, nationally representative National Alliance for Caregiving online survey that was conducted in 2014. To account for the study design, we used sampling weights and then added propensity score weighting to account for imbalances between LGBT respondents and their heterosexual and cisgender counterparts, that is, non-LGBT caregivers. Outcomes consisted of caregivers' self-reported health, financial strain, physical strain, and emotional stress. LGBT caregivers were significantly younger, more racially and ethnically diverse, less likely to be married, and more likely to be of low socioeconomic status than their non-LGBT counterparts. Caregiving experiences and intensity were similar, but after controlling for demographic and caregiving characteristics, LGBT caregivers were significantly more likely to report financial strain and showed trends toward elevated levels of poor health and emotional stress. Physical strain was similar by LGBT status. Caregiving itself is universal, yet LGBT caregivers differed demographically and were more likely to report financial strain compared with non-LGBT caregivers.

  7. Effect of Support Group Intervention Applied to the Caregivers of Individuals With Heart Failure on Caregiver Outcomes.

    Science.gov (United States)

    Barutcu, Canan Demir; Mert, Hatice

    2016-01-01

    This study was conducted to evaluate the effectiveness of support group intervention applied to the caregivers of individuals with heart failure on caregiver outcomes. Quasi-experimental research was conducted with 69 caregivers as control (n = 35) and intervention (n = 34) groups in the cardiology outpatient clinic of a university hospital. The intervention group participated in support group meetings structured according to the Neuman Systems Model, and the data were collected from both the intervention and control groups before the intervention and 3 and 6 months later. Caregivers in the intervention group had significantly lower burden scores compared with the control group in all subdimensions except objective personal care, in terms of the group × time interaction in a statistical way (P Caregivers in the intervention and control groups had similar scores of depression symptoms (P > .05). The burden of caregivers in the intervention group showed a statistically significant decrease compared with the preintervention in all dimensions at 3 months. Thus, it is suggested to extend the support group interventions for caregivers of patients with heart failure and conduct these interventions in a longer period.

  8. Preservice Teachers' Perceived Control over Negative Caregiving Outcomes: Implications for Early-Childhood Teacher Preparation

    Science.gov (United States)

    Guzell-Roe, Jacqueline; Stringer, Sharon A.

    2005-01-01

    This study is focused on preservice early-childhood teachers' attributions about control and responsibility for negative caregiving outcomes. Prior research has linked low perceived control over failed outcomes with harsh care-giving behavior. In this sample of 81 preservice teachers in a pre-kindergarten, Associate-degree program, bivariate…

  9. Long-term Outcome of Arterial Stroke in Children

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2015-05-01

    Full Text Available Investigators at University Children’s Hospital, Inselspital, and Universities of Bern, Geneva, Basel, and Zurich, Switzerland compared long-term outcome of children (1 month-16 years and young adults (16.1-45 years with arterial ischemic stroke (AIS using prospective data from the Swiss Neuropediatric Stroke Registry and the Adult Bernese stroke registry, between Jan 2000 and Dec 2008.

  10. Arterial Stiffness and Functional Outcome in Acute Ischemic Stroke

    OpenAIRE

    Lee, Yeong-Bae; Park, Joo-Hwan; Kim, Eunja; Kang, Chang-Ki; Park, Hyeon-Mi

    2014-01-01

    Objective Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. Methods One hundred patients were enrolled with a diagnosi...

  11. Caregivers

    Science.gov (United States)

    ... Lupus Planning Ahead Caregiving Tools & Tips Parenting with Lupus Exercise and Nutrition Family Life and Relationships Fast Facts Financial Resources: ... identify people who can help. PDF Diet and nutrition with lupus In general, you should always try to eat ...

  12. Controlled Education of patients after Stroke (CEOPS)- nurse-led multimodal and long-term interventional program involving a patient's caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Mendyk, Anne-Marie; Duhamel, Alain; Bejot, Yannick; Leys, Didier; Derex, Laurent; Dereeper, Olivier; Detante, Olivier; Garcia, Pierre-Yves; Godefroy, Olivier; Montoro, Francisco Macian; Neau, Jean-Philippe; Richard, Sébastien; Rosolacci, Thierry; Sibon, Igor; Sablot, Denis; Timsit, Serge; Zuber, Mathieu; Cordonnier, Charlotte; Bordet, Régis

    2018-02-22

    Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment, but necessary to prevent recurrence and improve patients' quality of life. To involve a referent nurse and a caregiver from the patient's social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family. The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up, and an interventional program directed to the patient and a caregiving member of their social circle, as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke. The design is a randomized, controlled, clinical trial conducted in the French Stroke Unit of the Strokavenir network. In total, 410 patients will be recruited and randomized in optimized follow up or usual follow up for 2 years. In both group, patients will be seen by a neurologist at 6, 12 and 24 months. The optimized follow up will include follow up by a nurse from the vascular neurology department, including therapeutic follow up, and a training program on secondary prevention directed to the patient and a caregiving member of their social circle. After discharge, a monthly telephone interview, in the first year and every 3 months in the second year, will be performed by the nurse. At 6, 12 and 24 month, the nurse will give the patient and caregiver another training session. Usual follow up is only done by the patient's general practitioner, after classical information on secondary prevention of risk factors during hospitalization. The primary outcome measure is blood pressure measured after the first year of follow up. Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been randomized. Secondary endpoints are

  13. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke.

    Science.gov (United States)

    Joundi, Raed A; Martino, Rosemary; Saposnik, Gustavo; Giannakeas, Vasily; Fang, Jiming; Kapral, Moira K

    2017-04-01

    Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

  14. Hypertensive patients using thiazide diuretics as primary stroke prevention make better functional outcome after ischemic stroke.

    Science.gov (United States)

    Shih, Hong-Mo; Lin, Wei Chun; Wang, Cheng-Hsien; Lin, Leng-Chieh

    2014-10-01

    Thiazides have been used for the control of blood pressure and primary prevention of ischemic stroke. No previous studies have assessed the influence of thiazides on functional prognosis after ischemic stroke. Demographics, prestroke conditions, poststroke National Institutes of Health Stroke Scale score, and clinical and laboratory parameters were prospectively registered in 216 Taiwanese patients. One hundred forty patients who completed follow-up 3 months after experiencing ischemic stroke were assessed with the modified Rankin scale as functional prognoses. Twenty-one patients used thiazide to control hypertension before experiencing ischemic stroke. No differences of stroke subtypes and comorbidities before stroke were observed between the 2 groups. The emergency department National Institutes of Health Stroke Scale was lesser among thiazide users (4 [2-7] versus 6 [4-16], P = .02). Among 140 patients who completed follow-up in 90 days, thiazide users had more favorable functional status (modified Rankin scale ≤2: 42.4% versus 26.9%, P = .02, odds ratio 3.34, 95%, confidence interval .130-.862). Hypertensive patients treated with thiazides long term had a lesser severity of stroke and better functional outcomes after ischemic stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Time to treatment with intravenous alteplase and outcome in stroke

    DEFF Research Database (Denmark)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger

    2010-01-01

    BACKGROUND: Early administration of intravenous recombinant tissue plasminogen activator (rt-PA) after ischaemic stroke improves outcome. Previous analysis of combined data from individual patients suggested potential benefit beyond 3 h from stroke onset. We re-examined the effect of time to trea...

  16. Effects of Transfer Training on Musculoskeletal pain in the Caregiver of a Stroke Patient: A Case Report

    Directory of Open Access Journals (Sweden)

    Atefeh Taghizadeh

    2015-06-01

    Full Text Available The purpose of this case report was to evaluate the effectiveness of training of transfer techniques to a caregiver of a person who had suffered a stroke in decreasing musculoskeletal pain, depression and anxiety. This study adopted a single subject research design to evaluate the effectiveness of transfer-techniques training on musculoskeletal pain, depression, and anxiety in a 25-year-old female caregiver of a person with a stroke. The study was completed in four phases, including a baseline evaluation (1st and 3rd week, training (3rd, 5th and 7th week, post-training (9th week, and follow-up evaluation (11th week. During the 1st week, demographic and descriptive information  (such as age, time since diagnosis, cognition and independence of daily living were collected from the stroke patient. Also, pain severity, anxiety and depression levels of the caregiver were evaluated. In weeks 3, 5 and 7, transfer training was undertaken. The patient was involved in the training with the caregiver under the supervision of an occupational therapist in their own home. The effectiveness of the training with regard to musculoskeletal pain and depression and anxiety levels of the caregiver was evaluated in the 5th, 9th and 11th weeks. The data were analyzed using a visual analysis of trends and levels. The results showed a decrease in pain severity, anxiety and depression during training and post-training. The changes continued during the follow-up stage. This study suggests promising results for the effectiveness of the transfer-techniques training and justifies further clinical trials. A larger trial is required to confirm the effectiveness of transfer training in improving pain management in caregivers of stroke survivors.

  17. A comparison of psychosocial outcomes in elderly Alzheimer caregivers and noncaregivers.

    Science.gov (United States)

    Mausbach, Brent T; Chattillion, Elizabeth A; Roepke, Susan K; Patterson, Thomas L; Grant, Igor

    2013-01-01

    To conduct an analysis of the stress, coping, and mood consequences of Alzheimer caregiving. Cross-sectional. Community-based study. Sample included 125 Alzheimer caregivers and 60 demographically similar older adults with nondemented spouses (i.e., noncaregivers). We compared caregivers and noncaregivers on stress, coping, and mood outcomes. We also examined antidepressant use within the caregiver sample. An emphasis was placed upon effect size differences, including Cohen's d as well as more clinically meaningful effect sizes. Caregivers were significantly more likely to endorse depressive symptoms and to meet clinically significant cutoff for depression (40% for caregivers; 5% for noncaregivers). Approximately 25% of caregivers reported taking antidepressant medication, although 69% of these continued to experience significant symptoms of depression. Caregivers also utilized fewer positive coping and greater negative coping strategies than noncaregivers. The number of caregivers will increase dramatically over the next two decades, and caregivers will likely seek care from primary care providers. We provide an overview of the psychological issues facing caregivers so that effective screening and treatment may be recommended. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  18. Maintenance of Normoglycemia May Improve Outcome in Acute Ischemic Stroke.

    Science.gov (United States)

    Nair, Sruthi S; Sylaja, P N; Sreedharan, Sapna Erat; Sarma, Sankara

    2017-01-01

    Several studies have shown that high admission glucose is associated with poor outcomes after stroke, but the impact of maintenance of normoglycemia on functional outcome during hospitalization for acute ischemic stroke is less well established. The aim of this study was to examine the independent association of postadmission glycemic status in the 1 st week with 3-month functional outcome in patients with acute ischemic stroke. Patients with acute ischemic stroke admitted within 48 h of symptom onset with National Institutes of Health Stroke Scale (NIHSS) of ≥4 were selected from a prospectively maintained database by chart review. Demographic data, risk factors, NIHSS, and blood glucose values in the 1 st week were collected. The primary outcome was Modified Rankin Scale (mRS) score at 3 months (good outcome-mRS ≤2). Over 3 years, 342 patients were enrolled with 220 (64.32%) males. Mean age was 60.5 ± 13.4 years, and median admission score on NIHSS was 10 (interquartile range: 6-16). Blood glucose values persistently <140 mg/dl in the 1 st week were associated with a good 3-month functional outcome in univariate analysis ( P = 0.036). Hypoglycemic episodes occurred only in 11 (3.22%) patients. Blood glucose values persistently below 140 mg/dl in the 1 st week after acute ischemic stroke were associated with a favorable outcome in our study. Future clinical trials are needed to confirm these findings.

  19. Renal Function Predicts Outcomes in Patients with Ischaemic Stroke and Haemorrhagic Stroke.

    Science.gov (United States)

    Snarska, Katarzyna; Kapica-Topczewska, Katarzyna; Bachórzewska-Gajewska, Hanna; Małyszko, Jolanta

    2016-01-01

    We evaluated renal function and the impact of renal function on in-hospital outcomes in patients with ischaemic and haemorrhagic stroke. We collected data from 766 patients with stroke; 637 (83.2 %) with ischaemic and 129 with haemorrhagic one. The mean serum creatinine on admission in patients with both types of stroke, who died, was significantly higher than in those who survived. Multivariate analysis showed that independent predictors of mortality in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital mortality among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke. © 2016 The Author(s) Published by S. Karger AG, Basel.

  20. Ischemic Stroke Profile, Risk Factors, and Outcomes in India: The Indo-US Collaborative Stroke Project.

    Science.gov (United States)

    Sylaja, P N; Pandian, Jeyaraj Durai; Kaul, Subhash; Srivastava, M V Padma; Khurana, Dheeraj; Schwamm, Lee H; Kesav, Praveen; Arora, Deepti; Pannu, Aman; Thankachan, Tijy K; Singhal, Aneesh B

    2018-01-01

    The Indo-US Collaborative Stroke Project was designed to characterize ischemic stroke across 5 high-volume academic tertiary hospitals in India. From January 2012 to August 2014, research coordinators and physician coinvestigators prospectively collected data on 2066 patients with ischemic stroke admitted Stroke Scale score was 10 (interquartile range, 5-15) and 24.5% had National Institutes of Health Stroke Scale ≥16. Hypertension (60.8%), diabetes mellitus (35.7%), and tobacco use (32.2%, including bidi/smokeless tobacco) were common risk factors. Only 4% had atrial fibrillation. All patients underwent computed tomography or magnetic resonance imaging; 81% had cerebrovascular imaging. Stroke etiologic subtypes were large artery (29.9%), cardiac (24.9%), small artery (14.2%), other definite (3.4%), and undetermined (27.6%, including 6.7% with incomplete evaluation). Intravenous or intra-arterial thrombolysis was administered in 13%. In-hospital mortality was 7.9%, and 48% achieved modified Rankin Scale score 0 to 2 at 90 days. On multivariate analysis, diabetes mellitus predicted poor 3-month outcome and younger age, lower admission National Institutes of Health Stroke Scale and small-artery etiology predicted excellent 3-month outcome. These comprehensive and novel clinical imaging data will prove useful in refining stroke guidelines and advancing stroke care in India. © 2017 American Heart Association, Inc.

  1. Stroke Burden in Rwanda: A Multicenter Study of Stroke Management and Outcome.

    Science.gov (United States)

    Nkusi, Agabe Emmy; Muneza, Severien; Nshuti, Steven; Hakizimana, David; Munyemana, Paulin; Nkeshimana, Menelas; Rudakemwa, Emmanuel; Amendezo, Etienne

    2017-10-01

    Cerebrovascular accidents or stroke constitute the second leading cause of mortality worldwide. Low- and middle-income countries bear most of the stroke burden worldwide. The main objective of this study is to determine the burden of stroke in Rwanda. This was a prospective observational study in 2 parts: 6 months baseline data collection and outcome assessment sessions at 1 year. A total of 96 patients were enrolled in our series. Stroke constituted 2100 per 100,000 population. Of all patients, 55.2% were male and most (60%) were 55 years and older. Of all patients and/or caretakers, 22% were not aware of their previous health status and 53.5% of hypertensive patients were not on treatment by the time of the event. Median presentation delay was 72 hours for patients with ischemic stroke and 24 hours for patients with hemorrhagic stroke. Most patients had hemorrhagic stroke (65% vs. 35%), and more patients with hemorrhagic stroke presented with loss of consciousness (80% vs. 51%). Many patients (62% ischemic group and 44% hemorrhagic group) presented with severe stroke scores, and this was associated with worst outcome (P = 0.004). At 1 year follow-up, 24.7% had no or mild disability, 14.3% were significantly disabled, and 61% had died. Our results show that stroke is a significant public health concern in Rwanda. Risk factor awareness and control are still low and case fatality of stroke is significantly high. The significant delay in presentation to care and presentation with severe stroke are major contributors for the high mortality and severe disability rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Five-Year Outcome in Stroke Patients Submitted to Thrombolysis.

    Science.gov (United States)

    Machado, Célia; Pinho, João; Alves, José Nuno; Santos, Ana Filipa; Ferreira, Maria do Céu; Abreu, Maria João; Oliveira, Liliana; Mota, João; Fontes, João Ramalho; Ferreira, Carla

    2015-08-01

    Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT). Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1. Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5-43.3) and mortality was 43.9% (95%CI=36.1-51.7). Increasing age (odds ratio =0.93, 95% CI =0.90-0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74-0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03-1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12-0.66) were independently associated with mortality during follow-up. One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome. © 2015 American Heart Association, Inc.

  3. Depressive symptoms in patients with heart failure negatively affect family caregiver outcomes and quality of life.

    Science.gov (United States)

    Chung, Misook L; Lennie, Terry A; Mudd-Martin, Gia; Dunbar, Sandra B; Pressler, Susan J; Moser, Debra K

    2016-02-01

    Depressive symptoms in people with heart failure (HF) are highly prevalent. Caring for patients with both HF and depression may be more burdensome than caring for patients with HF alone. The purpose of this study was to examine differences in caregivers' outcomes (i.e. caregiving burden, difficulty and time spent on caregiving, perceptions of life change as a result of caregiving, and quality of life) between caregivers who take care of HF patients with depressive symptoms and without depressive symptoms. Patient-caregiver dyads at an outpatient clinic completed survey questionnaires. Patients' depression was assessed using the Beck Depression Inventory-II (BDI-II); primary caregivers completed caregiving outcome questionnaires. Differences in caregiving outcomes between patients with and without depressive symptoms (BDI-II≥14) were examined using t-tests, Chi-square, and Mann-Whitney U-test. Of 102 patients (64% male, mean age 61, 41% NYHA Class III-IV, mean ejection fraction 35.8±13.9), 26.5% had clinically significant depressive symptoms. Of the primary caregivers (78% female; mean age 56.7), 42% reported severe burden (the Zarit Burden Interview (ZBI)≥17). Caregivers of patients with depressive symptoms had a higher level of burden (25±13 vs 13.5±12 on the ZBI; pquality of life (46±10 vs 51±10 on the SF-12v2; p=0.026) than those of patients without depressive symptoms. Family members caring for HF patients with depressive symptoms had significantly higher levels of caregiving burden and worse quality of life compared to those caring for patients without depressive symptoms. © The European Society of Cardiology 2014.

  4. Seizures, electroencephalographic abnormalities, and outcome of ischemic stroke patients.

    Science.gov (United States)

    Bentes, Carla; Peralta, Ana Rita; Martins, Hugo; Casimiro, Carlos; Morgado, Carlos; Franco, Ana Catarina; Viana, Pedro; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Pinho E Melo, Teresa; Paiva, Teresa; Ferro, José M

    2017-12-01

    Seizures and electroencephalographic (EEG) abnormalities have been associated with unfavorable stroke functional outcome. However, this association may depend on clinical and imaging stroke severity. We set out to analyze whether epileptic seizures and early EEG abnormalities are predictors of stroke outcome after adjustment for age and clinical/imaging infarct severity. A prospective study was made on consecutive and previously independent acute stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 on admission and an acute anterior circulation ischemic lesion on brain imaging. All patients underwent standardized clinical and diagnostic assessment during admission and after discharge, and were followed for 12 months. Video-EEG (<60 min) was performed in the first 72 h. The Alberta Stroke Program Early CT Score quantified middle cerebral artery infarct size. The outcomes in this study were an unfavorable functional outcome (modified Rankin Scale [mRS] ≥ 3) and death (mRS = 6) at discharge and 12 months after stroke. Unfavorable outcome at discharge was independently associated with NIHSS score (p = 0.001), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Unfavorable outcome 1 year after stroke was independently associated with age (p = 0.001), NIHSS score (p < 0.001), remote symptomatic seizures (p = 0.046), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Death in the first year after stroke was independently associated with age (p = 0.028), NIHSS score (p = 0.001), acute symptomatic seizures (p = 0.015), and EEG suppression (p = 0.019). Acute symptomatic seizures were independent predictors of vital outcome and remote symptomatic seizures of functional outcome in the first year after stroke. Therefore, their recognition and prevention strategies may be clinically relevant. Early EEG abnormalities were independent predictors and comparable to age and early

  5. Marital History and the Prior Relationship as Predictors of Positive and Negative Outcomes among Wife Caregivers.

    Science.gov (United States)

    Kramer, Betty J.

    1993-01-01

    Investigated interpersonal vulnerability variables (marital history and quality of relationship prior to onset of Alzheimer's disease), caregiver resources, and appraisals of stressors as predictors of positive and negative outcomes among 72 wife caregivers. All variables were significant predictors of depression and quality of life even after…

  6. Service Use and Satisfaction Following Acquired Brain Injury: A Preliminary Analysis of Family Caregiver Outcomes

    Science.gov (United States)

    Degeneffe, Charles Edmund; Green, Richard; Jones, Clair

    2016-01-01

    Purpose: The study aimed to understand how use and satisfaction with services following discharge from an acquired brain injury (ABI) acute-care facility related to family caregiver outcomes. Methods: A correlational and descriptive study design was used. Nineteen primary family caregivers of persons recently discharged from an ABI acute-care…

  7. Evaluation of stroke services in Anglia stroke clinical network to examine the variation in acute services and stroke outcomes

    Directory of Open Access Journals (Sweden)

    George Abraham

    2011-02-01

    Full Text Available Abstract Background Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors. Methods/Design We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy completed EuroQol (EQ-5D questionnaires will measure quality of life at baseline and follow-up for cost utility analyses. Discussion This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.

  8. Arterial stiffness and functional outcome in acute ischemic stroke.

    Science.gov (United States)

    Lee, Yeong-Bae; Park, Joo-Hwan; Kim, Eunja; Kang, Chang-Ki; Park, Hyeon-Mi

    2014-03-01

    Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. ONE HUNDRED PATIENTS WERE ENROLLED WITH A DIAGNOSIS OF ACUTE ISCHEMIC STROKE AND CATEGORIZED INTO TWO GROUPS: large-artery atherosclerosis (LAAS) or small vessel disease (SVD) subtype of Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Each group was divided into two sub-groups based on the functional outcome of acute ischemic stroke, indicated by modified Rankin Scale (mRS) at discharge. Poor functional outcome group was defined as a mRS ≥ 3 at discharge. Student's t-test or Mann-Whitney U-test were used to compare maximal brachial-ankle PWV (baPWV) values. Twenty-four patients whose state was inadequate to assess baPWV or mRS were excluded. There were 38 patients with good functional outcome (mRS vs. 1,789.80 ± 421.91, p = 0.022), while there was no significant difference of baPWV among patients with LAAS subtype (2,071.76 ± 618.42 vs. 1,878.00 ± 365.35, p = 0.579). Arterial stiffness indicated by baPWV is associated with the functional outcome of acute ischemic stroke. This finding suggests that measurement of baPWV predicts functional outcome in patients with stroke especially those whose TOAST classification was confirmed as SVD subtype.

  9. Positive psychology outcome measures for family caregivers of people living with dementia: a systematic review.

    Science.gov (United States)

    Stansfeld, Jacki; Stoner, Charlotte R; Wenborn, Jennifer; Vernooij-Dassen, Myrra; Moniz-Cook, Esme; Orrell, Martin

    2017-08-01

    Family caregivers of people living with dementia can have both positive and negative experiences of caregiving. Despite this, existing outcome measures predominately focus on negative aspects of caregiving such as burden and depression. This review aimed to evaluate the development and psychometric properties of existing positive psychology measures for family caregivers of people living with dementia to determine their potential utility in research and practice. A systematic review of positive psychology outcome measures for family caregivers of people with dementia was conducted. The databases searched were as follows: PsychINFO, CINAHL, MEDLINE, EMBASE, and PubMed. Scale development papers were subject to a quality assessment to appraise psychometric properties. Twelve positive outcome measures and six validation papers of these scales were identified. The emerging constructs of self-efficacy, spirituality, resilience, rewards, gain, and meaning are in line with positive psychology theory. There are some robust positive measures in existence for family caregivers of people living with dementia. However, lack of reporting of the psychometric properties hindered the quality assessment of some outcome measures identified in this review. Future research should aim to include positive outcome measures in interventional research to facilitate a greater understanding of the positive aspects of caregiving and how these contribute to well-being.

  10. Association between nih stroke scale score and functional outcome in acute ischemic stroke

    International Nuclear Information System (INIS)

    Saif, S.; Fazal, N.

    2014-01-01

    To evaluate the association between baseline national institutes of health stroke scale score and functional outcome after acute ischemic stroke. Study Design: Descriptive study. Place and Duration of Study: Medical unit-IV, Jinnah Hospital, Lahore, from May 2009 to October 2009. Patients and Methods: Patients who presented with stroke within 24 hours of onset of symptom and had a developing infarct on the CT- scan were further evaluated for neurological impairment using NIH stroke scale. The baseline NIHSS score was calculated using a proforma. Age of the patient, gender and time of presentation to the hospital was recorded. Follow-up was done on the 7th day of admission using Glasgow outcome scale (GOS). Results: Total number of subjects was 150. Good outcome (GOS=1-2) was noticed in those subjects who had a low baseline NIHSS score (0-6) while poor outcome (GOS=3-5) was noticed in those subjects who had a higher baseline NIHSS score (>16)( p value< 0.05). In cases who had a moderate score (7-15); the ratio of good outcome to bad outcome was almost 70:30. Likewise good outcome (GOS=1-2) was noticed in those subjects who were younger (less than 45 years) while poor outcome (GOS=3-5) was noticed in the elderly (more than 45 years)( p value< 0.05). Similarly patients who presented within 12 hrs of symptom onset had a good outcome compared to those who presented after 12 hrs( p value< 0.05). Conclusion: Baseline NIH Stroke Scale score is strongly associated with functional outcome after 1 week of acute ischemic stroke. (author)

  11. Improving Outcomes Achieved by a New Stroke Program in Hungary

    Directory of Open Access Journals (Sweden)

    Csilla Égi

    2015-10-01

    Full Text Available Background: Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a ‘lysis alarm' program in September 2013 at our medical center. Methods: This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013 and after (October 2013-June 2014 the ‘lysis alarm' program was introduced at our medical center. Results: Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The ‘door-to-needle' time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program. In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the ‘lysis alarm' program, we have reached a 4% thrombolysis rate at our medical center. Conclusions: Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome.

  12. Impact of Bilingualism on Cognitive Outcome After Stroke.

    Science.gov (United States)

    Alladi, Suvarna; Bak, Thomas H; Mekala, Shailaja; Rajan, Amulya; Chaudhuri, Jaydip Ray; Mioshi, Eneida; Krovvidi, Rajesh; Surampudi, Bapiraju; Duggirala, Vasanta; Kaul, Subhash

    2016-01-01

    Bilingualism has been associated with slower cognitive aging and a later onset of dementia. In this study, we aimed to determine whether bilingualism also influences cognitive outcome after stroke. We examined 608 patients with ischemic stroke from a large stroke registry and studied the role of bilingualism in predicting poststroke cognitive impairment in the absence of dementia. A larger proportion of bilinguals had normal cognition compared with monolinguals (40.5% versus 19.6%; Pbilinguals 49.0%; Pbilinguals 10.5%; P=0.354). Bilingualism was found to be an independent predictor of poststroke cognitive impairment. Our results suggest that bilingualism leads to a better cognitive outcome after stroke, possibly by enhancing cognitive reserve. © 2015 American Heart Association, Inc.

  13. Validation of the mobility nursing outcome in stroke survivors.

    Science.gov (United States)

    Moreira, Rafaella Pessoa; de Araujo, Thelma Leite; Cavalcante, Tahissa Frota; Guedes, Nirla Gomes; Costa, Alice Gabrielle de Sousa; Lopes, Marcos Venicios de Oliveira

    2013-10-01

    To validate the indicators of the mobility nursing outcome. This is a methodological study carried out from February to April 2011. The instrument was assessed by 23 nurses, and the data were analyzed using SPSS version 16.0. The title "physical mobility" was the most suitable. There was a statistical proportion of less than 85% of experts who agreed that the indicators running, crawling, jumping, and moves with ease were relevant to mobility nursing outcome (p stroke patients. For stroke patients, some indicators are not adequate to their evaluation. This work supports the tools' development to assess accurate outcome measurements in specific populations. © 2013 NANDA International.

  14. Age-related rehabilitation outcome in stroke patients.

    Science.gov (United States)

    Manimmanakorn, Nuttaset; Arrayawichanon, Preeda; Wattanapun, Pattra; Nuntharuksa, Chompilai; Kuptniratsaikul, Vilai

    2008-03-01

    Patients who survive a stroke usually have residual neurological deficits. Consequently, a rehabilitation program is valuable for improving their quality of life (QOL). However, age is a known factor that needs qualification vis-à-vis rehabilitation outcomes among Thai patients. To study the functional and psychological outcomes and the QOL before and after rehabilitation program among three age groups of Thai stroke patients ( or = 65 years of age). Prospective, analytical study. Three hundred and twenty seven stroke patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO QOL BREF questionnaire before and after undergoing an in-patient rehabilitation program. Data were collected from nine sites around Thailand. Functional and psychological outcomes and the quality of life score improved after the rehabilitation program. The youngest group of stroke victims showed the greatest improvement in functional outcome and QOL score in both the physical and social domains. No significant difference was found regarding anxiety and depression among the three groups. An in-patient rehabilitation program was of benefit to Thai stroke patients but age significantly determined rehabilitation outcomes.

  15. Long-term functional outcome of pediatric stroke survivors.

    Science.gov (United States)

    Hurvitz, Edward; Warschausky, Seth; Berg, Michelle; Tsai, Shane

    2004-01-01

    To examine the long-term functional, psychosocial, and medical outcome of pediatric stroke survivors. This was a descriptive survey performed on patients with childhood stroke who participated in an earlier study. Measures included the Vineland Adaptive Behavior Scales (VABS) and the Diener Satisfaction with Life Scale. Current information on living situation, school placement, employment, and medical outcome were obtained. Twenty-nine (58%) patients participated. The mean age was 19.3 years (SD = 6.6), mean age of onset of stroke was 7.0 years (SD = 5.4), and mean follow-up time was 11.9 years (SD = 3.9). Diagnoses included hemorrhagic (31%) and ischemic (69%) stroke. All but one adult had finished high school, and the majority of participants had gone to college. 60% of patients over age 16 were employed. The average VABS levels for communication, daily living skills, socialization, and adaptive behavior fell into the moderately low range. Use of seizure medications and ADL dependence were the predictors for lower VABS levels (p life satisfaction. Patients who scored below adequate on VABS tended toward lower life satisfaction. Pediatric stroke survivors had good educational and mobility outcomes, but communication, ADL, and socialization fell into the low-moderate range. The different predictors of functional and subjective quality of life outcomes suggest that functional outcomes may mediate the relations between medical factors and satisfaction with life.

  16. Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus

    DEFF Research Database (Denmark)

    Mishra, N K; Ahmed, N; Davalos, A

    2011-01-01

    BACKGROUND: Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. We examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy (T; data from Safe Implementation of Thrombolysis......,986), or concomitant DM and PS (OR 1.23 [0.996-1.52], p = 0.05, n = 1,136), all CMH p treatment (tissue...

  17. Stroke Incidence and Outcomes in Northeastern Greece: The Evros Stroke Registry.

    Science.gov (United States)

    Tsivgoulis, Georgios; Patousi, Athanasia; Pikilidou, Maria; Birbilis, Theodosis; Katsanos, Aristeidis H; Mantatzis, Michalis; Asimis, Aristeidis; Papanas, Nikolaos; Skendros, Panagiotis; Terzoudi, Aikaterini; Karamanli, Aikaterini; Kouroumichakis, Ioannis; Zebekakis, Pantelis; Maltezos, Efstratios; Piperidou, Charitomeni; Vadikolias, Konstantinos; Heliopoulos, Ioannis

    2018-02-01

    Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros prefecture, a region of a total 147 947 residents located in North Eastern Greece. Adult patients with first-ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population, World Health Organization, and Segi population. We also applied criteria of data quality proposed by the Monitoring Trends and Determinants in Cardiovascular Disease project. Stroke diagnosis and classification were performed using World Health Organization criteria on the basis of neuroimaging and autopsy data. We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% men; ischemic stroke: 80.8%; intracerebral hemorrhage: 11.8%; subarachnoid hemorrhage: 4.4%; undefined: 3.0%) with a total follow-up time of 119 805 person-years. The unadjusted and European Standard Population-adjusted incidences of all strokes were 586.8 (95% confidence interval [CI], 543.4-630.2) and 534.1 (95% CI, 494.6-573.6) per 100 000 person-years, respectively. The unadjusted incidence rates for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were 474.1 (95% CI, 435-513), 69.3 (95% CI, 54-84), and 25.9 (95% CI, 17-35) per 100 000 person-years, respectively. The corresponding European Standard Population-adjusted incidence rates per 100 000 person-years were 425.9 (95% CI, 390.9-460.9), 63.3 (95% CI, 49.7-76.9), and 25.8 (95% CI, 16.7-34.9) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall 28-day case fatality rate was 21.3% (95% CI, 18.3%-24.4%) for all strokes and was higher in hemorrhagic strokes than ischemic stroke (40

  18. Risk Factors, Subtypes, and Outcome of Ischemic Stroke in Kuwait: A National Study.

    Science.gov (United States)

    Al-Hashel, Jasem Y; Al-Sabah, Al-Alya; Ahmed, Samar F; Al-Enezi, Maha; Al-Tawheid, Nour; Al Mesailekh, Zainab; Eliwa, Jasmine; Alroughani, Raed

    2016-09-01

    Epidemiological studies of stroke burden in Kuwait are scarce. We aimed to identify the risk factors, subtypes, and outcome of ischemic stroke in the 6 major hospitals in Kuwait between 2008 and 2013. A cross-sectional survey was carried out using randomly selected ischemic stroke patients. It included data of sociodemographic status, stroke risk factors, stroke subtypes, treatment, and outcomes. A total of 1257 ischemic stroke patients (811 men and 446 women; mean age 60.2 ± 13.1) were included. Small-artery ischemic stroke was the most common stroke subgroup (69.8%) whereas hypertension was the most prevalent risk factor (80.9%). History of heart disease was significantly associated (P strokes (58.3%) compared to large-artery stroke (37.5%) and small-artery stroke (32.5%). Atrial fibrillation was significantly prevalent (P stroke (54.2%) compared to large-artery stroke (13%) and small-artery stroke (7.6%). Presentation at ages less than 45 years was significantly (P stroke was significantly associated with higher mortality rates (25% versus 12.4% and 6.8%; P strokes, respectively. Small-artery ischemic stroke was the most common stroke subgroup, and hypertension was the most common risk factor. The outcome was better in younger patients. Cardioembolic stroke was associated with worse outcome. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Volume of Plasma Expansion and Functional Outcomes in Stroke.

    Science.gov (United States)

    Miller, Joseph B; Lewandowski, Christopher; Wira, Charles R; Taylor, Andrew; Burmeister, Charlotte; Welch, Robert

    2017-04-01

    Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke. This was a secondary analysis of data from the Albumin in Acute Stroke Part 2 trial investigating the relationship between the magnitude of overall intravenous volume infusion (crystalloid and colloid) to clinical outcome. The data were inclusive of 841 patients with a mean age of 64 years and a median National Institutes of Health Stroke Scale (NIHSS) of 11. In a multivariable-adjusted logistic regression model, this analysis tested the volume of plasma expansion over the first 48 h of hospitalization as a predictor of favorable outcome, defined as either a modified Rankin Scale score of 0 or 1 or a NIHSS score of 0 or 1 at 90 days. This model included all study patients, irrespective of albumin or isotonic saline treatment. Patients that received higher volumes of plasma expansion more frequently had large vessel ischemic stroke and higher NIHSS scores. The multivariable-adjusted model revealed that there was decreased odds of a favorable outcome for every 250 ml additional volume plasma expansion over the first 48 h (OR 0.91, 95 % CI, 0.88-0.94). The present study demonstrates an association between greater volume of plasma expansion and worse neurological recovery.

  20. Exploration the Supportive Needs and Coping Behaviors of Daughter and Daughter in-Law Caregivers of Stroke Survivors, Shiraz-Iran: A Qualitative Content Analysis.

    Science.gov (United States)

    Gholamzadeh, Sakineh; Tengku Aizan, Hamid; Sharif, Farkhondeh; Hamidon, Basri; Rahimah, Ibrahim

    2015-07-01

    The period of hospital stay and the first month after discharge have been found to be the most problematic stages for family caregivers of stroke survivors. It is just at home that patients and caregivers actually understand the whole consequences of the stroke. The adult offspring often have more different needs and concerns than spousal caregivers. However, relatively little attention has been paid to the needs of this particular group of caregivers. Therefore, this qualitative content analysis study aimed to explore the supportive needs and coping behaviors of daughter and daughter in-law caregivers (DILs) of stroke survivors one month after the patient's discharge from the hospital in Shiraz, Southern of Iran. This is a qualitative content analysis study using semi-structured and in-depth interviews with a purposive sampling of seventeen daughter and daughter in-law caregivers. The data revealed seven major themes including information and training, financial support, home health care assistance need, self-care support need, adjusting with the cultural obligation in providing care for a parent in-law, and need for improving quality of hospital care. Also, data from the interview showed that daughter and daughter in-law caregivers mostly used emotional-oriented coping strategies, specially religiosity, to cope with their needs and problems in their care-giving role. The results of this qualitative study revealed that family caregivers have several unmet needs in their care-giving role. By providing individualized information and support, we can prepare these family caregivers to better cope with the home care needs of stroke survivors and regain control over aspects of life.

  1. An exploration into caring for a stroke-survivor in Lima, Peru: Emotional impact, stress factors, coping mechanisms and unmet needs of informal caregivers

    Directory of Open Access Journals (Sweden)

    M. Amalia Pesantes

    2017-03-01

    Conclusions: In the absence of structured institutional responses, family members are responsible of providing care for stroke survivors, a task escorted by major emotional, financial, and social strains. This burden could be prevented or curtailed if caregivers were to be targeted by interventions providing psychological and financial support, together with basic training on post-stroke care.

  2. Impact of language barriers on stroke care and outcomes.

    Science.gov (United States)

    Shah, Baiju R; Khan, Nadia A; O'Donnell, Martin J; Kapral, Moira K

    2015-03-01

    Language barriers may lead to poor quality of care, particularly for conditions like acute stroke for which diagnosis and treatment decision making rely on taking an accurate patient history. The purpose of this study was to determine the impact of patient language barriers on quality of stroke care and clinical outcomes. This retrospective cohort study used data from the Registry of the Canadian Stroke Network. All Ontario patients who were admitted with acute stroke or transient ischemic attack between July 2003 and March 2008 were selected. Mortality, stroke outcomes, in-hospital complications, quality of care, and disposition were compared between those without (n=12 787) and with (n=1506) language barriers, which was defined based on the patient's preferred language. Hierarchical multivariable regression models determined the effect of language barriers, independent of baseline covariates. Patients with language barriers had better 7-day mortality than those without (7.0% versus 9.2%; OR, 0.69; 95% CI, 0.57-0.82; Planguage barriers. Patients who had language barriers had reduced mortality and better performance on some quality of care measures. These differences existed despite adjustment for many potential confounders, including ethnicity, prognostic factors, and stroke characteristics. © 2015 American Heart Association, Inc.

  3. Comparing language outcomes in monolingual and bilingual stroke patients

    Science.gov (United States)

    Parker Jones, ‘Ōiwi; Grogan, Alice; Crinion, Jenny; Rae, Johanna; Ruffle, Louise; Leff, Alex P.; Seghier, Mohamed L.; Price, Cathy J.; Green, David W.

    2015-01-01

    Post-stroke prognoses are usually inductive, generalizing trends learned from one group of patients, whose outcomes are known, to make predictions for new patients. Research into the recovery of language function is almost exclusively focused on monolingual stroke patients, but bilingualism is the norm in many parts of the world. If bilingual language recruits qualitatively different networks in the brain, prognostic models developed for monolinguals might not generalize well to bilingual stroke patients. Here, we sought to establish how applicable post-stroke prognostic models, trained with monolingual patient data, are to bilingual stroke patients who had been ordinarily resident in the UK for many years. We used an algorithm to extract binary lesion images for each stroke patient, and assessed their language with a standard tool. We used feature selection and cross-validation to find ‘good’ prognostic models for each of 22 different language skills, using monolingual data only (174 patients; 112 males and 62 females; age at stroke: mean = 53.0 years, standard deviation = 12.2 years, range = 17.2–80.1 years; time post-stroke: mean = 55.6 months, standard deviation = 62.6 months, range = 3.1–431.9 months), then made predictions for both monolinguals and bilinguals (33 patients; 18 males and 15 females; age at stroke: mean = 49.0 years, standard deviation = 13.2 years, range = 23.1–77.0 years; time post-stroke: mean = 49.2 months, standard deviation = 55.8 months, range = 3.9–219.9 months) separately, after training with monolingual data only. We measured group differences by comparing prediction error distributions, and used a Bayesian test to search for group differences in terms of lesion-deficit associations in the brain. Our models distinguish better outcomes from worse outcomes equally well within each group, but tended to be over-optimistic when predicting bilingual language outcomes: our bilingual patients tended to have poorer language skills

  4. The relationship between the spiritual attitude of the family caregivers of older patients with stroke and their burden

    Directory of Open Access Journals (Sweden)

    Torabi Chafjiri R

    2017-03-01

    Full Text Available Razieh Torabi Chafjiri,1 Nasrin Navabi,2 Abbas Shamsalinia,2 Fatemeh Ghaffari2 1Gilan University of Medical Sciences, Rudsar Shahid Ansari Hospital, Rudsar, Gilan, Iran; 2Ramsar Nursing Care Research Center, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Mazandaran, Iran Introduction: Stroke is a chronic condition that necessitates multidimensional and overwhelming care. The caregivers of stroke patients are faced with various stressors that can threaten different aspects of their health, especially their mental health. Spiritual attitude and being spiritually oriented contribute significantly to mental health and can be used as a strategy for adapting to the stressful events that are part of the role of caregiving. This study was therefore conducted to investigate the relationship between the spiritual attitude of the family caregivers of older patients with stroke and their burden.Methods: This descriptive cross-sectional study was conducted in 2016. The study population consisted of all the family caregivers of older patients with stroke presenting to health care centers and nursing service companies of Gilan Province in Iran. The participants were selected through convenience sampling and consisted of 407 participants. Data were collected using the Spiritual Attitude Scale and the Caregiver Burden Inventory and were then analyzed in SPSS-18 using Pearson’s correlation coefficient at a significance level of 0.05.Results: The results showed that 88.9% of the caregivers were females. The mean age of the participants was 38.3±8.8 years. The duration of caregiving was <5 years in 84.4% of the participants, while its mean was 4.2±2.5 years. The mean score of spiritual attitude was 108.77±6.20. The majority of the participants (49.3% had moderate and relatively favorable spiritual attitude (a score of 72–120, 27.8% had high or favorable spiritual attitude; 8.7% had mild burden, 54.4% had moderate burden

  5. Splenectomy Does Not Improve Long-Term Outcome After Stroke.

    Science.gov (United States)

    Zierath, Dannielle; Shen, Angela; Stults, Astiana; Olmstead, Theresa; Becker, Kyra J

    2017-02-01

    Immune responses to brain antigens after stroke contribute to poor outcome. We hypothesized that splenectomy would lessen the development of such responses and improve outcome. Male Lewis rats (275-350 g) underwent 2-hour middle cerebral artery occlusion immediately after splenectomy or sham splenectomy. Animals were survived to 4 weeks (672 hrs), and immune responses to myelin basic protein determined at euthanasia. Infarct volume was determined in a subset of animals euthanized at 72 hours. Behavioral outcomes were assessed to 672 hours. Splenectomy was associated with worse neurological scores early after stroke, but infarct size at 72 hours was similar in both groups. Behavioral outcomes and immune responses to myelin basic protein were also similar among splenectomized and sham-operated animals 672 hours after middle cerebral artery occlusion. Splenectomy did not alter the immune responses to brain antigens or improve outcome after stroke. Differences between this study and other studies of splenectomy and stroke are examined. © 2017 American Heart Association, Inc.

  6. Survival and clinical outcome of dogs with ischaemic stroke

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Toft, Nils; Westrup, Ulrik

    2013-01-01

    The objectives of the present study were to investigate survival time, possible predictors of survival and clinical outcome in dogs with ischaemic stroke. A retrospective study of dogs with a previous diagnosis of ischaemic stroke diagnosed by magnetic resonance imaging (MRI) was performed....... The association between survival and the hypothesised risk factors was examined using univariable exact logistic regression. Survival was examined using Kaplan-Meier and Cox regression. Twenty-two dogs were identified. Five dogs (23%) died within the first 30days of the stroke event. Median survival in 30-day...... survivors was 505days. Four dogs (18%) were still alive by the end of the study. Right-sided lesions posed a significantly increased risk of mortality with a median survival time in dogs with right-sided lesions of 24days vs. 602days in dogs with left sided lesions (P=0.006). Clinical outcome was considered...

  7. Identifying factors of activities of daily living important for cost and caregiver outcomes in Alzheimer's disease.

    Science.gov (United States)

    Reed, Catherine; Belger, Mark; Vellas, Bruno; Andrews, Jeffrey Scott; Argimon, Josep M; Bruno, Giuseppe; Dodel, Richard; Jones, Roy W; Wimo, Anders; Haro, Josep Maria

    2016-02-01

    We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD). Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden. Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD. Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.

  8. Inpatient rehabilitation outcomes of patients with apraxia after stroke.

    Science.gov (United States)

    Wu, Andy J; Burgard, Emily; Radel, Jeff

    2014-01-01

    Stroke-induced paresis commands much attention during rehabilitation; other stroke-related consequences receive less consideration. Apraxia is a stroke disorder that may have important implications for rehabilitation and recovery. To investigate association of apraxia with stroke rehabilitation outcomes during inpatient rehabilitation. This cohort study compared patients with and without apraxia after a first left hemispheric stroke. All study patients received standard of care. Clinical measures were the Functional Independence Measure (FIM) and the upper extremity section of the Fugl-Meyer Assessment (FMA) administered upon admission and at discharge. Length of stay was also documented. Florida Apraxia Battery subtests were used to classify patients with apraxia. Fifteen patients were included in this study, 10 of whom had apraxia. Data analysis revealed that patients with apraxia exhibited improvement from admission to discharge in clinical measures; however, admission FIM score was significantly lower compared to patients without apraxia. There was no statistically significant difference between groups on FMA score, length of stay, or amount of change on clinical measures. This study of acute patients found those with apraxia to be significantly less independent upon admission to inpatient rehabilitation compared to patients without apraxia. Although both groups improved a similar amount during rehabilitation, patients with apraxia discharged at a level of independence comparable to patients without apraxia upon admission. Such disparity in independence is of concern, and apraxia as a factor in stroke rehabilitation and recovery deserves further attention.

  9. Stroke outcomes in a socio-economically disadvantaged urban ...

    African Journals Online (AJOL)

    Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation ...

  10. Stroke outcome in the absence of a structured rehabilitation ...

    African Journals Online (AJOL)

    The outcome of acute stroke in 210 hospitalised patients was investigated by retrospective case-note review and household follow-up. The first month was the critical period for survival, with the highest number of fatalities being recorded in the first week (38%). Survival to 1 year was much lower than expected. Functional ...

  11. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes.

    Science.gov (United States)

    Al-Khaled, Mohamed; Matthis, Christine; Binder, Andreas; Mudter, Jonas; Schattschneider, Joern; Pulkowski, Ulrich; Strohmaier, Tim; Niehoff, Torsten; Zybur, Roland; Eggers, Juergen; Valdueza, Jose M; Royl, Georg

    2016-01-01

    Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. © 2016 S. Karger AG, Basel.

  12. Survival and clinical outcome of dogs with ischaemic stroke.

    Science.gov (United States)

    Gredal, H; Toft, N; Westrup, U; Motta, L; Gideon, P; Arlien-Søborg, P; Skerritt, G C; Berendt, M

    2013-06-01

    The objectives of the present study were to investigate survival time, possible predictors of survival and clinical outcome in dogs with ischaemic stroke. A retrospective study of dogs with a previous diagnosis of ischaemic stroke diagnosed by magnetic resonance imaging (MRI) was performed. The association between survival and the hypothesised risk factors was examined using univariable exact logistic regression. Survival was examined using Kaplan-Meier and Cox regression. Twenty-two dogs were identified. Five dogs (23%) died within the first 30days of the stroke event. Median survival in 30-day survivors was 505days. Four dogs (18%) were still alive by the end of the study. Right-sided lesions posed a significantly increased risk of mortality with a median survival time in dogs with right-sided lesions of 24days vs. 602days in dogs with left sided lesions (P=0.006). Clinical outcome was considered excellent in seven of 17 (41%) 30-day survivors. Another seven 30-day survivors experienced new acute neurological signs within 6-17months of the initial stroke event; in two of those cases a new ischaemic stroke was confirmed by MRI. In conclusion, dogs with ischaemic stroke have a fair to good prognosis in terms of survival and clinical outcome. However, owners should be informed of the risk of acute death within 30days and of the possibility of new neurological events in survivors. Mortality was increased in dogs with right-sided lesions in this study. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. An evaluation of psychometric properties of caregiver burden outcome measures used in caregivers of children with cerebral palsy: a systematic review protocol.

    Science.gov (United States)

    Dambi, Jermaine M; Jelsma, Jennifer; Mlambo, Tecla; Chiwaridzo, Matthew; Dangarembizi-Munambah, Nyaradzai; Corten, Lieselotte

    2016-03-09

    Cerebral palsy (CP) is the most common, life-long paediatric disability. Taking care of a child with CP often results in caregiver burden/strain in the long run. As caregivers play an essential role in the rehabilitation of these children, it is therefore important to routinely screen for health outcomes in informal caregivers. Consequently, a plethora of caregiver burden outcome measures have been developed; however, there is a dearth of evidence of the most psychometrically sound tools. Therefore, the broad objective of this systematic review is to evaluate the psychometrical properties and clinical utility of tools used to measure caregiver burden in caregivers of children with CP. This is a systematic review for the evaluation of the psychometric properties of caregiver burden outcome tools. Two independent and blinded reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, PsychINFO and Africa-Wide Google Scholar. Information will be analysed using predefined criteria. Thereafter, three independent reviewers will then screen the retrieved articles. The methodological quality of studies on the development and validation of the identified tools will be evaluated using the four point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Finally, the psychometric properties of the tools which were developed and validated from methodological sound studies will then be analysed using predefined criteria. The proposed systematic review will give an extensive review of the psychometrical properties of tools used to measure caregiver burden in caregivers of children with CP. We hope to identify tools that can be used to accurately screen for caregiver burden both in clinical setting and for research purposes. PROSPERO CRD42015028026.

  14. High blood pressure in acute ischemic stroke and clinical outcome.

    Science.gov (United States)

    Manabe, Yasuhiro; Kono, Syoichiro; Tanaka, Tomotaka; Narai, Hisashi; Omori, Nobuhiko

    2009-11-16

    This study aimed to evaluate the prognostic value of acute phase blood pressure in patients with acute ischemic stroke by determining whether or not it contributes to clinical outcome. We studied 515 consecutive patients admitted within the first 48 hours after the onset of ischemic strokes, employing systolic and diastolic blood pressure measurements recorded within 36 hours after admission. High blood pressure was defined when the mean of at least 2 blood pressure measurements was ≥200 mmHg systolic and/or ≥110 mmHg diastolic at 6 to 24 hours after admission or ≥180 mmHg systolic and/or ≥105 mmHg diastolic at 24 to 36 hours after admission. The high blood pressure group was found to include 16% of the patients. Age, sex, diabetes mellitus, hypercholesterolemia, atrial fibrillation, ischemic heart disease, stroke history, carotid artery stenosis, leukoaraiosis, NIH Stroke Scale (NIHSS) on admission and mortality were not significantly correlated with either the high blood pressure or non-high blood pressure group. High blood pressure on admission was significantly associated with a past history of hypertension, kidney disease, the modified Rankin Scale (mRS) on discharge and the length of stay. On logistic regression analysis, with no previous history of hypertension, diabetes mellitus, atrial fibrillation, and kidney disease were independent risk factors associated with the presence of high blood pressure [odds ratio (OR), 1.85 (95% confidence interval (CI): 1.06-3.22), 1.89 (95% CI: 1.11-3.22), and 3.31 (95% CI: 1.36-8.04), respectively]. Multi-organ injury may be presented in acute stroke patients with high blood pressure. Patients with high blood pressure had a poor functional outcome after acute ischemic stroke.

  15. Differences on psychosocial outcomes between male and female caregivers of children with life-limiting illnesses.

    Science.gov (United States)

    Schneider, Monica; Steele, Rose; Cadell, Susan; Hemsworth, David

    2011-06-01

    This secondary analysis of data examined the psychosocial outcomes of meaning in caregiving, self-esteem, optimism, burden, depression, spirituality, and posttraumatic growth in 273 parents caring for children with life-limiting illnesses to (a) determine if there were gender differences and (b) identify gender-specific correlations among these outcomes. Findings suggest that significant gender differences exist. Women reported higher average scores compared with men for meaning in caregiving, depression, burden, and posttraumatic growth and lower average scores for optimism. Correlations also revealed some significant differences. Health care professionals need to be aware of gender differences and tailor their interventions appropriately. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Statin treatment and stroke outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Goldstein, L.B.; Amarenco, P.; Zivin, J.

    2009-01-01

    BACKGROUND AND PURPOSE: Laboratory experiments suggest statins reduce stroke severity and improve outcomes. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial was a placebo-controlled, randomized trial designed to determine whether treatment with atorvastatin reduces...... strokes in subjects with recent stroke or transient ischemic attack (n=4731). We analyzed SPARCL trial data to determine whether treatment favorably shifts the distribution of severities of ischemic cerebrovascular outcomes. METHODS: Severity was assessed with the National Institutes of Health Stroke...... Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. RESULTS: Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5...

  17. Effects of anti-inflammatory treatments on stroke outcome in animal models

    NARCIS (Netherlands)

    Tiebosch, I.A.C.W.

    2012-01-01

    Background: Stroke is a devastating disease with over 5.5 million yearly casualties worldwide. Acute treatment strategies are limited. The acute inflammatory response following stroke has been demonstrated to be detrimental on stroke outcome, for both ischemic and hemorrhagic stroke subtypes.

  18. Functional outcome in young adult ischemic stroke: impact of lipoproteins.

    Science.gov (United States)

    Putaala, J; Strbian, D; Mustanoja, S; Haapaniemi, E; Kaste, M; Tatlisumak, T

    2013-01-01

    To determine the functional outcome in a cohort of young adults with ischemic stroke patients, focusing on components of lipid profile. In our registry including consecutive patients with first-ever ischemic stroke aged 15-49 from 1994 to 2007, we analyzed predictors of 3-month functional outcome (modified Rankin Scale, mRS). Infarct size fell into small, medium, large posterior, or large anterior. Stroke severity was assessed with NIH Stroke Scale (NIHSS). Serum lipids were measured within 72 h after admission. Binary, multinomial ordinal, and Poisson regressions allowed revealing factors associated with size of infarct, stroke severity, and unfavorable outcome or death (mRS, 2-6) or mRS as an ordinal measure. In the 968 patients included (mean age, 41.3 ± 7.6; 62.6% men; 49.5% with mRS 0-1), factors associated with unfavorable outcome after multivariable analysis were increasing age (odds ratio, 1.03 per year; 95% confidence interval, 1.01-1.05), higher NIHSS score (1.23 per point, 1.17-1.29), large anterior (4.37, 2.26-8.42) or posterior (1.73, 1.05-2.85) infarcts, bilateral lesions (2.28, 1.30-3.98), internal carotid artery dissection (ICAD) (3.65, 1.41-9.47), and inversely high-density lipoprotein (HDL) levels (0.58 per unit increase, 0.38-0.86). Increasing HDL associated with smaller infarct size (0.71, 0.51-0.98). Both higher total and HDL cholesterol associated with lower NIHSS score (0.96, 0.93-0.98 for total cholesterol and 0.82, 0.75-0.88 for HDL) and lower 3-month mRS (0.87, 0.78-0.97 for total cholesterol and 0.65, 0.47-0.90 for HDL). In addition to known prognosticators, ICAD and lower HDL levels were independently associated with adverse clinical outcomes in our young adult stroke cohort. © 2012 John Wiley & Sons A/S.

  19. Ischemic Stroke in Young Adults with Moyamoya Disease: Prognostic Factors for Stroke Recurrence and Functional Outcome after Revascularization.

    Science.gov (United States)

    Zhao, Meng; Deng, Xiaofeng; Gao, Faliang; Zhang, Dong; Wang, Shuo; Zhang, Yan; Wang, Rong; Zhao, Jizong

    2017-07-01

    Stroke in young adults is uncommon and rarely described. Moyamoya disease is one of the leading causes of stroke in young adults. We aimed to study the prognostic factors for stroke recurrences and functional outcomes in young stroke patients with moyamoya disease after revascularization. We reviewed 696 consecutive patients with moyamoya disease admitted to our hospital from 2009-2015 and identified patients aged 18-45 years with first-ever stroke. Follow-up was conducted via face-to-face or structured telephone interviews. Outcome measures were recurrent stroke events and unfavorable functional outcomes (modified Rankin Scale >2). We included 121 young patients with moyamoya disease suffering from stroke (initial presentation age, 35.4 ± 7.5 years). All patients underwent revascularization after the acute phase of initial stroke events as the secondary prevention for recurrences. During follow-up (median, 40 months), 9 patients (7.4%) experienced recurrent strokes and 8 of them (6.6%) suffered unfavorable functional outcomes. In the multivariate analysis, diabetes was an independent predictor for stroke recurrences (hazard ratio 6.76; 95% confidence interval 1.30-35.11; P = 0.02) and was significantly associated with unfavorable functional outcomes (odds ratio 7.87; 95% confidence interval 1.42-38.74; P = 0.01). We identified diabetes as an independent risk factor for recurrent strokes and unfavorable functional outcomes after revascularization in young stroke patients with moyamoya disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Components and Outcomes of Internet-Based Interventions for Caregivers of Older Adults: Systematic Review.

    Science.gov (United States)

    Guay, Cassioppée; Auger, Claudine; Demers, Louise; Mortenson, W Ben; Miller, William C; Gélinas-Bronsard, Dominique; Ahmed, Sara

    2017-09-19

    When trying to access interventions to improve their well-being and quality of life, family caregivers face many challenges. Internet-based interventions provide new and accessible opportunities to remotely support them and can contribute to reducing their burden. However, little is known about the link existing between the components, the use of behavior change techniques, and the outcomes of these Internet-based interventions. This study aimed to provide an update on the best available evidence about the efficacy of Internet-based interventions for caregivers of older adults. Specifically, the components and the use of behavior change techniques and how they impact on the efficacy of the intervention were sought. A systematic review searched primary source studies published between 2000 and 2015. Included studies were scored with a high level of evidence by independent raters using the GRADE criteria and reported caregiver-specific outcomes about interventions delivered through the Internet for caregivers of people aged 50 years and older. A narrative synthesis identified intervention components (eg, content, multimedia use, interactive online activities, and provision of support), behavior change techniques, and caregiver outcomes (eg, effects on stressors, mediators, and psychological health). The risk of bias within the included studies was assessed. A total of 2338 articles were screened and 12 studies describing 10 Internet-based interventions were identified. Seven of these interventions led to statistically significant improvements in caregiver outcomes (eg, reducing depression or anxiety, n=4). These efficacious interventions used interactive components, such as online exercises and homework (n=4) or questionnaires on health status (n=2) and five of them incorporated remote human support, either by professionals or peers. The most frequently used behavior change techniques included in efficacious interventions were provision of social support (n=6) and

  1. Quality of caregiver-child play interactions with toddlers born preterm and full term: Antecedents and language outcome.

    Science.gov (United States)

    Loi, Elizabeth C; Vaca, Kelsey E C; Ashland, Melanie D; Marchman, Virginia A; Fernald, Anne; Feldman, Heidi M

    2017-12-01

    Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions. Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill. A longitudinal descriptive cohort study. 39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES). The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22months in relation to receptive language assessments at ages 18 and 36months. Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The caregiver composite measure was associated with later receptive vocabulary at 36months. PT-FT group membership did not moderate the association between caregiver interactional behavior and later receptive vocabulary. The quality of caregiver interactional behavior had similar associations with concurrent child interactional behavior and subsequent language outcome in the PT and FT groups. Greater caregiver sensitivity/responsiveness, verbal elaboration, and less intrusiveness support receptive language development in typically developing toddlers and toddlers at risk for language difficulty. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Manual and oral apraxia in acute stroke, frequency and influence on functional outcome: The Copenhagen Stroke Study.

    Science.gov (United States)

    Pedersen, P M; Jørgensen, H S; Kammersgaard, L P; Nakayama, H; Raaschou, H O; Olsen, T S

    2001-09-01

    To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome. Seven hundred seventy six unselected, acute stroke patients who were admitted within seven days of stroke onset with unimpaired consciousness were included. If possible, the patients were assessed for manual and oral apraxia on acute admission. Neurologic stroke severity including aphasia was assessed with the Scandinavian Stroke Scale, and activities of daily living function was assessed with the Barthel Index. All patients completed their rehabilitation in the same large stroke unit. Six hundred eighteen patients could cooperate with the apraxia assessments. Manual apraxia was found in 7% of subjects (10% in left and 4% in right hemispheric stroke; chi2 = 9.0; P = 0.003). Oral apraxia was found in 6% (9% in left and 4% in right hemispheric stroke; chi2 = 5.4; P = 0.02). Both manual and oral apraxia were related to increasing stroke severity, and manual, but not oral, apraxia was associated with increasing age. There was no gender difference in frequency of apraxia. Patients with either type of apraxia had temporal lobe involvement more often than patients without. When analyzed with multiple linear and logistic regression analyses, neither manual nor oral apraxia had any independent influence on functional outcome. Apraxia is significantly less frequent in unselected patients with acute stroke than has previously been assumed and has no independent negative influence on functional outcome.

  3. Risk Factors and Neurologic Outcomes in Childhood Arterial Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Taner Sezer

    2017-09-01

    Full Text Available Objective: The aim of this study is to describe clinical characteristics, treatment modalities and outcomes of children with arterial ischemic stroke (AIS. Material and Methods: We retrospectively reviewed the charts of 102 children (62 girls and 40 boys with AIS admitted at our hospital between 2009 and 2015. Age at stroke, sex, medical history, family history, clinical findings upon admission, history of seizure, and radiological findings were recorded. Cardiac assessment, hematological and immunological tests, metabolic screening were all performed in the patients. Results: In 25 children stroke occured as a complication of cardiac disease, 12 had transient cerebral arteriopathy, 11 had Down’s syndrome, 9 had thalassemia, 7 had moyamoya disease, 6 had MTHFR mutation, 4 had homozygote for factor V Leiden, 3 had protein C deficiency, 1 had sickle cell disease, and in 24 children no underlying cause could be found. Multiple risk factors were found in 16 children and recurrent stroke was observed in 4 patients. Hemiplegia was the commonest initial clinical presentation (88.2% followed by seizure (66.6% and decreased level of consciousness (54.9%. The avarage length of follow-up was 32.1±5.4 months. The outcome in all 102 stroke patients was as follows: asymptomatic 57.8%; persistent neurologic deficit or epilepsy 40.2%; and death 2%. Conclusion: Our study showed an underlying cause for AIS in 76.5% of the patients; 42.2% of the patients either died or had motor and/or cognitive sequelae and recurrence occured despite prophylactic aspirin treatment in 4 patients. [J Contemp Med 2017; 7(3.000: 278-283

  4. Outcome measurement in stroke: a scale selection strategy.

    Science.gov (United States)

    Baker, Karen; Cano, Stefan J; Playford, E Diane

    2011-06-01

    Evaluating the impact of new treatments requires the use of reliable, valid, and responsive outcome measures. However, given the wide range of instruments currently available, it is not always straightforward for healthcare professionals to select the most appropriate tool. In this review, we propose a potential approach to scale selection. In designing a new study of the impact of a robotic device in stroke rehabilitation, we developed a three-stage scale selection strategy. First, two guidance documents (Medical Outcome Trust and Food and Drug Administration PRO Guidance) were reviewed to identify key scale assessment criteria. Second, consideration was given at a theoretical level of the concepts and domains relevant to the goals our study. Third, a comprehensive literature search strategy and review were developed in conjunction with healthcare professionals and psychometricians. Identified scales were appraised regarding their psychometric properties and clinical content. Forty-five measures were initially identified and appraised. From a clinical content perspective, none of the measures were considered to be sufficient on their own to capture all the important outcome domains in this study. However, 3 measures were identified that best met our review criteria: Stroke Rehabilitation Assessment of Movement, Chedoke Arm and Hand Inventory, and ABILHAND. After the final stage of scale appraisal, two further upper limb scales (Fugl-Meyer and Action Research Arm Test) were included based on clinical content and study design issues. Our three-stage review process appears to be a potentially useful approach for evidence-based scale selection in stroke rehabilitation studies.

  5. Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten; Koch, Marcus W; Stewart, Roy E; Vroomen, Patrick C; Luijckx, Gert-Jan; De Keyser, Jacques

    Hyperglycaemia in acute ischaemic stroke is traditionally associated with a worsened outcome. However, it is unclear whether the impact of hyperglycaemia on stroke outcome is similar in lacunar and non-lacunar infarctions. The relation between serum glucose measured within 6 h after stroke onset and

  6. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  7. Schizophrenia: a five-year follow-up of patient outcome following psycho-education for caregivers.

    LENUS (Irish Health Repository)

    McWilliams, S

    2012-01-01

    There is evidence that psycho-education courses for caregivers of individuals with schizophrenia improve the short-term outcome of the condition. However, most of the outcome studies are limited to two-year follow-up.

  8. Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

    Science.gov (United States)

    Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui

    2017-08-01

    Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after intervention (P pre-hospital delays.

  9. Epidemiology and in-hospital outcome of stroke in South Ethiopia.

    Science.gov (United States)

    Deresse, Birrie; Shaweno, Debebe

    2015-08-15

    Although the burden of stroke in Sub-Saharan Africa, including Ethiopia, is increasing, there are few available data on stroke in Ethiopia. To describe the magnitude of risk factors, sub-types and in-hospital outcome of stroke at Hawassa University Referral Hospital, Ethiopia. A prospective hospital-based study was conducted with all adult patients admitted to Hawassa University Referral Hospital with stroke diagnosis between May 2013 and April 2014. Computerized tomography scan was performed in all patients to confirm the type of stroke. Stroke severity at admission was assessed by the National Institute of Health Stroke Scale. Stroke outcome at discharge was measured using the modified Rankin stroke scale. A total of 163 stroke patients were recruited during the study period, of which 82 (50.3%) patients had ischemic stroke while 81 (49.7%) had hemorrhagic stroke. Stroke risk factors included hypertension (50.9%), cardiac diseases (16.6%), diabetes mellitus (7.4%), alcohol (10.4%), cigarette smoking (4.9%) and tuberculous meningitis (3.1%). In-hospital stroke mortality was 14.7%. The main predictors of in-hospital stroke mortality were stroke severity at admission, hemorrhagic stroke, decreased level of consciousness and seizure. The proportion of hemorrhagic stroke is higher than in Western countries. Hypertension is the most common risk factor for stroke. More than half of the patients were discharged with severe disability. We recommend establishing stroke units in resource limited countries like Ethiopia in order to reduce stroke mortality and post stroke disability. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Burden and outcome of prevalent ischemic brain disease in a national acute stroke registry.

    Science.gov (United States)

    Koton, Silvia; Tsabari, Rakefet; Molshazki, Noa; Kushnir, Moshe; Shaien, Radi; Eilam, Anda; Tanne, David

    2013-12-01

    Previous overt stroke and subclinical stroke are frequent in patients with stroke; yet, their clinical significance and effects on stroke outcome are not clear. We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke. Patients with ischemic stroke in the National Acute Stroke Israeli prospective hospital-based registry (February to March 2004, March to April 2007, and April to May 2010) with information on previous overt stroke and subclinical stroke per computed tomography/MRI (n=3757) were included. Of them, a subsample (n=787) was followed up at 3 months. Logistic regression models were computed for outcomes in patients with prior overt stroke or subclinical stroke, compared with patients with first stroke, adjusting for age, sex, vascular risk factors, stroke severity, and clinical classification. Two-thirds of patients had a prior overt stroke or subclinical stroke. Death rates were similar for patients with and without prior stroke. Adjusted odds ratios (OR; 95% confidence interval [CI]) for disability were increased for patients with prior overt stroke (OR, 1.31; 95% CI, 1.03-1.66) and subclinical stroke (OR, 1.45; 95% CI, 1.16-1.82). Relative odds of Barthel Index≤60 for patients with prior overt stroke (OR, 2.04; 95% CI, 1.14-3.68) and with prior subclinical stroke (OR, 2.04; 95% CI, 1.15-3.64) were twice higher than for patients with a first stroke. ORs for dependency were significantly increased for patients with prior overt stroke (OR, 1.95; 95% CI, 1.19-3.20) but not for those with subclinical stroke (OR, 1.36; 95% CI, 0.84-2.19). In our national cohort of patients with acute ischemic stroke, nearly two thirds had a prior overt stroke or subclinical stroke. Risk of poor functional outcomes was increased for patients with prior stroke, both overt and subclinical.

  11. Children and Caregivers' Exposure to Adverse Childhood Experiences (ACES): Association with Children's and Caregivers' Psychological Outcomes in a Therapeutic Preschool Program.

    Science.gov (United States)

    Ziv, Yair; Sofri, Inbar; Capps Umphlet, Kristen L; Olarte, Stephanie; Venza, Jimmy

    2018-03-31

    Exposure to adverse childhood experiences (ACE) has been found to have a profound negative impact on multiple child outcomes, including academic achievement, social cognition patterns, and behavioral adjustment. However, these links have yet to be examined in preschool children that are already experiencing behavior or social-emotional problems. Thus, the present study examined the links between the caregiver's and the child's exposure to ACE and multiple child and caregiver's outcomes in a sample of 30 preschool children enrolled in a Therapeutic Nursery Program (TNP). Children are typically referred to this TNP due to significant delays in their social emotional development that often result in difficulty functioning in typical childcare, home, and community settings. Analyses revealed some contradictory patterns that may be specific to this clinical sample. Children with higher exposure to ACE showed more biased social information processing patterns and their caregivers reported lower child social skills than caregivers of children with less exposure, however their inhibitory control levels were higher (better control) and staff reported that these children exhibited better social skills as well as better approaches to learning than children with less exposure. No such contradictions were found in relation to the caregiver's exposure to ACE, as it was positively associated with a number of negative child and caregiver outcomes.

  12. Effectiveness of Caregiver Interventions on Patient Outcomes in Adults With Dementia or Alzheimer?s Disease

    OpenAIRE

    Griffin, Joan M.; Meis, Laura A.; Greer, Nancy; MacDonald, Roderick; Jensen, Agnes; Rutks, Indulis; Carlyle, Maureen; Wilt, Timothy J.

    2015-01-01

    Objective: We conducted a systematic review to evaluate whether caregiver-involved interventions improve patient outcomes among adults with dementia or Alzheimer’s disease. Method: We identified and summarized data from randomized controlled trials enrolling adults with dementia or Alzheimer’s disease by searching MEDLINE, PsycINFO, and other sources. Patient outcomes included global quality of life, physical and cognitive functioning, depression/anxiety, symptom control and management, and h...

  13. Life satisfaction two-years after stroke onset: the effects of gender, sex occupational status, memory function and quality of life among stroke patients (Newsqol) and their family caregivers (Whoqol-bref) in Luxembourg

    OpenAIRE

    Baumann, Mich?le; Couffignal, Sophie; Le Bihan, Etienne; Chau, Nearkasen

    2012-01-01

    Abstract Background Life satisfaction (LS) of cerebrovascular disease survivors and their family caregivers may relate to socioeconomic factors, impaired functions, health-related quality of life (QoL), but their respective influences remain unclear. This study assessed, two years post-stroke onset, the effects of these factors on patients’ LS and family caregivers’ LS in Luxembourg. Methods All stroke patients admitted to all hospitals in Luxembourg were identified by the ‘Inspection Général...

  14. Estimates of outcomes up to ten years after stroke: analysis from the prospective South London Stroke Register.

    Directory of Open Access Journals (Sweden)

    Charles D A Wolfe

    2011-05-01

    Full Text Available Although stroke is acknowledged as a long-term condition, population estimates of outcomes longer term are lacking. Such estimates would be useful for planning health services and developing research that might ultimately improve outcomes. This burden of disease study provides population-based estimates of outcomes with a focus on disability, cognition, and psychological outcomes up to 10 y after initial stroke event in a multi-ethnic European population.Data were collected from the population-based South London Stroke Register, a prospective population-based register documenting all first in a lifetime strokes since 1 January 1995 in a multi-ethnic inner city population. The outcomes assessed are reported as estimates of need and included disability (Barthel Index 10, and mental and physical domain scores of the Medical Outcomes Study 12-item short form (SF-12 health survey. Estimates were stratified by age, gender, and ethnicity, and age-adjusted using the standard European population. Plots of outcome estimates over time were constructed to examine temporal trends and sociodemographic differences. Between 1995 and 2006, 3,373 first-ever strokes were registered: 20%-30% of survivors had a poor outcome over 10 y of follow-up. The highest rate of disability was observed 7 d after stroke and remained at around 110 per 1,000 stroke survivors from 3 mo to 10 y. Rates of inactivity and cognitive impairment both declined up to 1 y (280/1,000 and 180/1,000 survivors, respectively; thereafter rates of inactivity remained stable till year eight, then increased, whereas rates of cognitive impairment fluctuated till year eight, then increased. Anxiety and depression showed some fluctuation over time, with a rate of 350 and 310 per 1,000 stroke survivors, respectively. SF-12 scores showed little variation from 3 mo to 10 y after stroke. Inactivity was higher in males at all time points, and in white compared to black stroke survivors, although black

  15. PA26 Unmet needs and stress among caregivers of bedridden stroke patients in north kerala - a community based study.

    Science.gov (United States)

    Usha, K

    2015-04-01

    In developing countries informal care by an unpaid relative is the most prevalent form of long-term care. Being bedridden consumes the victim and the caregiver physically, psychologically, socially and financially. In developing countries, strengthening support for family caregivers is essential to sustain long term health care system. Therefore unmet needs and burdens of family caregivers, including inadequate training, respite, and access to support programs should be studied and addressed. To study unmet needs of caregivers of stroke patients in the home settings. To study physical, psychological and social stress of these caregivers. Descriptive Study setting: Four rural panchayats, where home based care is given to bed ridden patients by the palliative team of our medical college. Sampling design: Convenience sampling study population: Care givers of bedridden stroke patients tool: A semi structured questionnaire Forty caregivers participated in the study. Their mean age was 51 years. Most were wives (15, 37.5%) and daughters (14, 35%). All belonged to low socioeconomic class. Unmet needs were lack of recreation (67%), inadequate sleep (67%), total responsibility (65%), illnesses (53%) and insufficient money (67%). Severe to moderate physical, psychological and social stress was seen in 90%, 87.5% and 70% of caregivers respectively. Services to be aimed primarily at informal caregivers may be designed to increase the level of knowledge and emotional support of caregivers, provide respite, or provide financial benefits as social schemes. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Imaging findings and referral outcomes of rapid assessment stroke clinics

    International Nuclear Information System (INIS)

    Widjaja, E.; Manuel, D.; Hodgson, T.J.; Connolly, D.J.A.; Coley, S.C.; Romanowski, C.A.J.; Gaines, P.; Cleveland, T.; Thomas, S.; Griffiths, P.D.; Doyle, C.; Venables, G.S.

    2005-01-01

    AIM: A rapid assessment stroke clinic (RASC) was established to provide a rapid diagnostic service to individuals with suspected transient cerebral or ocular ischaemia or recovered non-hospitalized strokes. In this report we review imaging findings and clinical outcomes of patients proceeding to the carotid surgery programme. METHODS: Between October 2000 and December 2002, 1339 people attended the RASC. The findings of head CT and carotid Doppler ultrasound of the 1320 patients who underwent brain and carotid imaging were reviewed, and the number subsequently proceeding to carotid angiography and intervention was reported. RESULTS: CT head scans were normal in 57% of cases; 38% demonstrated ischaemia or infarction; and 3% yielded incidental or other significant findings not related to ischaemia. On screening with carotid Doppler ultrasound, 7.5% showed greater than 50% stenosis on the symptomatic side. A total of 83 patients (6.2%) proceeded to cerebral angiography and 65 (4.8%) underwent carotid endarterectomy or endovascular repair. CONCLUSION: Rapid-access neurovascular clinics are efficient in selecting patients for carotid intervention, but this is at a cost and the number of potential strokes prevented is small. Alternative management pathways based on immediate medical treatment need to be evaluated

  17. Caregiver outcomes and interventions: a systematic scoping review of the traumatic brain injury and spinal cord injury literature.

    Science.gov (United States)

    Baker, Anne; Barker, Samantha; Sampson, Amanda; Martin, Clarissa

    2017-01-01

    To identify factors reported with negative and positive outcomes for caregivers of the traumatic brain injury and spinal cord injury cohorts, to investigate what interventions have been studied to support carers and to report what effectiveness has been found. Scoping systematic review. Electronic databases and websites were searched from 1990 to December 2015. Studies were agreed for inclusion using pre-defined criteria. Relevant information from included studies was extracted and quality assessment was completed. Data were synthesised using qualitative methods. A total of 62 studies reported caregiver outcomes for the traumatic brain injury cohort; 51 reported negative outcomes and 11 reported positive outcomes. For the spinal cord injury cohort, 18 studies reported caregiver outcomes; 15 reported negative outcomes and three reported positive outcomes. Burden of care was over-represented in the literature for both cohorts, with few studies looking at factors associated with positive outcomes. Good family functioning, coping skills and social support were reported to mediate caregiver burden and promote positive outcomes. A total of 21 studies further described interventions to support traumatic brain injury caregivers and four described interventions to support spinal cord injury caregivers, with emerging evidence for the effectiveness of problem-solving training. Further research is required to explore the effects of injury severity of the care recipient, as well as caregiver age, on the outcome of the interventions. Most studies reported negative outcomes, suggesting that barriers to caregiving have been established, but not facilitators. The interventions described to support carers are limited and require further testing to confirm their effectiveness.

  18. Family caregivers and outcome of people with schizophrenia in rural China: 14-year follow-up study.

    Science.gov (United States)

    Ran, Mao-Sheng; Chui, Cheryl H K; Wong, Irene Yin-Ling; Mao, Wen-Jun; Lin, Fu-Rong; Liu, Bo; Chan, Cecilia Lai-Wan

    2016-04-01

    This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family caregiver(s) in a rural community in China. All participants with schizophrenia (n = 510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. Individuals without family caregiver in 1994 had significantly higher rate of homelessness (23.8 %) and lower rate of survival (47.5 %) in 2008 than those with family caregivers (5.1 and 70.9 %). Compared with individuals with family caregivers, those without family caregivers were more likely to be male, live alone, have fewer family members, lower family economic status, lower rates of marriage and complete remission, higher mean scores on PANSS and lower mean score on GAF in 2008. The predictors of participants without family caregiver in 2008 included having a small number of family members at baseline and being male. The absence of a family caregiver is a predictive factor of poorer long-term outcome of persons with schizophrenia in the rural community. The critical role of family caregiving should be incorporated in the planning and delivering of mental health policies and community-based mental health services.

  19. Experience of using an interdisciplinary task force to develop a culturally sensitive multipronged tool to improve stroke outcomes in Nigeria

    Directory of Open Access Journals (Sweden)

    Oyedunni S. Arulogun

    2016-09-01

    Full Text Available The burden of stroke is on the rise in Nigeria. A multi-faceted strategy is essential for reducing this growing burden and includes promoting medication adherence, optimizing traditional biomarker risk targets (blood pressure, cholesterol and encouraging beneficial lifestyle practices. Successful implementation of this strategy is challenged by inadequate patient health literacy, limited patient/medical system resources, and lack of a coordinated interdisciplinary treatment approach. Moreover, the few interventions developed to improve medical care in Nigeria have generally been aimed at physicians (primarily and nurses (secondarily with minimal input from other key health care providers, and limited contributions from patients, caregivers, and the community itself. The Tailored Hospital-based Risk Reduction to Impede Vascular Events after Stroke (THRIVES study is assessing the efficacy of a culturally sensitive multidimensional intervention for controlling blood pressure in recent stroke survivors. A key component of the intervention development process was the constitution of a project task force comprising various healthcare providers and administrators. This paper describes the unique experience in Sub-Saharan Africa of utilizing of an interdisciplinary Task force to facilitate the development of the multipronged behavioral intervention aimed at enhancing stroke outcomes in a low-middle income country.

  20. Predicting mobility outcome one year after stroke: a prospective cohort study.

    NARCIS (Netherlands)

    Port, I.G. van de; Kwakkel, G.; Schepers, V.P.; Lindeman, E.

    2006-01-01

    OBJECTIVE: To develop a prognostic model to predict mobility outcome one year post-stroke. DESIGN: Prospective cohort study in patients with a first-ever stroke admitted for inpatient rehabilitation. PATIENTS: A total of 217 patients with stroke (mean age 58 years) following inpatient rehabilitation

  1. Components and Outcomes of Internet-Based Interventions for Caregivers of Older Adults: Systematic Review

    OpenAIRE

    Guay, Cassioppée; Auger, Claudine; Demers, Louise; Mortenson, W Ben; Miller, William C; Gélinas-Bronsard, Dominique; Ahmed, Sara

    2017-01-01

    Background When trying to access interventions to improve their well-being and quality of life, family caregivers face many challenges. Internet-based interventions provide new and accessible opportunities to remotely support them and can contribute to reducing their burden. However, little is known about the link existing between the components, the use of behavior change techniques, and the outcomes of these Internet-based interventions. Objective This study aimed to provide an update on th...

  2. One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis.

    Science.gov (United States)

    Park, Hong-Kyun; Kim, Beom Joon; Han, Moon-Ku; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Nah, Hyun-Wook; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Kim, Joon-Tae; Choi, Kang-Ho; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Jay Chol; Johansson, Saga; Lee, Su Jin; Lee, Won Hee; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee-Joon

    2017-11-01

    Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea. Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge. Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent cardiac evaluations; 25.1% had symptomatic stenosis or occlusion of intracranial arteries. At discharge, 95.2% of patients received antithrombotics (antiplatelet polytherapy, 37.1%; anticoagulation, 15.3%) and 86.2% received statins. The 3-month cumulative event rate was 5.9% for the primary outcome, 4.3% for stroke recurrence, 4.6% for a major vascular event, and 2.0% for all-cause death. Corresponding values at 1 year were 9.3%, 6.1%, 6.7%, and 4.1%, respectively. Patients receiving nonaspirin antithrombotic strategies or no antithrombotic agent had higher baseline risk profiles and at least 1.5× higher event rates for clinical event outcomes than those with aspirin monotherapy. Contemporary secondary stroke prevention strategies based on thorough diagnostic evaluation may contribute to the low subsequent vascular event rates observed in real-world clinical practice in Korea. © 2017 American Heart Association, Inc.

  3. Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS).

    Science.gov (United States)

    Goeggel Simonetti, Barbara; Mono, Marie-Luise; Huynh-Do, Uyen; Michel, Patrik; Odier, Celine; Sztajzel, Roman; Lyrer, Philippe; Engelter, Stefan T; Bonati, Leo; Gensicke, Henrik; Traenka, Christopher; Tettenborn, Barbara; Weder, Bruno; Fischer, Urs; Galimanis, Aekaterini; Jung, Simon; Luedi, Rudolf; De Marchis, Gian Marco; Weck, Anja; Cereda, Carlo W; Baumgartner, Ralf; Bassetti, Claudio L; Mattle, Heinrich P; Nedeltchev, Krassen; Arnold, Marcel

    2015-09-01

    Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16-55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60% men), median age was 46 (IQR 39-51) years and median NIHSS on admission 3 (IQR 1-8). Modifiable vascular risk factors were found in 73%. Stroke aetiology was mostly cardioembolism (32%) and of other defined origin (24%), including cervicocerebral artery dissection (17%). Fabry disease was diagnosed in 2 patients (0.3%). Aetiology remained unknown in 20%. Outcome at 3 months was favourable (mRS 0-1) in 61% and fatal in 2.9%. Stroke severity (p young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones.

  4. Risk factors of outcomes in elderly patients with acute ischemic stroke in China.

    Science.gov (United States)

    Wu, Qi; Zou, Chunying; Wu, Chengji; Zhang, Shuping; Huang, Zuoyi

    2016-08-01

    Stroke results in poor outcomes among elderly patients. However, the factors associated with outcome over different follow-up periods in this population are unknown. To evaluate the outcomes and risk factors of outcomes in elderly patients after stroke. Outcomes, including mortality, dependency (defined as a mRS >2), and recurrence rates, and associated risk factors were assessed at 3 and 12 months after stroke in patients aged ≥80 years. There were 419 acute ischemic stroke patients aged ≥80 years at 3 months, and 309 patients at 12 months; outcomes and relevant risk factors were assessed in these patients. Hypertension was more prevalent in women than in men. At 3 months, the mortality, dependency, and recurrence rates were 13.8, 54.2, and 18.1 %, respectively; the corresponding rates at 12 months were 26.9, 58.0, and 32.6 %, respectively. In the multivariate analysis, after adjusting by confounding factors, TOAST classification and stroke severity were associated with mortality and recurrence, while stroke severity was associated with dependency at 3 months. The mortality and dependency rates at 12 months were significantly associated with moderate and severe stroke, but severe stroke was an independent factor associated with recurrence. Stroke subtype and severity were associated with stroke outcomes among elderly patients in northern China. These findings suggest that it is crucial to highlight the affected factors of stroke outcome among elderly patients for reduce the burden of stroke in China.

  5. Preadmission oral anticoagulant treatment and clinical outcome among patients hospitalized with acute stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Svendsen, Marie Louise; Hansen, Morten Lock

    2014-01-01

    Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide...... historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further....

  6. A study of predictors of anxiety and depression among stroke patient-caregivers

    Directory of Open Access Journals (Sweden)

    Yatan Pal Singh Balhara

    2012-01-01

    Conclusions: Caring for the patients with stroke presents increased burden to the care givers which manifests as increased rate of anxiety and depression among them. It is important to assess the care givers along with the patients for emergence of these negative affective states. One needs to be extra cautious if the patient happens to be the primary earning member of the family.

  7. Statin treatment and stroke outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

    DEFF Research Database (Denmark)

    Goldstein, L.B.; Amarenco, P.; Zivin, J.

    2009-01-01

    Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. RESULTS: Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5...... or no event), there was only a trend toward lesser severity with treatment based on the modified Rankin Scale score (P=0.0647) with no difference based on the National Institutes of Health Stroke Scale or Barthel Index. CONCLUSIONS: The present exploratory analysis suggests that the outcome of recurrent...... or 4), moderate (modified Rankin Scale score 3 or 2), and mild (modified Rankin Scale score 1 or 0) outcome ischemic strokes and transient ischemic attacks and an increase in the proportion of event-free subjects randomized to atorvastatin (P

  8. Manual and oral apraxia in acute stroke, frequency and influence on functional outcome

    DEFF Research Database (Denmark)

    Pedersen, P M; Jørgensen, H S; Kammersgaard, L P

    2001-01-01

    To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome.......To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome....

  9. Direct and Indirect Effects of Caregiver Social Support on Adolescent Psychological Outcomes in Two South African AIDS-Affected Communities.

    Science.gov (United States)

    Casale, Marisa; Cluver, Lucie; Crankshaw, Tamaryn; Kuo, Caroline; Lachman, Jamie M; Wild, Lauren G

    2015-06-01

    Caregiver social support has been shown to be protective for caregiver mental health, parenting and child psychosocial outcomes. This is the first known analysis to quantitatively investigate the relationship between caregiver social support and adolescent psychosocial outcomes in HIV-endemic, resource-scarce Southern African communities. A cross-sectional household survey was conducted over 2009-2010 with 2,477 South African adolescents aged 10-17 and their adult caregivers (18 years or older) in one urban and one rural community in South Africa's KwaZulu-Natal province. Adolescent adjustment was assessed using adult caregiver reports of the Strengths and Difficulties questionnaire (SDQ), which measures peer problems, hyperactivity, conduct problems, emotional symptoms and child prosocial behavior. Hierarchical linear regressions and multiple mediation analyses, using bootstrapping procedures, were conducted to assess for: (a) direct effects of more caregiver social support on better adolescent psychosocial wellbeing; and (b) indirect effects mediated by better parenting and caregiver mental health. Direct associations (p adolescent outcomes. Findings reinforce the importance of social support components within parenting interventions but also point to scope for positive intervention on adolescent psychosocial wellbeing through the broader family social network.

  10. The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke

    DEFF Research Database (Denmark)

    Ekstam, Lisa; Johansson, Ulla; Guidetti, Susanne

    2015-01-01

    OBJECTIVES: The aim of the study was to explore the associations between the dyad's (person with stroke and informal caregiver) perception of the person with stroke's rehabilitation needs and stroke severity, personal factors (gender, age, sense of coherence), the use of rehabilitation services...... and qualitative data and analyses. SETTING: Data were mainly collected in the participants' homes. OUTCOME MEASURES: Data were collected through established instruments and open-ended interviews. The dyad's perceptions of the person with stroke's rehabilitation needs were assessed by the persons with stroke......, amount of informal care and caregiver burden. Further, the aim was to explore the personal experience of everyday life changes among persons with stroke and their caregivers and their strategies for handling these 1 year after stroke. DESIGN: A mixed methods design was used combining quantitative...

  11. Sex Differences in Outcomes among Stroke Survivors with Non-Valvular Atrial Fibrillation in China.

    Science.gov (United States)

    Hong, Yan; Yang, Xun; Zhao, Wenjuan; Zhang, Xianghui; Zhao, Junli; Yang, Yuanju; Ning, Xianjia; Wang, Jinghua; An, Zhongping

    2017-01-01

    Atrial fibrillation (AF) significantly increases the risk of stroke and disease burden and is an established predictor of poor outcomes after stroke. However, data regarding sex differences in long-term outcomes following stroke in patients with AF are scarce. We thus aimed to assess these differences. We recruited 951 consecutive patients with acute ischemic stroke and non-valvular atrial fibrillation (NVAF) treated at three hospitals in Tianjin, China, from January 2006 to September 2014. Information regarding stroke subtype, severity, risk factors, and outcomes (mortality, dependency, and recurrence) at 3, 12, and 36 months after stroke was recorded. The prevalence of NVAF was 8.4% overall, with a higher frequency in women than in men (11.3 vs. 6.9%, P  disease burden in women.

  12. Effect of GLP-1R Knockout on stroke outcome

    OpenAIRE

    Voinea, Alexandra

    2014-01-01

    Stroke is the leading cause of disability in adults in westernized societies and it has an important impact on health and economy. Comorbid health conditions such as hypertension, inactive lifestyle, smoking, obesity and diabetes considerably increase the risk of stroke. Moreover, studies have shown an increased probability of stroke occurrence and recurrence in the type 2 diabetes (T2D). Stroke leads to neurological deficits like motor impairments, disabilities and poor quality of life. The ...

  13. Direct and indirect effects of caregiver social support on adolescent psychological outcomes in two South African AIDS-affected communities

    Science.gov (United States)

    Casale, Marisa; Cluver, Lucie; Crankshaw, Tamaryn; Kuo, Caroline; Lachman, Jamie M.; Wild, Lauren G.

    2015-01-01

    Caregiver social support has been shown to be protective for caregiver mental health, parenting and child psychosocial outcomes. This is the first known analysis to quantitatively investigate the relationship between caregiver social support and adolescent psychosocial outcomes in HIV-endemic, resource-scarce Southern African communities. A cross-sectional household survey was conducted over 2009-2010 with 2477 South African adolescents aged 10-17 and their adult caregivers (18 years or older) in one urban and one rural community in South Africa’s KwaZulu-Natal province. Adolescent adjustment was assessed using adult caregiver reports of the Strengths and Difficulties questionnaire (SDQ), which measures peer problems, hyperactivity, conduct problems, emotional symptoms and child prosocial behavior. Hierarchical linear regressions and multiple mediation analyses, using bootstrapping procedures, were conducted to assess for: a) direct effects of more caregiver social support on better adolescent psychosocial wellbeing; and b) indirect effects mediated by better parenting and caregiver mental health. Direct associations (psocial support components within parenting interventions but also point to scope for positive intervention on adolescent psychosocial wellbeing through the broader family social network. PMID:25623784

  14. Effectiveness of two home ergonomic programs in reducing pain and enhancing quality of life in informal caregivers of post-stroke patients: A pilot randomized controlled clinical trial.

    Science.gov (United States)

    de Araújo Freitas Moreira, Karen Lucia; Ábalos-Medina, Gracia María; Villaverde-Gutiérrez, Carmen; Gomes de Lucena, Neide María; Belmont Correia de Oliveira, Anderson; Pérez-Mármol, José Manuel

    2018-02-13

    Informal caregivers of post-stroke patients usually undergo high levels of pain and stress and have a reduced quality of life. To evaluate the effectiveness of two home ergonomic interventions aimed at reducing pain intensity and perceived stress and enhancing the quality of life in informal caregivers of chronic post-stroke patients. A randomized single-blind controlled clinical trial was conducted, with a sample of 33 informal caregivers of patients with stroke. Three groups were included: one received postural hygiene training and kinesiotherapy, for 12 weeks, two days a week, one hour per session; another received adaptation of the home environment, and the third was a control group. Pain intensity, stress level and general quality of life were evaluated at three-time points: pre-intervention, post-intervention, and after a follow-up period of three months. Neck pain decreased in the two experimental groups, and increased in the control group. Pain in the shoulders and knees was alleviated in the group that received postural hygiene and kinesiotherapy. In addition, regarding quality of life, this group obtained an improvement in the physical health dimension, while the home adaptation group reported improved social relationships. These results suggest that 12 weeks of training in postural hygiene, combined with kinesiotherapy, and home adaptations can reduce pain and improve several aspects of the quality of life of this population. CLINICALTRIALS. NCT03284580. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Development and psychometric properties of ECPICID-AVC to measure informal caregivers' skills when caring for older stroke survivors at home.

    Science.gov (United States)

    Araújo, Odete; Lage, Isabel; Cabrita, José; Teixeira, Laetitia

    2016-12-01

    Informal caregivers provide a significant part of the total care needed by dependent older people poststroke. Although informal care is often the preferred option of those who provide and those who receive informal care, informal caregivers often report lack of preparation to take care of older dependent people. This article outlines the development and psychometric testing of informal caregivers' skills when providing care to older people after a stroke - ECPICID-AVC. Prospective psychometric instrument validation study. Eleven experts participated in a focus group in order to delineate, develop and validate the instrument. Data were gathered among adult informal caregivers (n = 186) living in the community in Northern Portugal from August 2013 to January 2014. The 32-item scale describes several aspects of informal caregiver's skills. The scale has eight factors: skill to feed/hydrate by nasogastric feeding, skill to assist the person in personal hygiene, skill to assist the person for transferring, skill to assist the person for positioning, skill to provide technical aids, skill to assist the person to use the toilet, skill to feed/hydrate and skill to provide technical aids for dressing/undressing. Analysis demonstrated adequate internal consistency (Cronbach's alpha = 0.83) and good temporal stability 0.988 (0.984-0.991). The psychometric properties of the measurement tool showed acceptable results allowing its implementation in clinical practice by the nursing community staff for evaluating practical skills in informal caregivers when providing care to older stroke survivors living at home. © 2016 Nordic College of Caring Science.

  16. Spared emotional perception in patients with Alzheimer's disease is associated with negative caregiver outcomes.

    Science.gov (United States)

    Daley, Ryan T; Sugarman, Michael A; Shirk, Steven D; O'Connor, Maureen K

    2018-05-01

    Caregivers (CGs) for patients with Alzheimer's disease (AD) often experience negative mental health and relationship outcomes. Additionally, emotional perception abilities are often compromised in early AD; the relationships between these deficits and CG outcomes are unclear. The present study investigated the relationship between emotional perception abilities in AD participants and CG well-being. Participants included 28 individuals with AD, their spousal CGs, and 30 older controls (OCs). Patients and controls completed the Montreal Cognitive Assessment and Advanced Clinical Solutions: Social Perception subtest. CGs completed questionnaires related to relationship satisfaction, burden, depression, and patient neuropsychiatric symptoms and activities of daily living. The patient group performed significantly worse than OCs on measures of cognition and emotional perception. Several significant relationships emerged between AD participant emotional perception and CG outcomes. Higher CG depression was associated with greater overall emotional perception abilities (r = .39, p = .041). Caregiver burden was positively correlated with AD participants' ability to label the emotional tones of voices (r = .47, p = .015). Relationship satisfaction was not significantly correlated with emotional perception. This study replicated earlier findings of impaired emotional perception abilities in AD participants. However, preserved abilities in emotional perception were associated greater CG depression and burden. Interestingly, the CGs satisfaction with the marital relationship did not appear to be influenced by changes in emotional perception. Higher emotional engagement among couples in which one spouse has cognitive impairment may contribute to increased negative interactions and in turn a greater sense of burden and depression, while leaving the marital relationship preserved.

  17. The Effect of Anemia on the Functional Outcomes of the Stroke Patients and the Efficiency of their Stroke Rehabilitation.

    Science.gov (United States)

    Chan, Tik; Ganasekaran, Ganesh

    2015-06-01

    There has been limited study focusing on the functional outcomes of stroke patients' after rehabilitation, such as functional improvement and discharge destination, length of stay (LOS), and complication rate. A retrospective study was conducted on 123 consecutive patients who were admitted to The Prince Charles Hospital Rehabilitation Unit from January 2011 to December 2012 with clinically defined stroke syndromes. Functional Independence Measure (FIM) score was used to measure the functional improvement. Anemia is defined by using the World Health Organization's criteria (hemoglobin concentration in men types of stroke were all comparable in both anemic and nonanemic groups. It was found that, when selecting only the patients with ischemic stroke for comparison (103 patients), there was a significantly higher FIM score improvement (discharge FIM - admission FIM) in nonanemic group (P = .042). FIM efficiency (FIM change/LOS) was also significantly higher in the nonanemic group (P = .027). Higher percentage of patients were discharged home in nonanemic group (94.3% versus 73.3%, P = .006). In addition, higher rate of complications was found in anemic group (60% versus 39%, P = .049). Anemia appears to have a significant effect on the functional improvement and discharge outcomes for patients who had an ischemic stroke. Anemia may also increase the complication rate and affect the efficiency of stroke rehabilitation for those patients. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  18. Weakness of Eye Closure with Central Facial Paralysis after Unilateral Hemispheric Stroke Predicts a Worse Outcome.

    Science.gov (United States)

    Lin, Jianwen; Chen, Yicong; Wen, Hongmei; Yang, Zhiyun; Zeng, Jinsheng

    2017-04-01

    Upper facial dysfunction is not generally considered a feature of central facial paralysis after unilateral hemispheric stroke; however, weakness of eye closure (WEC) has been observed in some cases. We aimed to investigate the frequency and characteristics of WEC in unilateral stroke and its association with stroke prognosis. Patients with unilateral stroke and central facial paralysis were prospectively recruited within 7 days of onset. Facial paralysis was evaluated via the fourth item in the National Institute of Health Stroke Scale (NIHSS-4) and the Japan Facial Score (JFS) on admission, and at days 7, 14, 21, and 30 after stroke. Eye closure strength was measured daily using an ergometer for 30 days after stroke. Primary outcome was assessed using the modified Rankin Scale (mRS) at 90 and 180 days. Univariate and multivariate analyses were performed to investigate risk factors of WEC. WEC was identified in 16 of 242 patients (6.6%). Baseline characteristics, stroke risk factors, and lesion volume were not significantly different between patients with and patients without WEC. Patients with WEC featured higher NIHSS-4 scores and lower JFS between admission and at 21 days after stroke. Severe central facial paralysis (odds ratio [OR] = 8.1, 95% confidence interval [CI] = 2.3-28.6, P = .001) and right hemispheric stroke (OR = 13.7, 95% CI = 3.7-51.2, P WEC. At 180 days after stroke, patients with WEC demonstrated a lower rate of functional independence (mRS = 0-2: 37.5% versus 72.1%, P WEC, which predicts a worse functional outcome at 180 days after unilateral stroke, demonstrates an association with severe central facial paralysis and right hemispheric stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Association Between Brain-Derived Neurotrophic Factor Genotype and Upper Extremity Motor Outcome After Stroke.

    Science.gov (United States)

    Chang, Won Hyuk; Park, Eunhee; Lee, Jungsoo; Lee, Ahee; Kim, Yun-Hee

    2017-06-01

    The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke. A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor. The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment stroke. Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement. © 2017 American Heart Association, Inc.

  20. Functional and motor outcome 5 years after stroke is equivalent to outcome at 2 months: follow-up of the collaborative evaluation of rehabilitation in stroke across Europe.

    Science.gov (United States)

    Meyer, Sarah; Verheyden, Geert; Brinkmann, Nadine; Dejaeger, Eddy; De Weerdt, Willy; Feys, Hilde; Gantenbein, Andreas R; Jenni, Walter; Laenen, Annouschka; Lincoln, Nadina; Putman, Koen; Schuback, Birgit; Schupp, Wilfried; Thijs, Vincent; De Wit, Liesbet

    2015-06-01

    Recovery of patients within the first 6 months after stroke is well documented, but there has been little research on long-term recovery. The aim of this study was to analyze functional and motor recovery between admission to rehabilitation centres and 5 years after stroke. This follow-up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe study, included patients from 4 European rehabilitation centres. Patients were assessed on admission, at 2 and 6 months, and 5 years after stroke, using the Barthel Index, Rivermead Motor Assessment Gross Function, Leg and Trunk function, and Arm function. Linear mixed models were used, corrected for baseline characteristics. To account for the drop-out during follow-up, the analysis is likelihood-based (assumption of missingness at random). A total of 532 patients were included in this study, of which 238 were followed up at 5 years post stroke. Mean age at stroke onset was 69 (±10 SD) years, 53% were men, 84% had ischemic strokes, and 53% had left-sided motor impairment. Linear mixed model analysis revealed a significant deterioration for all 4 outcomes between 6 months and 5 years (Pstroke. Higher age (Pstroke severity on admission (Pstroke severity negatively affected recovery up to 5 years after stroke. © 2015 American Heart Association, Inc.

  1. Serum Galectin-3 and Poor Outcomes Among Patients With Acute Ischemic Stroke.

    Science.gov (United States)

    Wang, Aili; Zhong, Chongke; Zhu, Zhengbao; Xu, Tian; Peng, Yanbo; Xu, Tan; Peng, Hao; Chen, Chung-Shiuan; Wang, Jinchao; Ju, Zhong; Li, Qunwei; Geng, Deqin; Sun, Yingxian; Zhang, Jianhui; Yuan, Xiaodong; Chen, Jing; Zhang, Yonghong; He, Jiang

    2018-01-01

    Elevated galectin-3 has been associated with atherosclerosis and poor outcomes in patients with heart failure. However, it remains unclear whether galectin-3 has any effect on the poor outcomes of ischemic stroke. The aim of the present study was to examine the association between galectin-3 with poor outcomes among patients with acute ischemic stroke. Serum galectin-3 was measured in 3082 patients with acute ischemic stroke. The primary outcome was a combination of death or major disability (modified Rankin Scale score, ≥3) at 3 months after stroke. Compared with the lowest quartile of galectin-3, multivariate adjusted odds ratios (95% confidence intervals) for the highest quartile of galectin-3 were 1.55 (1.15-2.09) for composite outcome, 2.10 (0.89-4.95) for death, and 1.43 (1.05-1.93) for major disability. The addition of galectin-3 to the conventional risk factors significantly improved prediction of the combined outcome of death or major disability in patients with ischemic stroke (net reclassification index, 18.9%; P stroke onset, suggesting that galectin-3 may have prognostic value in poor outcomes of ischemic stroke. © 2017 American Heart Association, Inc.

  2. Early Prediction and Outcome of Septic Encephalopathy in Acute Stroke Patients With Nosocomial Coma

    OpenAIRE

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui

    2015-01-01

    Background Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). Methods A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with...

  3. Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review

    OpenAIRE

    Janita Pak Chun Chau; Suzanne Hoi Shan Lo; Xingfeng Yu; Kai Chow Choi; Alexander Yuk Lun Lau; Alexander Yuk Lun Lau; Justin Che Yuen Wu; Justin Che Yuen Wu; Vivian Wing Yan Lee; William Hoi Ngai Cheung; Jessica Yuet Ling Ching; Jessica Yuet Ling Ching; David R. Thompson

    2018-01-01

    BackgroundPoststroke shoulder pain limits stroke survivors’ physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors wit...

  4. Effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain: A systematic review

    OpenAIRE

    Chau, Janita Pak Chun; Lo, Suzanne Hoi Shan; Yu, Xingfeng; Choi, Kai Chow; Lau, Alexander Yuk Lun; Wu, Justin Che Yuen; Lee, Vivian Wing Yan; Cheung, William Hoi Ngai; Ching, Jessica Yuet Ling; Thompson, David R.

    2018-01-01

    Background: Poststroke shoulder pain limits stroke survivors' physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors w...

  5. Early management and outcome of acute stroke in Auckland

    International Nuclear Information System (INIS)

    Anderson, N.E.; Bonita, R.; Broad, J.B.

    1997-01-01

    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors)

  6. Epilepsy after TIA or stroke in young patients impairs long-term functional outcome: The FUTURE Study

    NARCIS (Netherlands)

    Arntz, R.M.; Maaijwee, N.A.M.M.; Rutten-Jacobs, L.C.A.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Dijk, E.J. van; Leeuw, F.E. de

    2013-01-01

    OBJECTIVE: To determine the influence of poststroke epilepsy on long-term functional outcome in young stroke survivors. METHODS: This study is a prospective cohort study among 537 stroke survivors with a first-ever TIA, ischemic stroke, or intracerebral hemorrhagic (ICH) stroke, aged 18 to 50 years.

  7. The site of embolization related to infarct size, oedema and clinical outcome in a rat stroke model - further translational stroke research

    DEFF Research Database (Denmark)

    Overgaard, Karsten; Rasmussen, Rune S; Johansen, Flemming F

    2010-01-01

    Reliable models are essential for translational stroke research to study the pathophysiology of ischaemic stroke in an effort to find therapies that may ultimately reduce oedema, infarction and mortality in the clinic. The purpose of this study was to investigate the relation between the site...... of arterial embolization and the subsequent oedema, infarction and clinical outcome in a rat embolic stroke model....

  8. The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study

    NARCIS (Netherlands)

    Meijer, R.; van Limbeek, J.; Peusens, G.; Rulkens, M.; Dankoor, K.; Vermeulen, M.; de Haan, R. J.

    2005-01-01

    Objective: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit. Methods: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and

  9. Life satisfaction two-years after stroke onset: the effects of gender, sex occupational status, memory function and quality of life among stroke patients (Newsqol) and their family caregivers (Whoqol-bref) in Luxembourg.

    Science.gov (United States)

    Baumann, Michèle; Couffignal, Sophie; Le Bihan, Etienne; Chau, Nearkasen

    2012-09-25

    Life satisfaction (LS) of cerebrovascular disease survivors and their family caregivers may relate to socioeconomic factors, impaired functions, health-related quality of life (QoL), but their respective influences remain unclear. This study assessed, two years post-stroke onset, the effects of these factors on patients' LS and family caregivers' LS in Luxembourg. All stroke patients admitted to all hospitals in Luxembourg were identified by the 'Inspection Général de la Sécurité Sociale' using the only national system database for care expenditure reimbursement. Their diagnosis was confirmed by medical investigator. The sample included ninety four patients living at home having given consent (mean age 65.5 years) and sixty two main caregivers (mean age 59.3 years). Questionnaires were completed during face-to-face interviews. LS was assessed via European single question (range 1-10), survivors' QoL via Newsqol (11 dimensions), and caregivers' QoL via Whoqol-bref (4 domains) (range 0-100). Data were analysed using multiple regression models. Two years after stroke onset, 44.7% of patients suffered from impaired sensory function, 35.1% from impaired motor function, and 31.9% from impaired memory function. Mean patient' LS was 7.1/10 (SD 1.9). It was higher in women (+12.4) and lower among unemployed socioeconomically active patients (-13.1, vs. retired people). Adjusted for sex, occupation, impaired motor and memory functions, LS positively correlated with scores of Newsqol feelings, sleep, emotion, cognition and pain dimensions (slopes 0.20 to 0.31), but did not correlate with those of caregivers' Whoqol-bref domains. Family caregiver' LS was 7.2 (SD 1.7). It was lower in those with patients suffering from impaired memory function (-12.8) as well as from feelings and emotion issues (slopes 0.22). It was associated with all caregivers' Whoqol-bref domains (physical health, psychological health, environment, and social relationships) (slopes 0.53 to 0.68). Two

  10. Stroke outcomes in Malawi, a country with high prevalence of HIV: a prospective follow-up study.

    Directory of Open Access Journals (Sweden)

    Terttu Heikinheimo

    Full Text Available BACKGROUND: Stroke contributes significantly to disability and mortality in developing countries yet little is known about the determinants of stroke outcomes in such countries. 12% of Malawian adults have HIV/AIDS. It is not known whether having HIV-infection alters the outcome of stroke. The aim of this study was to document the functional outcome and mortality at 1 year of first-ever acute stroke in Malawi. Also to find out if the baseline variables, including HIV-infection, affect the outcome of stroke. METHODS AND FINDINGS: 147 adult patients with first-ever acute stroke were prospectively followed up for 12 months. Conventional risk factors and HIV-infection were assessed at baseline. Stroke severity was evaluated with modified National Institute of Health Stroke Scale (mNIHSS and functional outcome with modified Rankin scale (mRS. Fifty (34% of patients were HIV-seropositive. 53.4% of patients had a poor outcome (severe disability or death, mRS 4-6 at 1 year. Poor outcome was related to stroke severity and female gender but not to presence of HIV-infection. HIV-seropositive patients were younger and had less often common risk factors for stroke. They suffer more often ischemic stroke than HIV-seronegative patients. CONCLUSIONS: Mild stroke and male gender were associated with favourable outcome. HIV-infection is common in stroke patients in Malawi but does not worsen the outcome of stroke. However, it may be a risk factor for ischemic stroke for young people, who do not have the common stroke risk factors. Our results are significant, because stroke outcome in HIV-seropositive patients has not been studied before in a setting such as ours, with very limited resources and a high prevalence of HIV.

  11. Socioeconomic variations in the course of stroke: unequal health outcomes, equal care?

    NARCIS (Netherlands)

    Bos, G.A.M. van den; Smits, J.P.J.M.; Westert, G.P.; Straten, A. van

    2002-01-01

    Study objective: The aim of this paper is to quantify the socioeconomic gap in long term health outcomes after stroke and related health care utilisation, in order to evaluate whether those in need of care do actually receive appropriate levels of care. Design: Stroke patients from the lower

  12. The role of chronic kidney disease and atrial fibrillation on outcomes of ischaemic stroke patients

    DEFF Research Database (Denmark)

    Khan, Ahsan A; Lip, Gregory Y H

    2018-01-01

    and diabetes mellitus lead to impairment of renal function and development of chronic kidney disease (CKD). Indeed, CKD is increasingly prevalent in the elderly population and is an independent predictor of stroke recurrence, mortality and poor clinical outcomes after acute ischaemic stroke (1). This article...

  13. An International Standard Set of Patient-Centered Outcome Measures After Stroke

    NARCIS (Netherlands)

    Salinas, J. (Joel); Sprinkhuizen, S.M. (Sara M.); Ackerson, T. (Teri); Bernhardt, J. (Julie); Davie, C. (Charlie); George, M.G. (Mary G.); Gething, S. (Stephanie); Kelly, A.G. (Adam G.); Lindsay, P. (Patrice); Liu, L. (Liping); Martins, S.C.O. (Sheila C.O.); Morgan, L. (Louise); B. Norrving (Bo); Ribbers, G.M. (Gerard M.); Silver, F.L. (Frank L.); Smith, E.E. (Eric E.); Williams, L.S. (Linda S.); Schwamm, L.H. (Lee H.)

    2015-01-01

    markdownabstract__BACKGROUND AND PURPOSE:__ Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures

  14. Fatalism, optimism, spirituality, depressive symptoms, and stroke outcome: a population-based analysis.

    Science.gov (United States)

    Morgenstern, Lewis B; Sánchez, Brisa N; Skolarus, Lesli E; Garcia, Nelda; Risser, Jan M H; Wing, Jeffrey J; Smith, Melinda A; Zahuranec, Darin B; Lisabeth, Lynda D

    2011-12-01

    We sought to describe the association of spirituality, optimism, fatalism, and depressive symptoms with initial stroke severity, stroke recurrence, and poststroke mortality. Stroke cases from June 2004 to December 2008 were ascertained in Nueces County, TX. Patients without aphasia were queried on their recall of depressive symptoms, fatalism, optimism, and nonorganizational spirituality before stroke using validated scales. The association between scales and stroke outcomes was studied using multiple linear regression with log-transformed National Institutes of Health Stroke Scale and Cox proportional hazards regression for recurrence and mortality. Six hundred sixty-nine patients participated; 48.7% were women. In fully adjusted models, an increase in fatalism from the first to third quartile was associated with all-cause mortality (hazard ratio, 1.41; 95% CI, 1.06-1.88) and marginally associated with risk of recurrence (hazard ratio, 1.35; 95% CI, 0.97-1.88), but not stroke severity. Similarly, an increase in depressive symptoms was associated with increased mortality (hazard ratio, 1.32; 95% CI, 1.02-1.72), marginally associated with stroke recurrence (HR, 1.22; 95% CI, 0.93-1.62), and with a 9.0% increase in stroke severity (95% CI, 0.01-18.0). Depressive symptoms altered the fatalism-mortality association such that the association of fatalism and mortality was more pronounced for patients reporting no depressive symptoms. Neither spirituality nor optimism conferred a significant effect on stroke severity, recurrence, or mortality. Among patients who have already had a stroke, self-described prestroke depressive symptoms and fatalism, but not optimism or spirituality, are associated with increased risk of stroke recurrence and mortality. Unconventional risk factors may explain some of the variability in stroke outcomes observed in populations and may be novel targets for intervention.

  15. Preschool children's coping responses and outcomes in the vaccination context: child and caregiver transactional and longitudinal relationships.

    Science.gov (United States)

    Campbell, Lauren; Riddell, Rebecca Pillai; Cribbie, Robert; Garfield, Hartley; Greenberg, Saul

    2017-10-26

    This paper, based on two companion studies, presents an in-depth analysis of preschooler coping with vaccination pain. Study 1 employed an autoregressive cross-lagged path model to investigate the dynamic and reciprocal relationships between young children's coping responses (how they cope with pain and distress) and coping outcomes (pain behaviors) at the preschool vaccination. Expanding on this analysis, Study 2 then modeled preschool coping responses and outcomes using both caregiver and child variables from the child's 12-month vaccination (n=548), preschool vaccination (n=302), and a preschool psychological assessment (n=172). Summarizing over the five path models and post-hoc analyses over the two studies, novel transactional and longitudinal pathways predicting preschooler coping responses and outcomes were elucidated. Our research has provided empirical support for the need to differentiate between coping responses and coping outcomes: two different, yet interrelated, components of "coping." Among our key findings, the results suggest that: a preschooler's ability to cope is a powerful tool to reduce pain-related distress but must be maintained throughout the appointment; caregiver behavior and poorer pain regulation from the 12-month vaccination appointment predicted forward to preschool coping responses and/or outcomes; robust concurrent relationships exist between caregiver behaviors and both child coping responses and outcomes, and finally caregiver behaviors during vaccinations are not only critical to both child pain coping responses and outcomes in the short- and long-term but also show relationships to broader child cognitive abilities as well.

  16. Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis.

    Science.gov (United States)

    Findlay, Mark D; Thomson, Peter C; Fulton, Rachael L; Solbu, Marit D; Jardine, Alan G; Patel, Rajan K; Stevens, Kathryn K; Geddes, Colin C; Dawson, Jesse; Mark, Patrick B

    2015-09-01

    End-stage renal disease (ESRD) requiring hemodialysis carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge on risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke. All adult patients receiving hemodialysis for ESRD from January 1, 2007, to December 31, 2012, were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging, and dialysis-related variables were assessed, and case-fatality was determined. Follow-up was until December 31, 2013. A total of 1382 patients were identified (mean age, 60.5 years; 58.5% men). The prevalence of atrial fibrillation was 21.2%, and 59.4% were incident hemodialysis patients. One hundred and sixty patients (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident hemodialysis patients. Factors associated with stroke on regression analysis were prior stroke, diabetes mellitus, and age at starting renal replacement therapy. Atrial fibrillation was not significantly associated with stroke, and warfarin did not affect stroke risk in warfarin-treated patients. Fatality was 18.8% at 7 days, 26.9% at 28 days, and 56.3% at 365 days after stroke. Incidence of stroke is high in patients with ESRD on hemodialysis with high case-fatality. Incident hemodialysis patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving hemodialysis. © 2015 American Heart Association, Inc.

  17. Effect of Right Insular Involvement on Death and Functional Outcome After Acute Ischemic Stroke in the IST-3 Trial (Third International Stroke Trial).

    Science.gov (United States)

    Sposato, Luciano A; Cohen, Geoffrey; Wardlaw, Joanna M; Sandercock, Peter; Lindley, Richard I; Hachinski, Vladimir

    2016-12-01

    In patients with acute ischemic stroke, whether involvement of the insular cortex influences outcome is controversial. Much of the apparent adverse outcome may relate to such strokes usually being severe. We examined the influence of right and left insular involvement on stroke outcomes among patients from the IST-3 study (Third International Stroke Trial) who had visible ischemic stroke on neuroimaging. We used multiple logistic regression to compare outcomes of left versus right insular and noninsular strokes across strata of stroke severity, on death, proportion dead or dependent, and level of disability (ordinalized Oxford Handicap Score) at 6 months, with adjustment for the effects of age, lesion size, and presence of atrial fibrillation. Of 3035 patients recruited, 2099 had visible ischemic strokes limited to a single hemisphere on computed tomography/magnetic resonance scans. Of these, 566 and 714 had infarction of right and left insula. Six months after randomization, right insular involvement was associated with increased odds of death when compared with noninsular strokes on the left side (adjusted odds ratio, 1.83; 95% confidence interval, 1.33-2.52), whereas the adjusted odds ratio comparing mortality after insular versus noninsular strokes on the left side was not significant. Among mild/moderate strokes, outcomes for right insular involvement were worse than for left insular, but among more severe strokes, the difference in outcomes was less substantial. We found an association between right insular involvement and higher odds of death and worse functional outcome. The difference between right- and left-sided insular lesions on outcomes seemed to be most evident for mild/moderate strokes. URL: http://www.isrctn.com. Unique identifier: ISRCTN25765518. © 2016 American Heart Association, Inc.

  18. Sexually Dimorphic Outcomes after Neonatal Stroke and Hypoxia-Ischemia

    Directory of Open Access Journals (Sweden)

    Christiane Charriaut-Marlangue

    2017-12-01

    Full Text Available Cohort studies have demonstrated a higher vulnerability in males towards ischemic and/or hypoxic-ischemic injury in infants born near- or full-term. Male sex was also associated with limited brain repair following neonatal stroke and hypoxia-ischemia, leading to increased incidence of long-term cognitive deficits compared to females with similar brain injury. As a result, the design of pre-clinical experiments considering sex as an important variable was supported and investigated because neuroprotective strategies to reduce brain injury demonstrated sexual dimorphism. While the mechanisms underlining these differences between boys and girls remain unclear, several biological processes are recognized to play a key role in long-term neurodevelopmental outcomes: gonadal hormones across developmental stages, vulnerability to oxidative stress, modulation of cell death, and regulation of microglial activation. This review summarizes the current evidence for sex differences in neonatal hypoxic-ischemic and/or ischemic brain injury, considering the major pathways known to be involved in cognitive and behavioral deficits associated with damages of the developing brain.

  19. Methodology of a population-based stroke and TIA incidence and outcomes study: the Auckland Regional Community Stroke Study (ARCOS IV) 2011-2012.

    Science.gov (United States)

    Krishnamurthi, Rita; Jones, Amy; Barber, P Alan; Barker-Collo, Suzanne; McPherson, Kathryn; Bennett, Derrick; Rush, Elaine; Suh, Flora; Starkey, Nicola; Theadom, Alice; Parag, Varsha; Rathnasabapathy, Yogini; Feigin, Valery L

    2014-01-01

    Stroke is a leading cause of death and disability worldwide. Stroke burden is immense as it leads to premature deaths, leaves survivors with ongoing disabilities, and has a major financial impact on the individual, their families, and the community. Reliable, high-quality evidence is needed on stroke risk factors, incidence, and outcomes to provide information on how best to reduce this burden. Population-based studies are regarded as the 'gold-standard' of measuring disease burden but are not common due to the logistical and financial challenges they present. The Auckland Regional Community Stroke Studies are among a few in the world that have been carried out at a population level and at regular intervals. The aim of the fourth Auckland Regional Community Stroke Studies IV is to examine the current measures of stroke incidence, prevalence, and outcomes as well the trends over four decades. This article describes the methodology of the Auckland Regional Community Stroke Studies IV with stroke and transient ischemic attacks cases registered over a 12-month period from March 1, 2011 to February 29, 2012. The methodology described may be used as a guide in order to design similar population-based stroke incidence and outcome studies in other countries and populations, thus facilitating the collection of most consistent and accurate stroke epidemiological data. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  20. Prognosis and outcome of acute stroke in the University College ...

    African Journals Online (AJOL)

    2011-03-02

    Mar 2, 2011 ... the first 7 days and 19% at 1 month for first-ever stroke, falling drastically to about 9% per annum ... (c) Brain computerized tomographic (CT) scan and/or postmortem examinations results. Stroke sub-types were confirmed by brain CT scan in 55 patients; by postmortem examinations in 4 patients who died ...

  1. Clinical characteristics and outcomes of patients with stroke ...

    African Journals Online (AJOL)

    Background: Epidemiological data on stroke in Zimbabwe are scarce and few clinical studies have been performed to date. Methods: A retrospective review of the medical records of patients admitted for stroke during the year 2012 was performed at three tertiary hospitals. Sociodemographic data were recorded alongside ...

  2. Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: difference in outcomes within 6 months of stroke.

    Science.gov (United States)

    Liu, Ning; Cadilhac, Dominique A; Andrew, Nadine E; Zeng, Lingxia; Li, Zongfang; Li, Jin; Li, Yan; Yu, Xuewen; Mi, Baibing; Li, Zhe; Xu, Honghai; Chen, Yangjing; Wang, Juan; Yao, Wanxia; Li, Kuo; Yan, Feng; Wang, Jue

    2014-12-01

    Mechanisms, acute management, and outcomes for patients who experience intracerebral hemorrhage may differ from patients with ischemic stroke. Studies of very early rehabilitation have been mainly undertaken in patients with ischemic stroke, and it is unknown if benefits apply to those with intracerebral hemorrhage. We hypothesized that early rehabilitation, within 48 hours of stroke, would improve survival and functional outcomes in patients with intracerebral hemorrhage. This was a multicenter, randomized controlled study, with blinded assessment of outcome at 3 and 6 months. Eligible patients were randomized to receive standard care or standard care plus early rehabilitation. Primary outcome includes survival. Secondary outcomes includes health-related quality of life using the 36-item Short Form Questionnaire, function measured with the modified Barthel Index, and anxiety measured with the Zung Self-Rated Anxiety Scale. Two hundred forty-three of 326 patients were randomized (mean age, 59 years; 56% men). At 6 months, patients receiving standard care were more likely to have died (adjusted hazard ratio, 4.44; 95% confidence interval [CI], 1.24-15.87); for morbidity outcomes, a 6-point difference in the Physical Component Summary score of the 36-item Short Form Questionnaire (95% CI, 4.2-8.7), a 7-point difference for the Mental Component Summary score (95% CI, 4.5-9.5), a 13-point difference in Modified Barthel Index scores (95% CI, 6.8-18.3), and a 6-point difference in Self-Rating Anxiety Scale scores (95% CI, 4.4-8.3) was reported in favor of the intervention groups. For the first time, we have shown that commencing rehabilitation within 48 hours of intracerebral hemorrhage improves survival and functional outcomes at 6 months after stroke in hospitalized patients in China. http://www.chictr.org/en. Unique identifier: ChiCTR-TRC-13004039. © 2014 American Heart Association, Inc.

  3. Frequencies of circulating B- and T-lymphocytes as indicators for stroke outcomes

    Directory of Open Access Journals (Sweden)

    Wang Y

    2017-10-01

    Full Text Available Yanling Wang,1 Jihong Liu,1 Xuemei Wang,1 Zongjian Liu,2 Fengwu Li,1 Fenghua Chen,3 Xiaokun Geng,1 Zhili Ji,2 Huishan Du,1 Xiaoming Hu1,3 1Department of Neurology, China-America Institute of Neuroscience, 2Central Laboratory, Beijing Luhe Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Background: Stroke has high mortality and morbidity. Biomarkers are required for to predict stroke outcomes, which could help clinicians to provide rationale approaches for patient management. The dynamic changes in circulating immune cells have been reported in stroke patients and animal models of stroke.Aim: The aim of this study was to explore biomarkers to predict stroke outcomes by investigating the relationship between the frequencies of circulating immune cells and stroke outcomes.Methods: In all, 50 acute ischemic stroke (AIS patients were enrolled. Their blood samples were collected upon hospital admission and on day 1 and day 7 after stroke, and the leukocyte subsets were analyzed by flow cytometry. The dynamic changes in some types of immune cells in the AIS course and their correlation with clinical parameters were analyzed. Blood samples from 123 age- and gender-matched healthy subjects were used as controls.Results: The proportions of T-lymphocytes and NK cells in stroke patients were significantly lower than in healthy controls. The frequencies of B- and T-lymphocytes were negatively correlated with stroke severity at onset, including neurological deficits as assessed by National Institutes of Health Stroke Scale (NIHSS, and infarct volume as measured by the diffusion-weighted images (DWIs of magnetic resonance (MR. Logistic regression analysis showed that modified Rankin scale (mRs scores, a score system for the long-term neurological dysfunctions, were negatively correlated

  4. CORRELATION C-REACTIVE PROTEIN LEVELS WITH CLINICAL OUTCOME INTRACEREBRAL HEMORRHAGE STROKE PATIENTS

    OpenAIRE

    Catur Arisetianto; Hari Purnomo; Eko Arisetijono Marhendraputro; Widodo Mardi Santoso

    2015-01-01

    Background and aims. Intracerebral hemorrhage stroke remains a major health problem and disability. Increased levels of markers of inflammatory factors after hemorrhage stroke was able to predict poor clinical outcome. Until now, the role of C Reactive Protein (CRP) in the local inflammatory response and clinical determinants output remains unclear. Aims to investigate the correlation of CRP level with poor clinical outcome as measured by Barthel Index. Methods and material. This study was...

  5. Development, reliability, and validity of the Alberta Perinatal Stroke Project Parental Outcome Measure.

    Science.gov (United States)

    Bemister, Taryn B; Brooks, Brian L; Kirton, Adam

    2014-07-01

    Perinatal stroke is a leading cause of cerebral palsy and lifelong disability, although parent and family outcomes have not yet been studied in this specific population. The Alberta Perinatal Stroke Project Parental Outcome Measure was developed as a 26-item questionnaire on the impact of perinatal stroke on parents and families. The items were derived from expert opinion and scientific literature on issues salient to parents of children with perinatal stroke, including guilt and blame, which are not well captured in existing measures of family impact. Data were collected from 82 mothers and 28 fathers who completed the Parental Outcome Measure and related questionnaires (mean age, 39.5 years; mean child age, 7.4 years). Analyses examined the Parental Outcome Measure's internal consistency, test-retest reliability, validity, and factor structure. The Parental Outcome Measure demonstrated three unique theoretical constructs: Psychosocial Impact, Guilt, and Blame. The Parental Outcome Measure has excellent internal consistency (Cronbach α = 0.91) and very good test-retest reliability more than 2-5 weeks (r = 0.87). Regarding validity, the Parental Outcome Measure is sensitive to condition severity, accounts for additional variance in parent outcomes, and strongly correlates with measures of anxiety, depression, stress, quality of life, family functioning, and parent adjustment. The Parental Outcome Measure contributes to the literature as the first brief measure of family impact designed for parents of children with perinatal stroke. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Statins and clinical outcome of acute ischemic stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Lakhan Shaheen E

    2010-09-01

    Full Text Available Abstract Background Statin therapy is considered an effective measure for the prevention of ischemic stroke. Several recent studies have indicated that treatment with statins, prior to the onset of acute ischemic stroke, may also substantially reduce the severity of stroke and the degree of patient disability. The purpose of the present review is to systematically evaluate the effectiveness of statin pretreatment on functional outcome of acute ischemic stroke and to assess potential adverse events associated with statin use. Methods Relevant articles on the role of statins in acute ischemic stroke were identified via MEDLINE/PubMed, EMBASE, CENTRAL, and by manual searches of the references of identified papers. Clinical studies (most were prospective cohort studies assessing statin therapy for acute ischemic stroke were selected for the review. Only two randomized controlled clinical trials met the criteria to be included in the analysis. Clinical outcome was assessed based on the degree of disability determined with the modified Rankin Scale (mRS and Barthel index (BI. The National Institutes of Health Stroke Scale (NIHSS was used to measure stroke severity. Recurrence of stroke in patients who had suffered from a previous stroke was analyzed with and without statin therapy. Incidence and severity of adverse reactions was reviewed. Because there were too many differences in study outcome measures, a quantitative analysis of data was deemed inappropriate. A qualitative summary of the data was consequently completed. Results Thirteen reports were systematically reviewed to evaluate the efficacy and safety of statins in the pretreatment of acute ischemic stroke. Pretreatment with statins was found to reduce the recurrence of stroke and to result in more favorable outcomes for patients. The beneficial effects of prior statin therapy in acute ischemic stroke were shown to be especially profound in whites, diabetics, elderly patients with

  7. Quality-of-life outcomes among Alzheimer's disease family caregivers following community-based intervention.

    Science.gov (United States)

    Bartfay, Emma; Bartfay, Wally J

    2013-01-01

    This study sought to determine how community-based interventions such as adult day programs and caregiver support groups affected the quality of life (QOL) of caregivers of Alzheimer's disease clients. The authors hypothesized that using community-based interventions would increase the QOL of caregivers of Alzheimer's disease clients. They conducted a pilot study employing a cross-sectional comparative design involving 62 caregivers in the Durham region, Ontario, Canada. Individuals were recruited at five adult day programs and at six caregiver support groups, involving primary data collection consisting of a self-report questionnaire and a 13-item QOL scale. The authors' findings show that caregivers of Alzheimer's disease clients who used community-based interventions enjoyed similar levels of QOL as caregivers of non-Alzheimer's disease clients. These findings suggest that community-based interventions may be beneficial and should target the multiple needs of caregivers, including their knowledge of community resources and coping strategies.

  8. Comparison of Medicare claims versus physician adjudication for identifying stroke outcomes in the Women's Health Initiative.

    Science.gov (United States)

    Lakshminarayan, Kamakshi; Larson, Joseph C; Virnig, Beth; Fuller, Candace; Allen, Norrina Bai; Limacher, Marian; Winkelmayer, Wolfgang C; Safford, Monika M; Burwen, Dale R

    2014-03-01

    Many studies use medical record review for ascertaining outcomes. One large, longitudinal study, the Women's Health Initiative (WHI), ascertains strokes using participant self-report and subsequent physician review of medical records. This is resource-intensive. Herein, we assess whether Medicare data can reliably assess stroke events in the WHI. Subjects were WHI participants with fee-for-service Medicare. Four stroke definitions were created for Medicare data using discharge diagnoses in hospitalization claims: definition 1, stroke codes in any position; definition 2, primary position stroke codes; and definitions 3 and 4, hemorrhagic and ischemic stroke codes, respectively. WHI data were randomly split into training (50%) and test sets. A concordance matrix was used to examine the agreement between WHI and Medicare stroke diagnosis. A WHI stroke and a Medicare stroke were considered a match if they occurred within ±7 days of each other. Refined analyses excluded Medicare events when medical records were unavailable for comparison. Training data consisted of 24 428 randomly selected participants. There were 577 WHI strokes and 557 Medicare strokes using definition 1. Of these, 478 were a match. With regard to algorithm performance, specificity was 99.7%, negative predictive value was 99.7%, sensitivity was 82.8%, positive predictive value was 85.8%, and κ=0.84. Performance was similar for test data. Whereas specificity and negative predictive value exceeded 99%, sensitivity ranged from 75% to 88% and positive predictive value ranged from 80% to 90% across stroke definitions. Medicare data seem useful for population-based stroke research; however, performance characteristics depend on the definition selected.

  9. Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team.

    Science.gov (United States)

    Ryan, Tony; Harrison, Madeleine; Gardiner, Clare; Jones, Amanda

    2017-10-01

    To explore the organized stroke unit experience from the multiple perspectives of stroke survivor, family carer and the multi-disciplinary team. Organized stroke unit care reduces morbidity, mortality and institutionalization and is promoted globally as the most effective form of acute and postacute provision. Little research has focused on how care is experienced in this setting from the perspectives of those who receive and provide care. This study used a qualitative approach, employing Framework Analysis. This methodology allows for a flexible approach to data collection and a comprehensive and systematic method of analysis. Semi-structured interviews were undertaken during 2011 and 2012 with former stroke unit stroke survivors, family carers and senior stroke physicians. In addition, eight focus groups were conducted with members of the multi-disciplinary team. One hundred and twenty-five participants were recruited. Three key themes were identified across all data sets. First, two important processes are described: responses to the impact of stroke and seeking information and stroke-specific knowledge. These are underpinned by a third theme: the challenge in building relationships in organized stroke unit care. Stroke unit care provides satisfaction for stroke survivors, particularly in relation to highly specialized medical and nursing care and therapy. It is proposed that moves towards organized stroke unit care, particularly with the emphasis on reduction of length of stay and a focus on hyper-acute models, have implications for interpersonal care practices and the sharing of stroke-specific knowledge. © 2017 John Wiley & Sons Ltd.

  10. Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes.

    Science.gov (United States)

    Wu, Ona; Cloonan, Lisa; Mocking, Steven J T; Bouts, Mark J R J; Copen, William A; Cougo-Pinto, Pedro T; Fitzpatrick, Kaitlin; Kanakis, Allison; Schaefer, Pamela W; Rosand, Jonathan; Furie, Karen L; Rost, Natalia S

    2015-09-01

    Acute infarct volume, often proposed as a biomarker for evaluating novel interventions for acute ischemic stroke, correlates only moderately with traditional clinical end points, such as the modified Rankin Scale. We hypothesized that the topography of acute stroke lesions on diffusion-weighted magnetic resonance imaging may provide further information with regard to presenting stroke severity and long-term functional outcomes. Data from a prospective stroke repository were limited to acute ischemic stroke subjects with magnetic resonance imaging completed within 48 hours from last known well, admission NIH Stroke Scale (NIHSS), and 3-to-6 months modified Rankin Scale scores. Using voxel-based lesion symptom mapping techniques, including age, sex, and diffusion-weighted magnetic resonance imaging lesion volume as covariates, statistical maps were calculated to determine the significance of lesion location for clinical outcome and admission stroke severity. Four hundred ninety subjects were analyzed. Acute stroke lesions in the left hemisphere were associated with more severe NIHSS at admission and poor modified Rankin Scale at 3 to 6 months. Specifically, injury to white matter (corona radiata, internal and external capsules, superior longitudinal fasciculus, and uncinate fasciculus), postcentral gyrus, putamen, and operculum were implicated in poor modified Rankin Scale. More severe NIHSS involved these regions, as well as the amygdala, caudate, pallidum, inferior frontal gyrus, insula, and precentral gyrus. Acute lesion topography provides important insights into anatomic correlates of admission stroke severity and poststroke outcomes. Future models that account for infarct location in addition to diffusion-weighted magnetic resonance imaging volume may improve stroke outcome prediction and identify patients likely to benefit from aggressive acute intervention and personalized rehabilitation strategies. © 2015 American Heart Association, Inc.

  11. Early ficolin-1 is a sensitive prognostic marker for functional outcome in ischemic stroke

    DEFF Research Database (Denmark)

    Zangari, Rosalia; Zanier, Elisa R; Torgano, G

    2016-01-01

    : Plasma levels of the LP initiators ficolin-1, -2, and -3 and mannose-binding lectin (MBL) were measured in 80 stroke patients at 6 h only and in 85 patients at 48 h and later. Sixty-one age- and sex-matched healthy individuals served as controls. Stroke severity was measured on admission using...... the discriminating ability of an outcome model including NIHSS and age (area under the curve (AUC) 0.95, CI 95 % 0.90-0.99, p = 0.0001). CONCLUSIONS: The ficolins are consumed within 6 h after stroke implicating activation of the LP. Early ficolin-1 is selectively related to 3-month unfavorable outcome....

  12. Trans-sodium crocetinate improves outcomes in rodent models of occlusive and hemorrhagic stroke.

    Science.gov (United States)

    Wang, Yi; Yoshimura, Ryo; Manabe, Hiroaki; Schretter, Catherine; Clarke, Ryon; Cai, Yu; Fitzgerald, Mark; Lee, Kevin S

    2014-10-02

    Trans-sodium crocetinate (TSC) is a novel carotenoid compound capable of enhancing the diffusion of small molecules in aqueous solutions. TSC improves the diffusion of oxygen and glucose, and increases oxygenation in ischemic brain tissue. TSC also dampens the intensity of an ischemic challenge during an ongoing ischemic event. The current study examined the impact of TSC in rat models of ischemic and hemorrhagic stroke. Rat three vessel occlusion (3VO), and combined 3VO and one vessel occlusion (3VO/1VO) models of ischemic stroke were evaluated for structural and behavioral outcomes. The effects of TSC were also tested in a rat model of intracerebral hemorrhage (ICH). Delayed treatment with TSC reduced infarct volume in a rodent model of transient focal ischemia involving either 2 or 6h of ischemia. Neurological outcomes, based on a multi-scale assessment and automated gait analysis, also were improved by TSC treatment. Additionally, TSC reduced edema and hemorrhagic volume in a rat model of ICH. An optimal therapeutic candidate for early intervention in ischemic stroke should be effective when administered on a delayed basis and should not aggravate outcomes associated with hemorrhagic stroke. The current findings demonstrate that delayed TSC treatment improves outcomes in experimental models of both ischemic and hemorrhagic stroke. Together, these findings suggest that TSC may be a safe and beneficial therapeutic modality for early stroke intervention, irrespective of the type of stroke involved. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Relationships between brain and body temperature, clinical and imaging outcomes after ischemic stroke

    Science.gov (United States)

    Karaszewski, Bartosz; Carpenter, Trevor K; Thomas, Ralph G R; Armitage, Paul A; Lymer, Georgina Katherine S; Marshall, Ian; Dennis, Martin S; Wardlaw, Joanna M

    2013-01-01

    Pyrexia soon after stroke is associated with severe stroke and poor functional outcome. Few studies have assessed brain temperature after stroke in patients, so little is known of its associations with body temperature, stroke severity, or outcome. We measured temperatures in ischemic and normal-appearing brain using 1H-magnetic resonance spectroscopy and its correlations with body (tympanic) temperature measured four-hourly, infarct growth by 5 days, early neurologic (National Institute of Health Stroke Scale, NIHSS) and late functional outcome (death or dependency). Among 40 patients (mean age 73 years, median NIHSS 7, imaged at median 17 hours), temperature in ischemic brain was higher than in normal-appearing brain on admission (38.6°C-core, 37.9°C-contralateral hemisphere, P=0.03) but both were equally elevated by 5 days; both were higher than tympanic temperature. Ischemic lesion temperature was not associated with NIHSS or 3-month functional outcome; in contrast, higher contralateral normal-appearing brain temperature was associated with worse NIHSS, infarct expansion and poor functional outcome, similar to associations for tympanic temperature. We conclude that brain temperature is higher than body temperature; that elevated temperature in ischemic brain reflects a local tissue response to ischemia, whereas pyrexia reflects the systemic response to stroke, occurs later, and is associated with adverse outcomes. PMID:23571281

  14. Mediators and Moderators of Dementia Caregiver Depression and CVD Risk Outcomes in the Pleasant Events Program

    OpenAIRE

    Ho, Jennefer S.

    2016-01-01

    Rationale: Alzheimer’s disease caregivers demonstrate significant elevations in depression compared with noncaregivers. Addressing caregiver depression is of high public health importance due to its ties with overall wellbeing, increased risk for cardiovascular diseases (CVD), and ability to sustain caregiving duties. Improving caregiver mental and physical health may not only decrease healthcare costs, but it may also delay institutionalization of Alzheimer’s disease patients. Despite existi...

  15. Predictors and Outcomes of Health Related Quality of Life in Caregivers of Cardiothoracic Transplant Recipients

    OpenAIRE

    Myaskovsky, Larissa; Posluszny, Donna M.; Schulz, Richard; DiMartini, Andrea F.; Switzer, Galen E.; Dabbs, Annette DeVito; McNulty, Mary L.; Kormos, Robert L.; Toyoda, Yoshiya; Dew, Mary Amanda

    2012-01-01

    Cardiothoracic transplant programs generally require that transplant recipients have family caregivers to assist them post-transplant. The burden of caregiving on the family members remains poorly understood. If caregivers’ well-being is compromised by caregiving, it may bode poorly for transplant recipients’ own health in the long-term post-transplant. We examined caregiver HRQOL during the first year after their family member’s transplant, its predictors, and its relationship to subsequent ...

  16. Stroke quality metrics: systematic reviews of the relationships to patient-centered outcomes and impact of public reporting.

    Science.gov (United States)

    Parker, Carol; Schwamm, Lee H; Fonarow, Gregg C; Smith, Eric E; Reeves, Mathew J

    2012-01-01

    Stroke quality metrics play an increasingly important role in quality improvement and policies related to provider reimbursement, accreditation, and public reporting. We conducted 2 systematic reviews examining the relationships between compliance with stroke quality metrics and patient-centered outcomes, and public reporting of stroke metrics and quality improvement, quality of care, or outcomes. MEDLINE and EMBASE databases were searched to identify studies that evaluated the relationship between stroke quality metric compliance and patient-centered outcomes in acute hospital settings and public reporting of stroke quality metrics and quality improvement activities, quality of care, or patient outcomes. We specifically excluded studies that evaluated the effect of stroke units or hospital certification. Fourteen studies met eligibility criteria for the review of stroke quality metric compliance and patient-centered outcomes; 9 found mostly positive associations, whereas 5 found no or very limited associations. Only 2 eligible studies were found that directly addressed the public reporting of stroke quality metrics. Some studies have found positive associations between stroke metric compliance and improved patient-centered outcomes. However, high-quality studies are lacking and several methodological difficulties make the interpretation of the reported associations challenging. Information on the impact of public reporting of stroke quality metric data is extremely limited. Legitimate questions remain as to whether public reporting of stroke metrics is accurate, effective, or has the potential for unintended consequences. The generation of high-quality data examining quality metrics and stroke outcomes as well as the impact of public reporting should be given priority.

  17. Pharmacotherapy prior to and in acute ischaemic stroke. The use of pharmacotherapy and drug-associated outcomes in real world practice - findings from the Polish Hospital Stroke Registry.

    Science.gov (United States)

    Niewada, Maciej; Sarzyńska-Długosz, Iwona Marta; Skowrońska, Marta; Kamiński, Bogumił; Kobayashi, Adam; Członkowska, Anna

    2013-01-01

    Stroke is a preventable disease and acute ischaemic stroke can be effectively treated. Specific pharmacotherapy is recommended in either prevention or acute ischemic stroke treatment. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute ischaemic stroke in a real world practice. Ischaemic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, web-based questionnaire with authorized access. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute ischaemic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival. A total number of 26 153 ischaemic stroke patients (mean age: 71.8 years; females: 51.6%) was reported. The ana-lysis of pharmacotherapy showed that preventive use of hypo-tensive agents, anticoagulants in atrial fibrillation, antiplatelets and statins is inadequate. Regression models confirmed some expected drug benefits and additionally revealed that antihypertensive drugs or aspirin used prior to stroke and oral anticoagulants or statins used in hospital were associated with better stroke outcome. The prevention of ischaemic stroke needs to be monitored and improved. Evidence-based treatment of acute ischaemic stroke requires further promotion. The benefits of acute ischaemic stroke treatment with statins require to be confirmed in randomized controlled settings.

  18. A family involvement and patient-tailored health management program in elderly Korean stroke patients' day care centers.

    Science.gov (United States)

    Chang, Ae Kyung; Park, Yeon-Hwan; Fritschi, Cynthia; Kim, Mi Ja

    2015-01-01

    This study aimed to examine the effects of a family involvement and functional rehabilitation program in an adult day care center on elderly Korean stroke patients' perceived health, activities of daily living, instrumental activities of daily living, and cost of health services, and on family caregivers' satisfaction. Using one-group pre- and posttest design, dyads consisting of 19 elderly stroke patients and family caregivers participated in 12-week intervention, including involvement of family caregivers in day care services and patient-tailored health management. Outcomes of patients and caregivers were significantly improved (all p health services did not decrease significantly. This program improved functional levels and health perception of elderly stroke patients and caregivers' satisfaction. However, results must be interpreted with caution, because this was only a small, single-group pilot study. This program may be effective for elderly stroke patients and their caregivers. © 2013 Association of Rehabilitation Nurses.

  19. Trends in vascular risk factors, stroke performance measures, and outcomes in patients with first-ever ischemic stroke in Taiwan between 2000 and 2012.

    Science.gov (United States)

    Hsieh, Cheng-Yang; Wu, Darren Philbert; Sung, Sheng-Feng

    2017-07-15

    With the aging of the population in Taiwan, the financial burden of stroke on the healthcare system is expected to rise. We aimed to investigate the trends in vascular risk factors, adherence to stroke performance measures, and stroke outcomes based on a nationwide representative sample. Adult patients hospitalized for first-ever ischemic stroke between 2000 and 2012 were identified from a nationwide administrative database. The study period was divided into 1-year intervals. The Cuzick test and the Cochran-Armitage test were used to determine the significance of changes over time. Trends in stroke outcomes as a function of year were assessed using logistic regression, controlling for age, sex, comorbidity, and stroke severity. A total of 11,462 patients (mean age 67.3years, female 40.9%) were hospitalized. Between 2000 and 2012, the prevalence of hypertension, diabetes mellitus, hyperlipidemia, and atrial fibrillation increased while the prevalence of coronary artery disease decreased. The proportion of patients taking antihypertensive or antidiabetic medication prior to stroke decreased, whereas the proportion of patients taking lipid lowering medication increased. Adherence to the five selected performance measures significantly improved. A significant decreasing trend in the proportion of recurrent stroke or all-cause death within one year was observed regardless of whether adjustment for age, sex, comorbidity, and stroke severity was made. Despite the rising prevalence of vascular risk factors, improved adherence to stroke performance measures was accompanied by better stroke outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke.

    Science.gov (United States)

    Bouslama, Mehdi; Haussen, Diogo C; Aghaebrahim, Amin; Grossberg, Jonathan A; Walker, Gregory; Rangaraju, Srikant; Horev, Anat; Frankel, Michael R; Nogueira, Raul G; Jovin, Tudor G; Jadhav, Ashutosh P

    2017-12-01

    Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P =0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy. © 2017 American Heart Association, Inc.

  1. Measuring negative and positive caregiving experiences: A psychometric analysis of the Caregiver Strain Index Expanded

    NARCIS (Netherlands)

    Kruithof, WJ; Post, MWM; Meily, JMA

    2015-01-01

    Objective: To compare the psychometric properties of the Caregiver Strain Index Expanded with those of the original Caregiver Strain Index among partners of stroke patients. Design and subjects: Cross-sectional validation study among 173 caregivers of stroke patients six months post-stroke. Main

  2. Commentary: Addressing Racial Disparities in Stroke: The Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels (WISSDOM).

    Science.gov (United States)

    Adams, Robert J; Ellis, Charles; Magwood, Gayenell; Kindy, Mark S; Bonilha, Leonardo; Lackland, Daniel T

    2018-01-01

    Racial-ethnic disparities in stroke recovery are well-established in the United States but the underlying causes are not well-understood. The typical assumption that racial-ethnic disparities in stroke recovery are explained by health care access inequities may be simplistic as access to stroke-related rehabilitation, for example, does not adequately explain the observed disparities. To approach the problem in a more comprehensive fashion, the Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels (WISSDOM) was developed to bring together scientists from Regenerative Medicine, Neurology, Rehabilitation, and Nursing to examine disparities in stroke "recovery." As a result, three related projects (basic science, clinical science and population science) were designed utilizing animal modeling, mapping of brain connections, and community-based interventions. In this article we describe: 1) the goals and objectives of the individual projects; and 2) how these projects could provide critical evidence to explain why racial-ethnic minorities traditionally experience recovery trajectories that are worse than Whites.

  3. Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study.

    Science.gov (United States)

    Hayden, Derek T; Hannon, Niamh; Callaly, Elizabeth; Ní Chróinín, Danielle; Horgan, Gillian; Kyne, Lorraine; Duggan, Joseph; Dolan, Eamon; O'Rourke, Killian; Williams, David; Murphy, Sean; Kelly, Peter J

    2015-12-01

    Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors. We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan-Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke. Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5-46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA2DS2-VASc) score (hazard ratio [HR], 1.34; PStroke Scale (HR, 1.09; Pstroke onset (HR, 3.29; P=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40; P=0.001) and statin use after index stroke (HR, 0.52; P=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5-31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09; P=0.07) and CHA2DS2-VASc score (HR, 1.34; P=0.07). Nursing home care was needed for 25.9% of patients. AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed. © 2015 American Heart Association, Inc.

  4. Caregiving Statistics

    Science.gov (United States)

    ... Coping with Alzheimer’s COPD Caregiving Take Care! Caregiver Statistics Statistics on Family Caregivers and Family Caregiving Caregiving Population ... Health Care Caregiver Self-Awareness State by State Statistics Caregiving Population The value of the services family ...

  5. The feasibility of using electronic clinical outcome assessments in people with schizophrenia and their informal caregivers

    Directory of Open Access Journals (Sweden)

    Tolley C

    2015-03-01

    Full Text Available Chloe Tolley,1 Diana Rofail,2 Adam Gater,1 Justine K Lalonde31Adelphi Values Ltd, Bollington, UK; 2Roche Products Ltd, Welwyn Garden City, UK; 3Roche S.A.S, Paris, France Abstract: Many clinical outcome assessments (COAs were originally developed for completion via pen and paper. However, in recent years there have been movements toward electronic capture of such data in an effort to reduce missing data, provide time-stamped records, minimize administrative burden, and avoid secondary data entry errors. Although established in many patient populations, the implications of using electronic COAs in schizophrenia are unknown. In accordance with International Society for Pharmacoeconomics and Outcomes Research (ISPOR Task Force recommendations, in-depth cognitive debriefing and usability interviews were conducted with people with schizophrenia (n=12, their informal (unpaid caregivers (n=12, and research support staff (n=6 to assess the suitability of administration of various electronic COA measures using an electronic tablet device. Minimal issues were encountered by participants when completing or administering the COAs in electronic format, with many finding it easier to complete instruments in this mode than by pen and paper. The majority of issues reported were specific to the device functionality rather than the electronic mode of administration. Findings support data collection via electronic tablet in people with schizophrenia and their caregivers. The appropriateness of other forms of electronic data capture (eg, smartphones, interactive voice response systems, etc is a topic for future investigation. Keywords: ePRO, eCOA, mode of administration, electronic data capture, usability 

  6. Factors influencing outcome in acute ischaemic stroke : outcome scales, the role of blood glucose and rtPA treatment

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten

    2008-01-01

    This thesis describes several aspects that influence outcome in acute ischaemic strok. In the first part, two frequently used outcome scales - the Barthel index and modified Rankin scale - are studied and for both scales, optimal endpoints for stroke trials are proposed. In the second part, the

  7. Pre-stroke use of statins on stroke outcome : a meta-analysis of observational studies

    NARCIS (Netherlands)

    Cordenier, Ann; De Smedt, Ann; Brouns, Raf; Uyttenboogaart, Maarten; De Raedt, Sylvie; Luijckx, Gert-Jan; De Keyser, Jacques

    2011-01-01

    Background: Animal pre-clinical studies suggest that statins may have neuroprotective effects in acute ischaemic stroke. Statins might also increase the risk of developing haemorrhagic transformation after thrombolytic treatment. Methods: We performed a systematic review and included studies that

  8. Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke.

    Science.gov (United States)

    Senda, Joe; Ito, Keiichi; Kotake, Tomomitsu; Kanamori, Masahiko; Kishimoto, Hideo; Kadono, Izumi; Suzuki, Yoshiro; Katsuno, Masahisa; Nishida, Yoshihiro; Ishiguro, Naoki; Sobue, Gen

    2016-01-01

    We investigated the factors influencing inpatient convalescent rehabilitation outcomes in patients with ischemic stroke, particularly severity of leukoaraiosis on magnetic resonance imaging. Participants included 520 patients with ischemic stroke (317 men and 203 women; mean age, 72.8±8.4 years) who were transferred from acute care hospitals for inpatient convalescent rehabilitation. Ischemic stroke subtypes included lacunar infarction (n=41), atherothrombosis (n=223), artery-to-artery embolism (n=67), cardiogenic embolism (n=97), undetermined embolism (n=76), and uncategorized ischemic stroke (n=16). Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on magnetic resonance imaging. Functional Independence Measure scores were assessed on admission and at discharge. Multiple regression analysis revealed that rehabilitation outcomes, measured as total Functional Independence Measure scores, were significantly associated with leukoaraiosis estimated by PVH grade. This association was observed after adjustment for factors such as severity, age, and poststroke history. In all patients, PVH grades were associated with Functional Independence Measure motor scores (Prehabilitation outcome in patients with ischemic stroke. Furthermore, the PVH grade was associated with motor function outcome, whereas the deep white matter hyperintensity grade correlated with cognitive function outcome, likely because the progression patterns and anatomic backgrounds of PVH and deep white matter hyperintensity differ according to ischemic stroke subtype. © 2015 American Heart Association, Inc.

  9. Interventions for Caregivers of Patients with Alzheimer's Disease: A Review and Analysis of Content, Process, and Outcomes.

    Science.gov (United States)

    Bourgeois, Michelle S.; And Others

    1996-01-01

    Examines the content and process of Alzheimer's disease caregiver interventions. Describes the types of interventions currently in use and factors affecting intervention outcomes. Concludes with specific recommendations for the application of intervention technology and for the documentation of intervention research. (KW)

  10. Toll-like receptors 2 and 4 in ischemic stroke: outcome and therapeutic values.

    Science.gov (United States)

    Brea, David; Blanco, Miguel; Ramos-Cabrer, Pedro; Moldes, Octavio; Arias, Susana; Pérez-Mato, María; Leira, Rogelio; Sobrino, Tomás; Castillo, José

    2011-06-01

    Stroke triggers an intense inflammatory response that could be a consequence of Toll-like receptors (TLRs) activation. However, the clinical significance and the therapeutic possibilities of TLR in stroke is not completely clear. In this study, we analyze the association between the expression of TLR2 and TLR4, inflammatory molecules and endogenous ligands, and clinical outcome of ischemic stroke patients, and we test the potential of TLR2/TLR4 and their endogenous ligands as therapeutic targets. For this purpose, we included 110 patients with ischemic stroke finding that TLR2 and TLR4 are independently associated to poor outcome and correlated with higher serum levels of interleukin (IL)1β, IL6, tumor necrosis factor α, and VCAM1, and that TLR4 was independently associated to lesion volume. In addition, we have developed an in vitro model to test the potential therapeutic value of blocking TLR2/TLR4 or their endogenous ligands. Cultured cells (monocytes and human umbilical vein endothelial cells) were treated with serum from ischemic stroke patients, showing a strong inflammatory response that was blocked when TLR2/4 or cellular fibronectin (cFN) or HSP60 were blocked. In conclusion, TLR2 and TLR4 are associated to outcome in stroke patients and TLR2/4 or their endogenous ligands, cFN/HSP60 could be new therapeutic targets for ischemic stroke.

  11. Dehydration is an independent predictor of discharge outcome and admission cost in acute ischaemic stroke.

    Science.gov (United States)

    Liu, C-H; Lin, S-C; Lin, J-R; Yang, J-T; Chang, Y-J; Chang, C-H; Chang, T-Y; Huang, K-L; Ryu, S-J; Lee, T-H

    2014-09-01

    Our aim was to investigate the influence of admission dehydration on the discharge outcome in acute ischaemic and hemorrhagic stroke. Between January 2009 and December 2011, 4311 ischaemic and 1371 hemorrhagic stroke patients from the stroke registry of Chang Gung healthcare system were analyzed. The eligible patients were identified according to inclusion/exclusion criteria. In total, 2570 acute ischaemic and 573 acute hemorrhagic stroke patients were finally recruited. According to the blood urea nitrogen (BUN) to creatinine (Cr) ratio (BUN/Cr), these patients were divided into dehydrated (BUN/Cr ≥ 15) and non-dehydrated (BUN/Cr dehydration had higher infection rates (P = 0.006), worse discharge BI (62.8 ± 37.4 vs. 73.4 ± 32.4, P dehydration. However, acute hemorrhagic stroke with or without admission dehydration showd no difference in admission costs (P = 0.618) and discharge outcomes (BI, P = 0.058; mRS, P = 0.058). Admission dehydration is associated with worse discharge outcomes and higher admission costs in acute ischaemic stroke but not in hemorrhagic stroke. © 2014 The Author(s) European Journal of Neurology © 2014 EAN.

  12. Study of association of severity of sleep disordered breathing and functional outcome in stroke patients.

    Science.gov (United States)

    Kumar, Rohit; Suri, J C; Manocha, Rajesh

    2017-06-01

    Sleep disordered breathing (SDB) is a prevalent yet underrecognized condition that may have major adverse consequences for those affected by it. We performed a prospective observational study to seek a correlation of severity of SDB with the severity of stroke and its functional outcome. Patients with history of recent-onset stroke were recruited and underwent overnight polysomnography (PSG) after the acute phase of the stroke was over; for defining hypopneas, 3% and 4% desaturation limits were used, and the apnea-hypopnea index was respectively calculated as AHI 3% and AHI 4% . Stroke severity was graded using the Scandinavian Stroke Scale. Functional disability and neurological impairment was evaluated six weeks after the PSG using the Barthel Index (2 = poor outcome; ≤2 = good outcome). A total of 50 patients were enrolled, 30 (60%) with ischemic stroke and 20 (40%) with hemorrhagic strokes. Of the patients, 39 (78%) had an AHI 4% of >5/h, 23 (46%) had an AHI 4% of >15/h, and 9 (18%) had an AHI 4% of >30/h. Multivariate analysis showed that body mass index (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.04-1.54, p = 0.019) and Scandinavian Stroke Scale score (stroke severity) (OR = 0.86; 95% CI = 0.76-0.96, p = 0.009) were significant risk factors for predicting SDB (AHI 4%  > 15) in patients of stroke. When we looked for factors predicting outcomes, only AHI 4% (OR = 1.20; 95% CI 1.01-1.43, p value 0.041) was predictive of the functional dependence (based on Barthel Index) of the patient and AHI 4% (OR = 1.14; 95% CI 1.03-1.25, p = 0.008) and body mass index (OR = 0.75; 95% CI 0.59-0.96, p = 0.024) were found to be predictive of poor outcome (based on modified Rankins Scale). We obtained similar results, regardless of the hypopnea definition used. In conclusion, given the high frequency of SDB in stroke patients and its correlation with poor outcome, screening for obstructive sleep apnea in all stroke and transient

  13. An outcomes approach to stroke care: the importance of teamwork and evidence-based nursing care.

    Science.gov (United States)

    Middleton, Sandy

    2012-04-01

    The Quality in Acute Stroke Care (QASC) was a cluster randomised control trial (CRCT) which evaluated the effectiveness of evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing, in conjunction with multidisciplinary team building workshops, and a standardised interactive staff education program (collectively known as the Fever, Sugar, Swallowing (FeSS) intervention) to improve patient outcomes 90-days. We found that patients cared for in stroke units who received our intervention were 15·7% more likely to be alive and independent 90 days following their stroke. They also had significantly: fewer episodes of fever, lower mean temperatures, lower mean blood glucose levels, and better screening for swallowing difficulties. © 2012 The Author. International Journal of Stroke © 2012 World Stroke Organization.

  14. Impact of caring for persons with Alzheimer's disease or dementia on caregivers' health outcomes: findings from a community based survey in Japan.

    Science.gov (United States)

    Goren, Amir; Montgomery, William; Kahle-Wrobleski, Kristin; Nakamura, Tomomi; Ueda, Kaname

    2016-06-10

    This study assessed how family caregivers for patients with Alzheimer's disease (AD) or dementia in Japan differed from non-caregivers in characteristics and health outcomes (i.e., comorbidities, health-related quality of life [HRQoL], productivity, and resource use). Caregivers were hypothesized to experience significantly poorer outcomes than non-caregivers. Data were combined from the 2012 and 2013 National Health and Wellness Survey in Japan (n = 60000). Caregivers for adult relatives with AD or dementia were compared with non-caregivers on: comorbidities (including Patient Health Questionnaire (PHQ-9) cutoff scores suggesting presence/absence of major depressive disorder (MDD)), Work Productivity and Activity Impairment (WPAI), SF-36v2-based HRQoL, and healthcare resource utilization. Sociodemographic characteristics, health characteristics and behaviors, and Charlson comorbidity index (CCI) scores were compared across groups. Propensity matching, based on scores generated from a logistic regression predicting caregiving, was used to match caregivers with non-caregivers with similar likelihood of being caregivers. Bivariate comparisons across matched groups served to estimate outcomes differences due to caregiving. Among 55060 respondents, compared with non-caregivers (n = 53758), caregivers (n = 1302) were older (52.6 vs. 47.5 years), more frequently female (53 % vs. 49 %), married/partnered, frequent alcohol drinkers, current smokers, exercisers, and not employed, and they averaged higher CCI scores (0.37 vs. 0.14), all p children in household. A greedy matching algorithm produced 1297 exact matches, excluding 5 non-matched caregivers. Health utilities scores were significantly lower among caregivers (0.724) vs. non-caregivers (0.764), as were SF-36v2 Physical and Mental Component Summary scores. Caregivers vs. non-caregivers had significantly higher absenteeism, presenteeism-related impairment, overall work impairment (25.8 % vs. 20.4

  15. Sulfonylureas Improve Outcome in Patients With Type 2 Diabetes and Acute Ischemic Stroke

    Science.gov (United States)

    Kunte, Hagen; Schmidt, Sein; Eliasziw, Michael; del Zoppo, Gregory J.; Simard, J. Marc; Masuhr, Florian; Weih, Markus; Dirnagl, Ulrich

    2009-01-01

    Background and Purpose The sulfonylurea receptor 1-regulated NCCa-ATP channel is upregulated in rodent models of stroke with block of the channel by the sulfonylurea, glibenclamide (glyburide), significantly reducing mortality, cerebral edema, and infarct volume. We hypothesized that patients with type 2 diabetes mellitus taking sulfonylurea agents both at the time of stroke and during hospitalization would have superior outcomes. Methods We reviewed medical records of patients with diabetes mellitus hospitalized within 24 hours of onset of acute ischemic stroke in the Neurology Clinic, Charité Hospital, Berlin, Germany, during 1994 to 2000. After exclusions, the cohort comprised 33 patients taking a sulfonylurea at admission through discharge (treatment group) and 28 patients not on a sulfonylurea (control group). The primary outcome was a decrease in National Institutes of Health Stroke Scale of 4 points or more from admission to discharge or a discharge National Institutes of Health Stroke Scale score of 0. The secondary outcome was a discharge modified Rankin Scale score ≤2. Results No significant differences, other than stroke subtype, were observed among baseline variables between control and treatment groups. The primary outcome was reached by 36.4% of patients in the treatment group and 7.1% in the control group (P=0.007). The secondary outcome was reached by 81.8% versus 57.1% (P=0.035). Subgroup analyses showed that improvements occurred only in patients with nonlacunar strokes and were independent of gender, previous transient ischemic attack, and blood glucose levels. Conclusion Sulfonylureas may be beneficial for patients with diabetes mellitus with acute ischemic stroke. Further investigation of similar cohorts and a prospective randomized trial are recommended to confirm the present observations. PMID:17673715

  16. The role of clinical pathway on the outcomes of ischemic stroke patients at Bethesda Hospital Yogyakarta

    Directory of Open Access Journals (Sweden)

    Francisca Diana Alexandra, Iwan Dwiprahasto, Rizaldy Pinzon

    2014-04-01

    Full Text Available Stroke becomes world health problem all over the world because it is the causal factor of high mortality and disability. Good and well-organized process of healthcare service will improve the outcome of the patients with stroke. Clinical pathway may be used as clear standard to help reduce unnecessary variations of medical treatment and measure. The study aimed at finding out the correlation between the use of clinical pathway and the outcome of the patients with ischemic stroke in Bethesda Hospital Yogyakarta. It was an observational and analytic study with cohort restorative study design. The author compared the outcomes of acute ischemic stroke between the group with clinical pathway and the group without the clinical pathway. Data was collected using consecutive sampling from the electronic registry and medical record data of the patients from January 1st, 2011 to December 31st, 2011. It was conducted to 124 patients with ischemic stroke assigned to two groups (the first groups of 62 patients with clinical pathway and the second groups of 62 patients without clinical pathway. The basic characteristics of the two groups were the same. The results of the analysis showed that there was a significant decrease in the incidence of complication and a significant increase in the use of antiplatelete drugs, antidiabetic drugs and statin as secondary preventive measure of the recurrent stroke. There was not any significant difference in the duration of the hospitalized healthcare, the financing and the mortality between the two observation groups. The study indicated that the use of the clinical pathway in the stroke treatment improved the outcome of the patients with stroke. It was necessary to conduct further study to evaluate the effectiveness of the clinical pathway in improving the outcome of the patients with bigger number of the subjects and the longer period of time.

  17. Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome

    Directory of Open Access Journals (Sweden)

    Lukman Femi Owolabi

    2016-01-01

    Full Text Available Background: Posterior circulation stroke (PCS, though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. Objective: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. Materials and Methods: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. Results: Posterior circulation ischemic stroke accounted for 57 (9.6% of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7 and 13 females (mean age 46.3 ± 13.7. Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7. However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9% patients. Hypertension was the most common risk factor (86%. Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7% patients had an ischemic stroke. Twenty-one (36.8% of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. Conclusions: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.

  18. Methodological Issues in Monitoring Health Services and Outcomes for Stroke Survivors: A Case Study

    Science.gov (United States)

    Stuart, Mary; Papini, Donato; Benvenuti, Francesco; Nerattini, Marco; Roccato, Enrico; Macellari, Velio; Stanhope, Steven; Macko, Richard; Weinrich, Michael

    2010-01-01

    Background Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation. Objective The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany. Methods This study used qualitative and quantitative methods to study health resources available to and utilized by stroke survivors during the first 12 months post-stroke in two Italian health authorities (AUSL10 and 11). Mortality rates were used as an outcome measure. Results Number of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared to AUSL 11. There was no significant difference between mortality rates. Conclusion Using administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed. PMID:21057665

  19. Central auditory processing outcome after stroke in children

    Directory of Open Access Journals (Sweden)

    Karla M. I. Freiria Elias

    2014-09-01

    Full Text Available Objective To investigate central auditory processing in children with unilateral stroke and to verify whether the hemisphere affected by the lesion influenced auditory competence. Method 23 children (13 male between 7 and 16 years old were evaluated through speech-in-noise tests (auditory closure; dichotic digit test and staggered spondaic word test (selective attention; pitch pattern and duration pattern sequence tests (temporal processing and their results were compared with control children. Auditory competence was established according to the performance in auditory analysis ability. Results Was verified similar performance between groups in auditory closure ability and pronounced deficits in selective attention and temporal processing abilities. Most children with stroke showed an impaired auditory ability in a moderate degree. Conclusion Children with stroke showed deficits in auditory processing and the degree of impairment was not related to the hemisphere affected by the lesion.

  20. Processes and outcomes of ischemic stroke care: the influence of hospital level of care.

    Science.gov (United States)

    Tung, Yu-Chi; Jeng, Jiann-Shing; Chang, Guann-Ming; Chung, Kuo-Piao

    2015-08-01

    Processes of stroke care play an increasingly important role in comparing hospital performance. The relationship between processes of care and outcomes for stroke is unclear. Moreover, in terms of stroke care regionalization, little information is available with regard to the relationships among hospital level of care, processes and outcomes of stroke care. We used nationwide population-based data to examine the relationship between processes of care and mortality and the relationships among hospital level of care, processes and mortality for ischemic stroke. Cross-sectional study. General acute care hospitals throughout Taiwan. A total of 31 274 ischemic stroke patients admitted in 2010 through Taiwan's National Health Insurance Research Database. Processes of care and 30-day mortality. Multilevel models were used after adjustment for patient and hospital characteristics to test the relationship between processes of care and 30-day mortality and the relationships among hospital level of care, processes and 30-day mortality. The use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment was associated with lower mortality. Hospital level of care was associated with the use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment, and mortality. These processes of care were mediators of the relationship between hospital level of care and mortality. Outcomes among patients with ischemic stroke can be improved by thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment. Among patients with ischemic stroke, admission to designated stroke center hospitals may be associated with lower mortality through better processes of care. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  1. Caregiver-Child Verbal Interactions in Child Care: A Buffer against Poor Language Outcomes when Maternal Language Input is Less.

    Science.gov (United States)

    Vernon-Feagans, Lynne; Bratsch-Hines, Mary E

    2013-12-01

    Recent research has suggested that high quality child care can buffer young children against poorer cognitive and language outcomes when they are at risk for poorer language and readiness skills. Most of this research measured the quality of parenting and the quality of the child care with global observational measures or rating scales that did not specify the exact maternal or caregiver behaviors that might be causally implicated in the buffering of these children from poor outcomes. The current study examined the actual language by the mother to her child in the home and the verbal interactions between the caregiver and child in the child care setting that might be implicated in the buffering effect of high quality childcare. The sample included 433 rural children from the Family Life Project who were in child care at 36 months of age. Even after controlling for a variety of covariates, including maternal education, income, race, child previous skill, child care type, the overall quality of the home and quality of the child care environment; observed positive caregiver-child verbal interactions in the child care setting interacted with the maternal language complexity and diversity in predicting children's language development. Caregiver-child positive verbal interactions appeared to buffer children from poor language outcomes concurrently and two years later if children came from homes where observed maternal language complexity and diversity during a picture book task was less.

  2. A comparison of outcome for stroke patients in Barbados and South London.

    Science.gov (United States)

    Smeeton, Nigel C; Corbin, David O C; Hennis, Anselm J M; Hambleton, Ian R; Rose, Angela M C; Fraser, Henry S; Heuschmann, Peter U; Wolfe, Charles D A

    2011-04-01

    Little is known about the poststroke outcome in Caribbean populations. We investigated differences in the activities of daily living, level of social activities, living circumstances and survival for stroke patients in Barbados and London. Data were collected from the South London Stroke Register and the Barbados Register of Strokes for patients with a first-ever stroke registered between January 2001 and December 2004. The ability to perform activities of daily living was measured by the Barthel Index and level of social activities by the Frenchay Activities Index. Living circumstances were categorised into private household vs. institutional care. Death and dependency, activities of daily living and social activities were assessed at three-months, one- and two-years using logistic regression, adjusted for differences in demographic, socioeconomic and stroke severity characteristics. At three-months, a high level of social activities was more likely for the Barbados Register of Strokes (odds ratio 1.84; 95% confidence interval 1.03-3.29); there were no differences in activities of daily living; and Barbados Register of Strokes patients were less likely to be in institutional care (relative risk ratio 0.38; 95% confidence interval 0.18-0.79). Following adjustment, Barbados Register of Strokes patients had a higher risk of mortality at three-months (relative risk ratio 1.85; 95% confidence interval 1.03-3.30), one-year (relative risk ratio 1.83; 95% confidence interval 1.08-3.09) and two-years (relative risk ratio 1.82; 95% confidence interval 1.08-3.07). This difference was due to early poststroke deaths; for patients alive at four-weeks poststroke, survival thereafter was similar in both settings. In Barbados, there was evidence for a healthy survivor effect, and short-term social activity was greater than that in the South London Stroke Register. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

  3. Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma.

    Science.gov (United States)

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui

    2015-07-01

    Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with or without SE. Risk factors for patients with SE were compared with those without SE by univariate and multivariate analysis. Of 94 stroke patients with NC, 46 (49%) had NC with SE and 48 (51%) had NC without SE. The onset-to-NC time was significant later in stroke patients with SE than those without SE (P stroke patients with SE was higher than those without SE (76.1% vs. 45.8%, P = 0.003). High fever and severe SIRS are two early predictors of stroke patients with SE, and survival rates were worse in stroke patients with SE than those without SE.

  4. Dysarthria in stroke: a narrative review of its description and the outcome of intervention.

    Science.gov (United States)

    Mackenzie, Catherine

    2011-04-01

    Dysarthria is a frequent and persisting sequel to stroke and arises from varied lesion locations. Although the presence of dysarthria is well documented, for stroke there are scant data on presentation and intervention outcome. A literature search was undertaken to evaluate (a) the features of dysarthria in adult stroke populations relative to the conventional Mayo system for classification, which was developed from diverse pathological groups, and (b) the current status of evidence for the effectiveness of intervention in dysarthria caused by stroke. A narrative review of results is presented. The limited data available indicate that, regardless of stroke location, imprecise articulation and slow speaking rate are consistent features, and voice disturbances, especially harshness, and reduced prosodic variation are also common. Dysarthria is more prevalent in left than in right hemisphere lesions. There is a need for comprehensive, thorough analysis of dysarthria features, involving larger populations, with stroke and other variables controlled and with appropriate age-referenced control data. There is low level evidence for benefits arising from intervention in stroke-related dysarthria. Because studies involve few participants, without external control, and sometimes include stroke with other aetiologies, their results lack the required weight for confident evidence-based practice.

  5. Early consciousness disorder in acute ischemic stroke: incidence, risk factors and outcome.

    Science.gov (United States)

    Li, Jie; Wang, Deren; Tao, Wendan; Dong, Wei; Zhang, Jing; Yang, Jie; Liu, Ming

    2016-08-17

    Little is known about the incidence and risk factors of early consciousness disorder (ECD) in patients with acute ischemic stroke, or about how ECD may affect complications and outcomes. Patients admitted to our hospital within 24 h of onset of acute ischemic stroke were consecutively enrolled. ECD was evaluated clinically and using the Glasgow coma scale. Multivariate analysis was used to identify risk factors of ECD, as well as associations between ECD and clinical outcomes. Of the 569 patients enrolled, 199 (35 %) had ECD. Independent risk factors of ECD were advanced age (OR 1.027, 95 % CI 1.007 to 1.048), National Institutes of Health Stroke Score on admission (OR 1.331, 95 % CI 1.257 to 1.410), and massive cerebral infarct (OR 3.211, 95 % CI 1.642 to 6.279). ECD was associated with higher frequency of stroke-related complications (83.4 % vs. 31.1 %, P stroke. Risk factors include advanced age, stroke severity, and massive cerebral infarct. ECD is associated with higher frequency of stroke-related complications and 3-month death/disability.

  6. Queue-based modelling and detection of parameters involved in stroke outcome

    DEFF Research Database (Denmark)

    Vilic, Adnan; Petersen, John Asger; Wienecke, Troels

    2017-01-01

    We designed a queue-based model, and investigated which parameters are of importance when predicting stroke outcome. Medical record forms have been collected for 57 ischemic stroke patients, including medical history and vital sign measurement along with neurological scores for the first twenty-f......, where outcome for patients were 36.75 ± 10.99. The queue-based model integrating multiple linear regression shows promising results for automatic selection of significant medically relevant parameters.......-four hours of admission. The importance of each parameter is identified using multiple regression combined with a circular queue to iteratively fit outcome. Out of 39 parameters, the model isolated 14 which combined could estimate outcome with a root mean square error of 1.69 on the Scandinavian Stroke Scale...

  7. Hubungan Antara Lama Pembacaan Ct Scan Terhadap Outcome Penderita Stroke Non Hemoragik

    OpenAIRE

    Prakasita, Masayu; Tugasworo, Dodik; Ismail, Akhmad

    2015-01-01

    Background : Stroke is world's health problem that can leads into death and disability. Stroke is one of emergency case because it can threatening life so that it needs an urgent intervention with an accurate and fast diagnosis using non-contrast CT Scan as gold standart. Faster the diagnosis is made then faster the intervention is given, so the outcome of non-hemorrhagic stroke patients which is measured by Barthel Index are better.Methods : This study is an observational analytic study with...

  8. Chronic Stroke Outcome Measures for Motor Function Intervention Trials: Expert Panel Recommendations.

    Science.gov (United States)

    Bushnell, Cheryl; Bettger, Janet Prvu; Cockroft, Kevin M; Cramer, Steven C; Edelen, Maria Orlando; Hanley, Daniel; Katzan, Irene L; Mattke, Soeren; Nilsen, Dawn M; Piquado, Tepring; Skidmore, Elizabeth R; Wing, Kay; Yenokyan, Gayane

    2015-10-01

    About half of survivors with stroke experience severe and significant long-term disability. The purpose of this article is to review the state of the science and to make recommendations for measuring patient-centric outcomes in interventions for motor improvement in the chronic stroke phase. A 9-member expert panel reviewed evidence to identify measures of upper and lower extremity function used to date as outcomes in trials with patients who experienced a stroke ≥6 months before assessment. Outcome measures were screened using StrokEDGE consensus panel recommendations, and evaluated for availability of a published minimal clinically important difference. Measures meeting these criteria were further evaluated with regard to their level of measurement, psychometric properties, and ability of minimal clinically important difference to capture gains associated with improved function and clinical relevance to patients, to arrive at recommendations. A systematic literature review yielded 115 clinical trials of upper and lower extremity function in chronic stroke that used a total of 34 outcome measures. Seven of these had published minimal clinically important differences and were recommended or highly recommended by StrokEDGE. Those are the Fugl-Meyer Upper Extremity and Lower Extremity scales, Wolf Motor Function Test, Action Research Arm Test, Ten-Meter and Six-Minute Walk Tests, and the Stroke Impact Scale. All had evidence for their psychometric performance, although the strength of evidence for validity varied, especially in populations with chronic stroke Fugl-Meyer Upper and Lower Extremity scales showing the strongest evidence for validity. The panel recommends that the Fugl-Meyer Upper and Lower Extremity scales be used as primary outcomes in intervention trials targeting motor function in populations with chronic stroke. The other 6 measures are recommended as secondary outcomes. © 2015 American Heart Association, Inc.

  9. Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: an exploratory cohort study.

    Science.gov (United States)

    Gandolfi, Marialuisa; Smania, Nicola; Bisoffi, Giulia; Squaquara, Teresa; Zuccher, Paola; Mazzucco, Sara

    2014-12-01

    Stroke is a major cause of dysphagia. Few studies to date have reported on standardized multidisciplinary protocolized approaches to the management of post-stroke dysphagia. The aim of this retrospective cohort study was to evaluate the impact of a standardized multidisciplinary protocol on clinical outcomes in patients with post-stroke dysphagia. We performed retrospective chart reviews of patients with post-stroke dysphagia admitted to the neurological ward of Verona University Hospital from 2004 to 2008. Outcomes after usual treatment for dysphagia (T- group) were compared versus outcomes after treatment under a standardized diagnostic and rehabilitative multidisciplinary protocol (T+ group). Outcome measures were death, pneumonia on X-ray, need for respiratory support, and proportion of patients on tube feeding at discharge. Of the 378 patients admitted with stroke, 84 had dysphagia and were enrolled in the study. A significantly lower risk of in-hospital death (odds ratio [OR] 0.20 [0.53-0.78]), pneumonia (OR 0.33 [0.10-1.03]), need for respiratory support (OR 0.48 [0.14-1.66]), and tube feeding at discharge (OR 0.30 [0.09-0.91]) was recorded for the T+ group (N = 39) as compared to the T- group (N = 45). The adjusted OR showed no difference between the two groups for in-hospital death and tube feeding at discharge. Use of a standardized multidisciplinary protocolized approach to the management of post-stroke dysphagia may significantly reduce rates of aspiration pneumonia, in-hospital mortality, and tube feeding in dysphagic stroke survivors. Consistent with the study's exploratory purposes, our findings suggest that the multidisciplinary protocol applied in this study offers an effective model of management of post-stroke dysphagia.

  10. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome

    DEFF Research Database (Denmark)

    Sandset, Else C; Murray, Gordon D; Bath, Philip M W

    2012-01-01

    The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome....

  11. Health-related quality of life and mental health outcomes in Mexican TBI caregivers.

    Science.gov (United States)

    Gulin, Shaina L; Perrin, Paul B; Stevens, Lillian F; Villaseñor-Cabrera, Teresita J; Jiménez-Maldonado, Miriam; Martínez-Cortes, Ma Luisa; Arango-Lasprilla, Juan Carlos

    2014-03-01

    Research has documented the deleterious effects on caregivers of providing care for an individual with traumatic brain injury (TBI). TBI caregivers in Mexico specifically have reduced health-related quality of life (HRQOL) across both physical and mental health domains. The purpose of the current study was to uncover the system of connections between Mexican TBI caregivers' HRQOL and their mental health. A cross-sectional survey was conducted at a public medical facility in Guadalajara, México. Ninety family caregivers of individuals with TBI completed measures of HRQOL, satisfaction with life, depression, and burden. A canonical correlation analysis revealed that the better the caregivers' HRQOL, the better their mental health was, with the effect reaching a large-sized effect. A distinct pattern emerged linking caregivers' higher energy levels and better social functioning to lower depression and greater satisfaction with life. A series of multiple regressions similarly uncovered that the most robust independent HRQOL predictors of caregiver mental health were vitality and social functioning. Especially for TBI caregivers with poor health, behavioral health interventions in Latin America that target the HRQOL domains of social functioning and vitality may significantly improve caregiver mental health, and as a result, informal care for TBI.

  12. Prognosis and outcome of acute stroke in the University College ...

    African Journals Online (AJOL)

    2011-03-02

    Mar 2, 2011 ... Teaching Hospital, Calabar, 2University College Hospital Ibadan, Nigeria. Address for ... University College Hospital (U.C.H), Ibadan, in coma from acute stroke, from August 2004 to March 2005, was undertaken after obtaining ethical ... presentation, and on clinical grounds alone in 7 patients. After initial ...

  13. absence of programme outcome in the rehabilitation Stroke a ...

    African Journals Online (AJOL)

    1990-08-18

    Aug 18, 1990 ... to the World Health Organisation's recommendation, as 'a vascular lesion of acute onset resulting in disability ... hospital's medical records retrieval system. Careful case-note review resulted in the exclusion .... stroke is predominantly a disease of the elderly. Survival to I year was calculated at 37%. This·is ...

  14. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke.

    Science.gov (United States)

    Yu, Sungwook; Arima, Hisatomi; Bertmar, Carin; Clarke, Stephen; Herkes, Geoffrey; Krause, Martin

    2018-04-15

    The neutrophil to lymphocyte ratio (NLR) is closely linked to mortality in patients with cardiovascular disease. We investigated whether NLR is associated with early clinical outcomes in patients with acute ischemic stroke. We collated data from a tertiary hospital's stroke registry including admitted patients with a first-ever acute ischemic stroke within 72 h of onset. White blood cell counts and peripheral differential counts were measured on admission. Early clinical outcomes were in-hospital mortality and disability at discharge assessed by the modified Rankin scale (mRS). Among 1131 stroke patients, 454 patients were included and classified into tertile groups based on NLR on admission. Patients in higher tertiles of NLR were likely to have severe neurologic deficit at discharge. Higher NLR tertiles were associated with an unfavourable shift of mRS score (p < .0001). This association remained significant after adjustment for clinical and laboratory variables including age, sex, hypertension, hypercholesterolemia, atrial fibrillation, stroke severity, and glucose level (p = .032 for trend). However, risk of death or major disability (score of 3-6 on mRS) and in-hospital mortality were not significantly different across NLR tertile groups. In patients with acute ischemic stroke, NLR was predictive of short-term functional outcome. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

  15. A comparison of acute hemorrhagic stroke outcomes in 2 populations: the Crete-Boston study.

    Science.gov (United States)

    Zaganas, Ioannis; Halpin, Amy P; Oleinik, Alexandra; Alegakis, Athanasios; Kotzamani, Dimitra; Zafiris, Spiros; Chlapoutaki, Chryssanthi; Tsimoulis, Dimitris; Giannakoudakis, Emmanouil; Chochlidakis, Nikolaos; Ntailiani, Aikaterini; Valatsou, Christina; Papadaki, Efrosini; Vakis, Antonios; Furie, Karen L; Greenberg, Steven M; Plaitakis, Andreas

    2011-12-01

    Although corticosteroid use in acute hemorrhagic stroke is not widely adopted, management with intravenous dexamethasone has been standard of care at the University Hospital of Heraklion, Crete with observed outcomes superior to those reported in the literature. To explore this further, we conducted a retrospective, multivariable-adjusted 2-center study. We studied 391 acute hemorrhagic stroke cases admitted to the University Hospital of Heraklion, Crete between January 1997 and July 2010 and compared them with 510 acute hemorrhagic stroke cases admitted to Massachusetts General Hospital, Boston, from January 2003 to September 2009. Of the Cretan cases, 340 received a tapering scheme of intravenous dexamethasone, starting with 16 to 32 mg/day, whereas the Boston patients were managed without steroids. The 2 cohorts had comparable demographics and stroke severity on admission, although anticoagulation was more frequent in Boston. The in-hospital mortality was significantly lower on Crete (23.8%, n=340) than in Boston (38.0%, n=510; Phemorrhages. After adjusting for acute hemorrhagic stroke volume/location, Glasgow Coma Scale, hypertension, diabetes mellitus, smoking, coronary artery disease and statin, antiplatelet, and anticoagulant use, intravenous dexamethasone treatment was associated with better functional outcomes and significantly lower risk of death at 30 days (OR, 0.357; 95% CI, 0.174-0.732). This study suggests that intravenous dexamethasone improves outcome in acute hemorrhagic stroke and supports a randomized clinical trial using this approach.

  16. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

    Science.gov (United States)

    Broeg-Morvay, Anne; Meisterernst, Julia; Schlager, Markus; Mono, Marie-Luise; El-Koussy, Marwan; Kägi, Georg; Jung, Simon; Sarikaya, Hakan

    2016-01-01

    Background Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. Methods We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia. Results Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, pdysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; pdysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality. Conclusion Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization. PMID:26863627

  17. Stroke warning campaigns: delivering better patient outcomes? A systematic review

    Directory of Open Access Journals (Sweden)

    Mellon L

    2015-02-01

    Full Text Available Lisa Mellon,1 Frank Doyle,1 Daniela Rohde,1 David Williams,2 Anne Hickey1 1Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland; 2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Background: Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms. Methods: A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO, were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED presentations with stroke. Results: Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance

  18. Enhancing Resourcefulness to Improve Outcomes in Family Caregivers and Persons with Alzheimer’s Disease: A Pilot Randomized Trial

    Directory of Open Access Journals (Sweden)

    Elizabeth W. Gonzalez

    2014-01-01

    Full Text Available This pilot randomized trial tested an intervention aimed at enhancing resourcefulness in family caregivers of persons with dementia, postulating that caregivers’ emotional outcomes (anxiety and depression and role outcomes (reward, strain, mutuality, and preparedness would be improved, and problem behaviors in the care recipients (persons with dementia would be reduced as a result of the intervention. Subjects were stratified by race (white or African American and by baseline resourcefulness (high or low. Family caregivers were randomly assigned to an intervention group in which subjects attended six resourcefulness training sessions, meeting for 2 hours weekly over 6 weeks, or to a control group that received no treatment. Small to medium effects were shown for the intervention program on resourcefulness, anxiety, and preparedness of the caregivers and on frequency of behavior problems in the care recipients. Caregivers in the intervention group reported significantly more resourcefulness skills, with a medium effect at week 6 and a small effect 12 weeks later, compared with the control group. Persons with dementia had fewer behavior problems in the intervention group compared with control, although the difference was not significant. Caregivers’ anxiety was reduced in the intervention group at 12 weeks.

  19. Sex Differences in Outcomes among Stroke Survivors with Non-Valvular Atrial Fibrillation in China

    Directory of Open Access Journals (Sweden)

    Zhongping An

    2017-04-01

    Full Text Available Atrial fibrillation (AF significantly increases the risk of stroke and disease burden and is an established predictor of poor outcomes after stroke. However, data regarding sex differences in long-term outcomes following stroke in patients with AF are scarce. We thus aimed to assess these differences. We recruited 951 consecutive patients with acute ischemic stroke and non-valvular atrial fibrillation (NVAF treated at three hospitals in Tianjin, China, from January 2006 to September 2014. Information regarding stroke subtype, severity, risk factors, and outcomes (mortality, dependency, and recurrence at 3, 12, and 36 months after stroke was recorded. The prevalence of NVAF was 8.4% overall, with a higher frequency in women than in men (11.3 vs. 6.9%, P < 0.001. Among patients with NVAF, women were older than men. Women were more likely than men to have severe stroke (38.8 vs. 29.5%, P < 0.001, high levels of total cholesterol and high- and low-density lipoprotein cholesterol (all P < 0.001, hypertension (69.1 vs. 61.2%, P = 0.012, dyslipidemia (29.8 vs. 20.7%, P = 0.001, and obesity (18.5 vs. 11.6%, P = 0.003; they were less likely than men to be current smokers (12.2 vs. 33.6%, P < 0.001 and to consume alcohol (0.9 vs. 13.9%, P < 0.001. There were greater risks of dependency and recurrence at 36 months after stroke in women than in men [odds ratios (95% confidence intervals, 1.64 (1.02–2.64 for dependency, P = 0.043; and 2.03 (1.28–3.20 for recurrence, P = 0.002] after adjustment for stroke subtype, severity, and risk factors. These findings suggest that it is crucial to emphasize the need for individualized stroke prevention education and promotion of healthy lifestyles in order to improve NVAF-related stroke outcomes and reduce disease burden in women.

  20. A randomized controlled trial of a community-based dementia care coordination intervention: effects of MIND at Home on caregiver outcomes.

    Science.gov (United States)

    Tanner, Jeremy A; Black, Betty S; Johnston, Deirdre; Hess, Edward; Leoutsakos, Jeannie-Marie; Gitlin, Laura N; Rabins, Peter V; Lyketsos, Constantine G; Samus, Quincy M

    2015-04-01

    To assess whether MIND at Home, a community-based, multicomponent, care coordination intervention, reduces unmet caregiving needs and burden in informal caregivers of persons with memory disorders. An 18-month randomized controlled trial of 289 community-living care recipient (CR)-caregiver (informal caregivers, i.e., unpaid individuals who regularly assisted the CR) dyads from 28 postal code areas of Baltimore, Maryland was conducted. All dyads and the CR's primary care physician received the written needs assessment results and intervention recommendations. Intervention dyads then received an 18-month care coordination intervention delivered by nonclinical community workers to address unmet care needs through individualized care planning, referral and linkage to dementia services, provision of caregiver dementia education and skill-building strategies, and care progress monitoring by an interdisciplinary team. Primary outcome was total percent of unmet caregiver needs at 18 months. Secondary outcomes included objective and subjective caregiver burden measures, quality of life (QOL), and depression. Total percent of unmet caregiver needs declined in both groups from baseline to 18 months, with no statistically significant between-group difference. No significant group differences occurred in most caregiver burden measures, depression, or QOL. There was a potentially clinically relevant reduction in self-reported number of hours caregivers spent with the CR for MIND participants compared with control subjects. No statistically significant impacts on caregiver outcomes were found after multiple comparison adjustments. However, MIND at Home appeared to have had a modest and clinically meaningful impact on informal caregiver time spent with CRs. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  1. A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: self-management programs for stroke survivors

    NARCIS (Netherlands)

    Warner, G.; Packer, T.L.; Villeneuve, M.; Audulv, A.; Versnel, J.

    2015-01-01

    PURPOSE: A systematic review of stroke self-management programs was conducted to: (i) identify how many and what self-management support strategies were included in stroke self-management interventions and (ii) describe whether self-management programs effectively improved outcomes, focusing

  2. Association Between Onset-to-Door Time and Clinical Outcomes After Ischemic Stroke.

    Science.gov (United States)

    Matsuo, Ryu; Yamaguchi, Yuko; Matsushita, Tomonaga; Hata, Jun; Kiyuna, Fumi; Fukuda, Kenji; Wakisaka, Yoshinobu; Kuroda, Junya; Ago, Tetsuro; Kitazono, Takanari; Kamouchi, Masahiro

    2017-11-01

    The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T 0-1 , ≤1 hour; T 1-2 , >1 and ≤2 hours; T 2-3 , >2 and ≤3 hours; T 3-6 , >3 and ≤6 hours; T 6-12 , >6 and ≤12 hours; T 12-24 , >12 and ≤24 hours; and T 24- , >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement ( T 0- 1 , 2.79 [2.28-3.42]; T 1-2 , 2.49 [2.02-3.07]; T 2-3 , 1.52 [1.21-1.92]; T 3-6 , 1.72 [1.44-2.05], with reference to T 24- ) and good functional outcome ( T 0-1 , 2.68 [2.05-3.49], T 1-2 2.10 [1.60-2.77], T 2-3 1.53 [1.15-2.03], T 3-6 1.31 [1.05-1.64], with reference to T 24- ), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after

  3. Exemplary Care as a Mediator of the Effects of Caregiver Subjective Appraisal and Emotional Outcomes

    Science.gov (United States)

    Harris, Grant M.; Durkin, Daniel W.; Allen, Rebecca S.; DeCoster, Jamie; Burgio, Louis D.

    2011-01-01

    Purpose: Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of…

  4. Primary Care Interventions for Dementia Caregivers: 2-Year Outcomes from the REACH Study

    Science.gov (United States)

    Burns, Robert; Nichols, Linda O.; Martindale-Adams, Jennifer; Graney, Marshall J.; Lummus, Allan

    2003-01-01

    Purpose: This study developed and tested two 24-month primary care interventions to alleviate the psychological distress suffered by the caregivers of those with Alzheimer's disease. The interventions, using targeted educational materials, were patient behavior management only, and patient behavior management plus caregiver stress-coping…

  5. Cognitive-communication disorder following right hemisphere stroke: exploring rehabilitation access and outcomes.

    Science.gov (United States)

    Hewetson, Ronelle; Cornwell, Petrea; Shum, David

    2017-07-01

    Rehabilitation positively influences return to activities and social roles in people with aphasia. The cognitive-communication disorder (CCD) found following a right hemisphere stroke has been less extensively researched with rehabilitation access and outcomes yet to be determined. To document rehabilitation access and outcomes for people with CCD post-stroke; and compare outcomes based on presence (viz CCD; aphasia) or absence of communication impairment. A retrospective chart audit was completed for patients with first onset unilateral stroke, with a hospital length of stay (LOS) of at least two days and a communication assessment by a speech pathologist. Data extracted included presence and severity of communication impairment, access to and LOS in a rehabilitation unit, and functional outcome measures recorded at rehabilitation discharge. The majority of the 115 patients who met inclusion criteria were living independently (n = 112, 97.4%) at the time of stroke. CCD (66%) was diagnosed with similar frequency to aphasia (68%). The presence of communication impairment did not result in significant differences in rehabilitation LOS and discharge destination when compared to hemispheric strokes without communication impairment. Severity of CCD was an independent predictor of functional gain by rehabilitation discharge. People with CCD require comparable access to rehabilitation as people with aphasia, and severity of CCD should be considered in determining rehabilitation LOS. A large number of people are discharged with ongoing CCD which warrants exploration of potential participation restrictions created by the communication impairment.

  6. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes.

    Science.gov (United States)

    Perry, Lin; Hamilton, Sharon; Williams, Jane; Jones, Susan

    2013-02-01

    Stroke produces many effects that impact eating. Nutrition is fundamental for recovery and rehabilitation, but the nursing nutritional role and associated outcomes have not been delineated. (1) To identify nursing interventions intended to improve nutritional status and related outcomes of stroke survivors, and (2) To examine the outcomes of identified nursing interventions on nutrition-related outcomes, including dietary intake, functional status, complications, activities of daily living, mortality, and quality of life for stroke survivors. A modified version of Cochrane literature searching and review methods was used to identify studies that described and evaluated nursing nutritional interventions for adult stroke patients in hospital and community settings. A minimum of 10 years content of seven databases and nine journals was searched to March 2011. Findings were presented descriptively. In total 27 papers from 26 studies were included: 5 randomized controlled trials, 5 clinical trials, 6 quasi-experiments, 4 case studies, and 6 qualitative/observational studies. Stroke nursing nutritional care encompassed screening of nutritional status and swallowing function; assessment of nutritional characteristics and preferences; referral; mealtime organization, supervision and monitoring; mealtime assistance and feeding skills. Nurses individualized care, coordinated or managed meal delivery and enteral feeding systems, were responsible for the dining environment and conduct of mealtimes; they taught staff, patients, and carers. There was little indication of integrated or psychosocial nursing nutritional care, or concepts, theories or models of nursing nutritional care. Many interventions were described but not evaluated. Little high quality evidence was of available. This review indicated the parameters of nursing nutritional care, and provided a framework for future research. A functional, supportive, and educational nursing nutritional role was described but

  7. Validation of Serial Alberta Stroke Program Early CT Score as an Outcome Predictor in Thrombolyzed Stroke Patients.

    Science.gov (United States)

    Kong, Wan-Yee; Tan, Benjamin Y Q; Ngiam, Nicholas J H; Tan, Deborah Y C; Yuan, Christine H; Holmin, Staffan; Andersson, Tommy; Lundström, Erik; Teoh, Hock Luen; Chan, Bernard P L; Rathakrishnan, Rahul; Ting, Eric Y S; Sharma, Vijay K; Yeo, Leonard L L

    2017-10-01

    The Alberta Stroke Program Early CT Score (ASPECTS) on baseline imaging is an established predictor of functional outcome in anterior circulation acute ischemic stroke (AIS). We studied ASPECTS before intravenous thrombolysis (IVT) and at 24 hours to assess its prognostic value. Data for consecutive anterior circulation AIS patients treated with IVT from 2006 to 2013 were extracted from a prospectively managed registry at our tertiary center. Pre-thrombolysis and 24-hour ASPECTS were evaluated by 2 independent neuroradiologists. Outcome measures included symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS) at 90 days, and mortality. Unfavorable functional outcome was defined by mRS >1. Dramatic ASPECTS progression (DAP) was defined as deterioration in ASPECTS by 6 points or more. Of 554 AIS patients thrombolyzed during the study period, 400 suffered from anterior circulation infarction. The median age was 65 years (interquartile range (IQR): 59-70) and the median National Institutes of Health Stroke Scale score was 18 points (IQR: 12-22). Compared with the pre-IVT ASPECTS (area under the curve [AUC] = .64, 95% confidence interval [CI]: .54-.65, P = .001), ASPECTS on the 24-hour CT scan (AUC = .78, 95% CI: .73-.82, P < .001), and change in ASPECTS (AUC = .69, 95% CI: .64-.74, P < .001) were better predictors of unfavorable functional outcome at 3 months. DAP, noted in 34 (14.4%) patients with good baseline ASPECTS (8-10 points), was significantly associated with unfavorable functional outcome (odds ratio [OR]: 9.91, 95% CI: 3.37-29.19, P ≤ .001), mortality (OR: 21.99, 95% CI: 7.98-60.58, P < .001), and SICH (OR: 8.57, 95% CI: 2.87-25.59, P < .001). Compared with the pre-thrombolysis score, ASPECTS measured at 24 hours as well as serial change in ASPECTS is a better predictor of 3-month functional outcome. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke: a mixed methods study

    Science.gov (United States)

    Ekstam, Lisa; Johansson, Ulla; Guidetti, Susanne; Eriksson, Gunilla; Ytterberg, Charlotte

    2015-01-01

    Objectives The aim of the study was to explore the associations between the dyad’s (person with stroke and informal caregiver) perception of the person with stroke’s rehabilitation needs and stroke severity, personal factors (gender, age, sense of coherence), the use of rehabilitation services, amount of informal care and caregiver burden. Further, the aim was to explore the personal experience of everyday life changes among persons with stroke and their caregivers and their strategies for handling these 1 year after stroke. Design A mixed methods design was used combining quantitative and qualitative data and analyses. Setting Data were mainly collected in the participants’ homes. Outcome measures Data were collected through established instruments and open-ended interviews. The dyad's perceptions of the person with stroke’s rehabilitation needs were assessed by the persons with stroke and their informal caregivers using a questionnaire based on Ware’s taxonomy. The results were combined and classified into three groups: met, discordant (ie, not in agreement) and unmet rehabilitation needs. To assess sense of coherence (SOC) in persons with stroke, the SOC-scale was used. Caregiver burden was assessed using the Caregiver Burden Scale. Data on the use of rehabilitation services were obtained from the computerised register at the Stockholm County Council. Participants 86 persons with stroke (mean age 73 years, 38% women) and their caregivers (mean age 65 years, 40% women). Results Fifty-two per cent of the dyads perceived that the person with stroke’s need for rehabilitation was met 12 months after stroke. Met rehabilitation needs were associated with less severe stroke, more coping strategies for solving problems in everyday activities and less caregiver burden. Conclusions Rehabilitation interventions need to focus on supporting the dyads’ process of psychological and social adaptation after stroke. Future studies need to explore and evaluate

  9. Reduced kidney function and outcome in acute ischaemic stroke: relationship to arterial hypertension and diabetes.

    Science.gov (United States)

    Losito, Attilio; Pittavini, Loretta; Ferri, Carla; De Angelis, Luigi

    2012-03-01

    Stroke is a dangerous long-term complication of kidney failure, yet its occurrence early in disease is poorly characterized. Our aim was to investigate the association of reduced kidney function, hypertension and diabetes with acute ischaemic stroke and the outcome thereof. In this prospective cohort study, the association of reduced kidney function, hypertension and diabetes with stroke and 2-year all-cause mortality was investigated. Glomerular filtration rate (eGFR) was estimated by the simplified Modification of Diet in Renal Disease formula in 13 365 consecutive patients (671 with acute ischaemic stroke) admitted to our clinical facility over a 12-month period. Ischaemic stroke, after adjustment for age and gender, was significantly associated with eGFR stroke. Age and gender-adjusted survival analysis by Cox regression showed an association of mortality with reduced eGFR alone (HR = 4.29, 95% CI 1.02-19.60). In patients acutely admitted to hospital, reduced kidney function, hypertension and diabetes are independently associated with ischaemic stroke, but do not exert a synergic effect. After hospital discharge, mortality is strongly associated with reduced eGFR but with neither hypertension nor diabetes.

  10. Impact of Cognitive Impairment on Functional Outcome in Stroke

    Directory of Open Access Journals (Sweden)

    Nurdan Paker

    2010-01-01

    Full Text Available The aim of this study was to investigate the effect of the cognitive impairment on functional status in patients with subacute stroke. Fifty-two patients with subacute stroke were included in the study. Mini mental state examination (MMSE test was used for the evaluation of cognitive status. Patients were separated into two groups according to their cognitive functions. Functional follow-up parameters were activities of daily living (ADL, global recovery and ambulation status. All patients were evaluated on admission to rehabilitation unit, at discharge and 6 months after discharge. Forty-four patients were completed the study. Mean age was 66 and 57 years; disease duration on admission was 4,8 and 3,5 months in the cognitively impaired and normal groups, respectively. Significant improvement was found in terms of functional follow-up parameters in both groups at discharge (<.05. Functional follow-up parameters did not show statistically significant difference between the groups. But community ambulation rate was higher in cognitively normal group at the sixth month visit. As a result of this study, inpatient rehabilitation was effective both cognitively normal and impaired subacute stroke patients.

  11. Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke.

    Science.gov (United States)

    Zaheer, Sana; Beg, Mujahid; Rizvi, Imran; Islam, Najmul; Ullah, Ekram; Akhtar, Nishat

    2013-10-01

    The use of biomarkers to predict stroke prognosis is gaining particular attention nowadays. Neuron specific enolase (NSE), which is a dimeric isoenzyme of the glycolytic enzyme enolase and is found mainly in the neurons is one such biomarker. This study was carried out on patients of acute ischemic stroke with the aims to determine the correlation between NSE levels on the day of admission with infarct volume, stroke severity, and functional neurological outcome on day 30. Seventy five patients of acute ischemic stroke admitted in the Department of Medicine were included in the study. Levels of NSE were determined on day 1 using the human NSE ELISA kit (Alpha Diagnostic International Texas 78244, USA). Volume of infarct was measured by computed tomography (CT) scan using the preinstalled software Syngo (version A40A) of Siemen's medical solutions (Forchheim, Germany). Stroke severity at admission was assessed using Glasgow coma scale (GCS) and functional neurological outcome was assessed using modified Rankin scale (mRS) on day 30. Statistical analysis was performed using the SPSS software for windows version 15.0 (SPSS). A positive correlation was found between concentration of NSE on day 1 and infarct volume determined by CT scan (r = 0.955, P < 0.001). A strong negative correlation was found between GCS at presentation and concentration of NSE on day 1 (r = -0.806, P < 0.001). There was a positive correlation between NSE levels at day 1 and functional neurological outcome assessed by mRS at day 30 (r = 0.744, P < 0.001). Serum levels of NSE in first few days of ischemic stroke can serve as a useful marker to predict stroke severity and early functional outcome. However, larger studies with serial estimation of NSE are needed to establish these observations more firmly.

  12. Stroke

    Science.gov (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  13. Serum uric acid levels and outcome during admission in acute ischaemic stroke, depending on renal function.

    Science.gov (United States)

    Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana; Robles, Nicolás Roberto

    2018-02-26

    The relationship between serum uric acid (SUA) levels and stroke is controversial. The discrepancies in the results could be due to the uneven setting of comorbidity. It is known that hyperuricaemia increases in parallel with the decline in renal function; however, there are few studies that adjust for renal disease. To investigate the relationship between SUA levels in the acute phase of ischaemic stroke according to the presence or absence of chronic kidney disease and clinical outcomes during admission. Retrospective cross-sectional analysis of patients recruited through a unicentric stroke registry. The sample was divided according to its quartiles of SUA. Renal disease was defined based on the haematocrit, urea and Gender (HUGE) formula. The outcome was determined by the National Institutes of Health Stroke Scale (NIHSS) score. Statistically robust methods were used with R (version 3.3.2). A total of 412 patients (53.8% male) were analysed. The NIHSS score decreased as the SUA levels increased (p function (p stroke (OR = 0.67, 95% CI 0.51-0.88, p = 0.004). Our results support the hypothesis that hyperuricaemia plays a protective role in the prognosis of stroke, independently from renal function, and that even in patients with chronic kidney disease, it remains as a protective agent.

  14. Cuidador familiar de seqüelados de acidente vascular cerebral: significado e implicações Family caregiver of stroke sequel patients: meanings and implications

    Directory of Open Access Journals (Sweden)

    Fernanda de Freitas Mendonça

    2008-01-01

    Full Text Available O acidente vascular cerebral (AVC está entre as principais causas de morte no mundo. Diante das incapacidades impostas pelo AVC, surge o cuidador familiar. O objetivo desta pesquisa foi analisar o significado e as implicações de se tornar cuidador de um indivíduo seqüelado de AVC. Trata-se de um estudo qualitativo, realizado com cinco cuidadores, em Londrina-PR, no período de agosto a dezembro de 2005. Os dados foram coletados por meio de entrevistas semi-estruturadas e submetidos à análise de discurso proposta por Martins e Bicudo. Da análise das entrevistas emergiram sete categorias: voltando-se para o Ser cuidado, descrevendo os cuidados, apresentando as mudanças, o apoio da espiritualidade, compreendendo o significado do cuidado, expressando as necessidades para cuidar e perspectivas para o futuro. Os resultados revelaram que ser cuidador familiar é um fenômeno complexo, que gera nos sujeitos sentimentos de alegria e felicidade concomitantes aos sentimentos de medo, ansiedade e revolta.The brain vascular accident (BVA is one of the main death causes worldwide. Due to the impairments imposed by the BVA, there is the family caregiver. This work aims to analyze the meaning and implications of being a caregiver of a stroke sequel person. It is a qualitative research, carried out with five caregivers in Londrina-PR, from August to December 2005. Data were collected in semi-structured interviews and were subjected to discourse analysis proposed by Martins and Bicudo. From the analysis of interviews seven categories arouse: turning to the being cared, describing care, presenting changes, spirituality support, understanding the meaning of care, expressing the needs to take care and future perspectives. Results revealed that being a family caregiver is a complex phenomenon, that creates in the subjects feelings of happiness and along with feelings of fear, anxiety and revolt.

  15. Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke

    Science.gov (United States)

    Xing, Shihui; Lacey, Elizabeth H.; Skipper-Kallal, Laura M.; Jiang, Xiong; Harris-Love, Michelle L.; Zeng, Jinsheng

    2016-01-01

    The neural mechanisms underlying recovery of language after left hemisphere stroke remain elusive. Although older evidence suggested that right hemisphere language homologues compensate for damage in left hemisphere language areas, the current prevailing theory suggests that right hemisphere engagement is ineffective or even maladaptive. Using a novel combination of support vector regression-based lesion-symptom mapping and voxel-based morphometry, we aimed to determine whether local grey matter volume in the right hemisphere independently contributes to aphasia outcomes after chronic left hemisphere stroke. Thirty-two left hemisphere stroke survivors with aphasia underwent language assessment with the Western Aphasia Battery-Revised and tests of other cognitive domains. High-resolution T1-weighted images were obtained in aphasia patients and 30 demographically matched healthy controls. Support vector regression-based multivariate lesion-symptom mapping was used to identify critical language areas in the left hemisphere and then to quantify each stroke survivor’s lesion burden in these areas. After controlling for these direct effects of the stroke on language, voxel-based morphometry was then used to determine whether local grey matter volumes in the right hemisphere explained additional variance in language outcomes. In brain areas in which grey matter volumes related to language outcomes, we then compared grey matter volumes in patients and healthy controls to assess post-stroke plasticity. Lesion–symptom mapping showed that specific left hemisphere regions related to different language abilities. After controlling for lesion burden in these areas, lesion size, and demographic factors, grey matter volumes in parts of the right temporoparietal cortex positively related to spontaneous speech, naming, and repetition scores. Examining whether domain general cognitive functions might explain these relationships, partial correlations demonstrated that grey matter

  16. Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

    Directory of Open Access Journals (Sweden)

    Heitor Castelo Branco Rodrigues Alves

    2016-01-01

    Full Text Available ABSTRACT Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

  17. High Homocysteine and Blood Pressure Related to Poor Outcome of Acute Ischemia Stroke in Chinese Population

    Science.gov (United States)

    Liu, Changjiang; Zhao, Liang; Zhou, Mo; Sun, Wenjie; Xu, Tan; Tong, Weijun

    2014-01-01

    Objectives To assess the association between plasma homocysteine (Hcy), blood pressure (BP) and poor outcome at hospital discharge among acute ischemic stroke patients, and if high Hcy increases the risk of poor outcome based on high BP status in a northern Chinese population. Methods Between June 1, 2009 and May 31, 2013, a total of 3695 acute ischemic stroke patients were recruited from three hospitals in northern Chinese cities. Demographic characteristics, lifestyle risk factors, medical history, and other clinical characteristics were recorded for all subjects. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score ≥3 or death. The association between homocysteine concentration, admission blood pressure, and risk of poor outcome following acute ischemic stroke was analyzed by using multivariate non-conditional logistic regression models. Results Compared with those in the lowest quartile of Hcy concentration in a multivariate-adjusted model, those in the highest quartile of Hcy concentration had increased risk of poor outcome after acute ischemic stroke, (OR = 1.33, P<0.05). The dose-response relationship between Hcy concentration and risk of poor outcome was statistically significant (p-value for trend  = 0.027). High BP was significantly associated with poor outcome following acute ischemic stroke (adjusted OR = 1.44, 95%CI, 1.19–1.74). Compared with non-high BP with nhHcy, in a multivariate-adjusted model, the ORs (95% CI) of non-high BP with hHcy, high BP with nhHcy, and high BP with hHcy to poor outcome were 1.14 (0.85–1.53), 1.37 (1.03–1.84) and 1.70 (1.29–2.34), respectively. Conclusion The present study suggested that high plasma Hcy and blood pressure were independent risk factors for prognosis of acute ischemic stroke, and hHcy may further increase the risk of poor outcome among patients with high blood pressure. Additionally, the results indicate that high Hcy with high BP may cause increased susceptibility

  18. Embolic strokes of undetermined source in young adults: baseline characteristics and long-term outcome.

    Science.gov (United States)

    Martinez-Majander, N; Aarnio, K; Pirinen, J; Lumikari, T; Nieminen, T; Lehto, M; Sinisalo, J; Kaste, M; Tatlisumak, T; Putaala, J

    2018-03-01

    Embolic strokes of undetermined source (ESUS) are a recent entity, not yet thoroughly investigated in young stroke patients. The clinical characteristics and long-term risks of vascular events and all-cause mortality between young-onset ESUS and other aetiological subgroups were compared. Patients with ESUS were identified amongst the 1008 patients aged 15-49 years with first-ever ischaemic stroke in Helsinki Young Stroke Registry, and primary end-points were defined as recurrent stroke, composite vascular events and all-cause mortality. Cumulative 15-year risks for each end-point were analysed with life tables and adjusted risks were based on Cox proportional hazard analyses. Of the 971 eligible patients, 203 (20.9%) were classified as ESUS. They were younger (median age 40 years, interquartile range 32-46 vs. 45 years, 39-47), more often female (43.3% vs. 35.7%) and had fewer cardiovascular risk factors than other modified TOAST groups. With a median follow-up time of 10.1 years, ESUS patients had the second lowest cumulative risk of recurrent stroke and composite vascular events and lowest mortality compared to other TOAST groups. Large-artery atherosclerosis and small vessel disease carried significantly higher risk for recurrent stroke than did ESUS, whilst no difference appeared between cardioembolism from high-risk sources and ESUS. In our cohort, ESUS patients were younger and had milder cardiovascular risk factor burden and generally better long-term outcome compared to other causes of young-onset stroke. The comparable risk of recurrent stroke between ESUS and high-risk sources of cardioembolism might suggest similarities in their pathophysiology. © 2017 EAN.

  19. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial.

    Science.gov (United States)

    2003-06-01

    Previous studies suggest that undernourished patients with acute stroke do badly. The data, however, are not robust. We aimed to reliably assess the importance of baseline nutritional status as an independent predictor of long-term outcome after stroke in a large prospective cohort enrolled in the Feed Or Ordinary Diet (FOOD) trial, a multicenter randomized trial evaluating various feeding policies. Patients admitted to hospital with a recent stroke were enrolled in the FOOD trial. Data on nutritional status and other clinical predictors of outcome were collected at trial entry. At 6 months, the coordinating center collected data on survival and functional status (modified Rankin Scale). Outcome assessment was done by researchers blinded to baseline assessments and treatment allocation. Between November 1996 and November 2001, 3012 patients were enrolled, and 2955 (98%) were followed up. Of the 275 undernourished patients, 102 (37%) were dead by final follow-up compared with only 445 (20%) of 2194 patients of normal nutritional status (odds ratio [OR], 2.32; 95% CI, 1.78 to 3.02). After adjustment for age, prestroke functional state, and stroke severity, this relationship, although weakened, still held (OR, 1.82; 95% CI, 1.34 to 2.47). Undernourished patients were more likely to develop pneumonia, other infections, and gastrointestinal bleeding during their hospital admission than other patients. These data provide reliable evidence that nutritional status early after stroke is independently associated with long-term outcome. It supports the rationale for the FOOD trial, which continues to recruit and aims to estimate the effect of different feeding regimes on outcome after stroke and thus determine whether the association observed in this study is likely to be causal.

  20. Structural Integrity of Normal Appearing White Matter and Sex-Specific Outcomes After Acute Ischemic Stroke.

    Science.gov (United States)

    Etherton, Mark R; Wu, Ona; Cougo, Pedro; Giese, Anne-Katrin; Cloonan, Lisa; Fitzpatrick, Kaitlin M; Kanakis, Allison S; Boulouis, Gregoire; Karadeli, Hasan H; Lauer, Arne; Rosand, Jonathan; Furie, Karen L; Rost, Natalia S

    2017-12-01

    Women have worse poststroke outcomes than men. We evaluated sex-specific clinical and neuroimaging characteristics of white matter in association with functional recovery after acute ischemic stroke. We performed a retrospective analysis of acute ischemic stroke patients with admission brain MRI and 3- to 6-month modified Rankin Scale score. White matter hyperintensity and acute infarct volume were quantified on fluid-attenuated inversion recovery and diffusion tensor imaging MRI, respectively. Diffusivity anisotropy metrics were calculated in normal appearing white matter contralateral to the acute ischemia. Among 319 patients with acute ischemic stroke, women were older (68.0 versus 62.7 years; P =0.004), had increased incidence of atrial fibrillation (21.4% versus 12.2%; P =0.04), and lower rate of tobacco use (21.1% versus 35.9%; P =0.03). There was no sex-specific difference in white matter hyperintensity volume, acute infarct volume, National Institutes of Health Stroke Scale, prestroke modified Rankin Scale score, or normal appearing white matter diffusivity anisotropy metrics. However, women were less likely to have an excellent outcome (modified Rankin Scale score stroke. The correlation between markers of white matter integrity and functional outcomes in women, but not men, suggests a potential sex-specific mechanism. © 2017 American Heart Association, Inc.

  1. Stroke rehabilitation outcome variation in Veterans Affairs rehabilitation units: accounting for case-mix.

    Science.gov (United States)

    Reker, D M; O'Donnell, J C; Hamilton, B B

    1998-07-01

    To assess variation in stroke outcomes and create a case-mix adjustment model for stroke rehabilitation in Veterans Affairs Medical Centers. Observational Within Veteran's Health Administration hospitals, there are 63 acute rehabilitation bedservice units that care for approximately 2,000 stroke patients annually. Functional gain in FIM points, length of stay (LOS), LOS efficiency (FIM gain/LOS). Significant variation in average patient functional gain, LOS, and LOS efficiency was observed among the 37 highest-volume rehabilitation units. Using analysis of covariance, a model was developed that adjusted functional gain and LOS (logged LOS) unit means using 10 potential covariates identified in a literature review and in pilot studies. Four and six covariates, respectively, were retained in the final models for FIM gain and LOS. The R2 for FIM gain and LOS accounted for by rehabilitation unit alone increased from .07 to .31 (FIM gain) and from .13 to .34 (logLOS) with the addition of the significant covariates to each model. As much as 24% of the variation in two important stroke rehabilitation outcomes is attributable to largely immutable patient and system characteristics (eg, patient function on admission, age, days since stroke onset, year of discharge, marital status, and referral source). Hence, controlling for case-mix is critical for accurate comparison of unit outcomes. Further, the variation in LOS efficiency between VA rehabilitation units suggests a large potential for cost and resource utilization savings system-wide.

  2. Prediction of stroke thrombolysis outcome using CT brain machine learning

    Directory of Open Access Journals (Sweden)

    Paul Bentley

    2014-01-01

    Full Text Available A critical decision-step in the emergency treatment of ischemic stroke is whether or not to administer thrombolysis — a treatment that can result in good recovery, or deterioration due to symptomatic intracranial haemorrhage (SICH. Certain imaging features based upon early computerized tomography (CT, in combination with clinical variables, have been found to predict SICH, albeit with modest accuracy. In this proof-of-concept study, we determine whether machine learning of CT images can predict which patients receiving tPA will develop SICH as opposed to showing clinical improvement with no haemorrhage. Clinical records and CT brains of 116 acute ischemic stroke patients treated with intravenous thrombolysis were collected retrospectively (including 16 who developed SICH. The sample was split into training (n = 106 and test sets (n = 10, repeatedly for 1760 different combinations. CT brain images acted as inputs into a support vector machine (SVM, along with clinical severity. Performance of the SVM was compared with established prognostication tools (SEDAN and HAT scores; original, or after adaptation to our cohort. Predictive performance, assessed as area under receiver-operating-characteristic curve (AUC, of the SVM (0.744 compared favourably with that of prognostic scores (original and adapted versions: 0.626–0.720; p < 0.01. The SVM also identified 9 out of 16 SICHs, as opposed to 1–5 using prognostic scores, assuming a 10% SICH frequency (p < 0.001. In summary, machine learning methods applied to acute stroke CT images offer automation, and potentially improved performance, for prediction of SICH following thrombolysis. Larger-scale cohorts, and incorporation of advanced imaging, should be tested with such methods.

  3. Diffusional Kurtosis Imaging and Motor Outcome in Acute Ischemic Stroke.

    Science.gov (United States)

    Spampinato, M V; Chan, C; Jensen, J H; Helpern, J A; Bonilha, L; Kautz, S A; Nietert, P J; Feng, W

    2017-07-01

    Motor impairment is the most common deficit after stroke. Our aim was to evaluate whether diffusional kurtosis imaging can detect corticospinal tract microstructural changes in the acute phase for patients with first-ever ischemic stroke and motor impairment and to assess the correlations between diffusional kurtosis imaging-derived diffusion metrics for the corticospinal tract and motor impairment 3 months poststroke. We evaluated 17 patients with stroke who underwent brain MR imaging including diffusional kurtosis imaging within 4 days after the onset of symptoms. Neurologic evaluation included the Fugl-Meyer Upper Extremity Motor scale in the acute phase and 3 months poststroke. For the corticospinal tract in the lesioned and contralateral hemispheres, we estimated with diffusional kurtosis imaging both pure diffusion metrics, such as the mean diffusivity and mean kurtosis, and model-dependent quantities, such as the axonal water fraction. We evaluated the correlations between corticospinal tract diffusion metrics and the Fugl-Meyer Upper Extremity Motor scale at 3 months. Among all the diffusion metrics, the largest percentage signal changes of the lesioned hemisphere corticospinal tract were observed with axial kurtosis, with an average 12% increase compared with the contralateral corticospinal tract. The strongest associations between the 3-month Fugl-Meyer Upper Extremity Motor scale score and diffusion metrics were found for the lesioned/contralateral hemisphere corticospinal tract mean kurtosis (ρ = -0.85) and axial kurtosis (ρ = -0.78) ratios. This study was designed to be one of hypothesis generation. Diffusion metrics related to kurtosis were found to be more sensitive than conventional diffusivity metrics to early poststroke corticospinal tract microstructural changes and may have potential value in the prediction of motor impairment at 3 months. © 2017 by American Journal of Neuroradiology.

  4. Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke

    DEFF Research Database (Denmark)

    Krarup, L.H.; Truelsen, T.; Gluud, C.

    2008-01-01

    were randomized in the ExStroke Pilot Trial to an intervention of repeated instructions and encouragement to increase the level of physical activity or to a control group. Prestroke level of physical activity was assessed retrospectively by interview using the Physical Activity Scale for the Elderly......OBJECTIVE: To determine whether prestroke level of physical activity influenced stroke severity and long-term outcome. METHODS: Patients included into the present analyses represent a subset of patients with first-ever stroke enrolled into the ExStroke Pilot Trial. Patients with ischemic stroke...... (PASE) questionnaire. The PASE questionnaire quantifies the amount of physical activity done during a 7-day period. In this prospectively collected patient population initial stroke severity was measured using the Scandinavian Stroke Scale and long-term outcome was assessed after 2 years using...

  5. Influence of statin therapy at time of stroke onset on functional outcome among patients with atrial fibrillation.

    Science.gov (United States)

    Ko, Darae; Thigpen, Jonathan L; Otis, James A; Forster, Kristen; Henault, Lori; Quinn, Emily; Tripodis, Yorghos; Berger, Peter B; Limdi, Nita; Hylek, Elaine M

    2017-01-15

    Statin pretreatment has been associated with reduced infarct volume in nonlacunar strokes. The effect of statins on functional outcomes of strokes related to atrial fibrillation (AF) is unknown. We aimed to define the influence of prestroke statin use on functional outcome in AF. We assembled a cohort of consecutive ischemic stroke patients from 2006 to 2010. All patients underwent CT or MRI and were adjudicated by site investigators. AF was confirmed by electrocardiogram in 100% of patients. Site neurologists blinded to the study hypothesis affirmed the type of stroke and assessed the severity of disability at the time of hospital discharge. The frequency of death at 30-days was calculated. Ischemic stroke (n=1030) resulted in a severe neurological deficit or death (modified Rankin scale ≥4) at 30days in 711 patients (69%). Using multivariable logistic regression models adjusting for factors associated with statin treatment and factors associated with functional outcome, prestroke statin use was associated with a 32% reduction in frequency of severe stroke (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92; P=0.011). Other independent factors associated with severe stroke included older age, female sex, non-White race, diabetes mellitus, prior ischemic stroke, prior venous thromboembolism, and dementia. Ischemic strokes in AF are associated with high mortality and morbidity. Statin use at time of stroke onset among patients with AF was associated in this study with less severe stroke and warrant validation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Adult Day Center Programs and Their Associated Outcomes on Clients, Caregivers, and the Health System: A Scoping Review.

    Science.gov (United States)

    Ellen, Moriah E; Demaio, Peter; Lange, Ariella; Wilson, Michael G

    2017-11-10

    Adult day centers (ADCs) offer a heterogeneous group of services that provide for the daily living, care, nutritional, and social needs of older adults. We sought to conceptually map and identify key gaps and findings from literature focused on ADCs, including the types of programs that exist and their associated outcomes on improving health and strengthening health systems. We conducted a scoping review by searching 5 databases for studies evaluating the outcomes of ADCs specifically for community-dwelling older adults. Included studies were conceptually mapped according to the methods used, type of outcome(s) assessed, study population, disease focus, service focus, and health system considerations. The mapping was used to derive descriptive analyses to profile the available literature in the area. ADC use has positive health-related, social, psychological, and behavioral outcomes for care recipients and caregivers. There is a substantial amount of literature available on some ADC use outcomes, such as health-related, satisfaction-related and psychological and behavioral outcomes, while less research exists on issues of accessibility and cost-effectiveness. As the population ages, policymakers must carefully consider how ADCs can best serve each user and their caregivers with their unique circumstances. ADCs have the potential to help shape health system interventions, especially those targeting caregivers and people requiring long-term care support. Due to the variation among types of ADC programs, future research on ADCs should consider different characteristics of ADC programs to better contextualize their results. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Web-Based Interventions to Improve Mental Health, General Caregiving Outcomes, and General Health for Informal Caregivers of Adults With Chronic Conditions Living in the Community: Rapid Evidence Review.

    Science.gov (United States)

    Ploeg, Jenny; Markle-Reid, Maureen; Valaitis, Ruta; McAiney, Carrie; Duggleby, Wendy; Bartholomew, Amy; Sherifali, Diana

    2017-07-28

    Most adults with chronic conditions live at home and rely on informal caregivers to provide support. Caregiving can result in negative impacts such as poor mental and physical health. eHealth interventions may offer effective and accessible ways to provide education and support to informal caregivers. However, we know little about the impact of Web-based interventions for informal caregivers of community-dwelling adults with chronic conditions. The purpose of this rapid evidence review was to assess the impact of Web-based interventions on mental health, general caregiving outcomes, and general health for informal caregivers of persons with chronic conditions living in the community. A rapid evidence review of the current literature was employed to address the study purpose. EMBASE, MEDLINE, PsychInfo, CINAHL, Cochrane, and Ageline were searched covering all studies published from January 1995 to July 2016. Papers were included if they (1) included a Web-based modality to deliver an intervention; (2) included informal, unpaid adult caregivers of community-living adults with a chronic condition; (3) were either a randomized controlled trial (RCT) or controlled clinical trial (CCT); and (4) reported on any caregiver outcome as a result of use or exposure to the intervention. A total of 20 papers (17 studies) were included in this review. Study findings were mixed with both statistically significant and nonsignificant findings on various caregiver outcomes. Of the 17 included studies, 10 had at least one significant outcome. The most commonly assessed outcome was mental health, which included depressive symptoms, stress or distress, and anxiety. Twelve papers examined the impact of interventions on the outcome of depressive symptoms; 4 found a significant decrease in depressive symptoms. Eight studies examined the outcome of stress or distress; 4 of these found a significant reduction in stress or distress as a result of the intervention. Three studies examined the

  8. Ischemic lesion volume correlates with long-term functional outcome and quality of life of middle cerebral artery stroke survivors

    NARCIS (Netherlands)

    Schiemanck, S. K.; Post, M. W. M.; Kwakkel, G.; Witkamp, Th D.; Kappelle, L. J.; Prevo, A. J. H.

    2005-01-01

    PURPOSE: Previous studies investigating relationships between stroke lesion volume and outcome were restricted to short follow-up periods (3-6 months) and outcome measures of stroke severity and activities only, whereas functional improvement has been found to extend far beyond six months.

  9. Relevance of Post-Stroke Circulating BDNF Levels as a Prognostic Biomarker of Stroke Outcome. Impact of rt-PA Treatment.

    Science.gov (United States)

    Rodier, Marion; Quirié, Aurore; Prigent-Tessier, Anne; Béjot, Yannick; Jacquin, Agnès; Mossiat, Claude; Marie, Christine; Garnier, Philippe

    2015-01-01

    The recombinant form of tissue plasminogen activator (rt-PA) is the only curative treatment for ischemic stroke. Recently, t-PA has been linked to the metabolism of brain-derived neurotrophic factor (BDNF), a major neurotrophin involved in post-stroke neuroplasticity. Thus, the objective of our study was to investigate the impact of rt-PA treatment on post-stroke circulating BDNF levels in humans and in animals. Serum BDNF levels and t-PA/plasmin activity were measured at hospital admission and at up to 90 days in stroke patients receiving (n = 24) or not (n = 14) rt-PA perfusion. We investigated the relationships between serum BDNF with concurrent t-PA/plasmin activity, neurological outcomes and cardiovascular scores at admission. In parallel, serum BDNF levels and t-PA/plasmin activity were assessed before and after (1, 4 and 24h) the induction of ischemic stroke in rats. Our study revealed higher serum BDNF levels and better neurological outcome in rt-PA-treated than non-treated patients. However, serum BDNF levels did not predict stroke outcome when the whole cohort of stroke patients was analyzed. By contrast, serum BDNF levels when measured at admission and at day 90 correlated with cardiovascular scores, and those at day 1 correlated with serum t-PA/plasmin activity in the whole cohort of patients whereas no association could be found in the rt-PA-treated group. In rats devoid of cardiovascular risk, no difference in post-stroke serum BDNF levels was detected between rt-PA- and vehicle-treated animals and no correlation was found between serum BDNF levels and t-PA/plasmin activity. Overall, the data suggest that serum BDNF levels may not be useful as a prognostic biomarker of stroke outcome and that endothelial dysfunction could be a confounding factor when serum BDNF levels after stroke are used to reflect of brain BDNF levels.

  10. Angiotensin AT2-receptor stimulation improves survival and neurological outcome after experimental stroke in mice

    DEFF Research Database (Denmark)

    Schwengel, Katja; Namsolleck, Pawel; Lucht, Kristin

    2016-01-01

    of C21 on neurological outcome, infarct size and expression of BDNF or GAP-43 in AT2-KO mice. From these data, it can be concluded that AT2R stimulation attenuates early mortality and neurological deficits after experimental stroke through neuroprotective mechanisms in an AT2R-specific way. Key message......This study investigated the effect of post-stroke, direct AT2-receptor (AT2R) stimulation with the non-peptide AT2R-agonist compound 21 (C21) on infarct size, survival and neurological outcome after middle cerebral artery occlusion (MCAO) in mice and looked for potential underlying mechanisms. C57...... • AT2R stimulation after MCAO in mice reduces mortality and neurological deficits.• AT2R stimulation increases BDNF synthesis and protects neurons from apoptosis.• The AT2R-agonist C21 acts protectively when applied post-stroke and peripherally....

  11. Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

    Science.gov (United States)

    Asadi, Hamed; Dowling, Richard; Yan, Bernard; Mitchell, Peter

    2014-01-01

    Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408). We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter datasets, likely further improving prediction. Finally, we

  12. Functional Outcome of Hemorrhagic Transformation after Thrombolysis for Ischemic Stroke: A Prospective Study.

    Science.gov (United States)

    Annan, Mariam; Gaudron, Marie; Cottier, Jean-Philippe; Cazals, Xavier; Dejobert, Maelle; Corcia, Philippe; Bertrand, Philippe; Mondon, Karl; de Toffol, Bertrand; Debiais, Séverine

    2015-01-01

    Hemorrhagic transformation (HT) is usually taken into account when symptomatic, but the role of asymptomatic HT is not well known. The aim of our study was to evaluate the link between HT after thrombolysis for ischemic stroke and functional outcome at 3 months, with particular emphasis on asymptomatic HT. Our study was performed prospectively between June 2012 and June 2013 in the Stroke Unit of the University Hospital Center of Tours (France). All patients treated with intravenous thrombolysis were consecutively included. HT was classified on susceptibility-weighted imaging (SWI) with 3-tesla MRI at 7 ± 3 days after treatment. We evaluated functional outcome at 3 months using the modified Rankin Scale (mRS). Dependency was defined as an mRS score of ≥ 3. After 1 year, 128 patients had received thrombolytic therapy for ischemic stroke, of whom 90 patients underwent both 3-tesla MRI and SWI at day 7. Fifty-two had HT, including 8 symptomatic cases. At 3 months, 68% of those patients were dependent compared to 31% of patients without HT [OR 4.6 (1.9-11.4), p = 0.001]. In asymptomatic HT, the rate was 62% [OR 3.5 (1.4-8.9), p = 0.007], but did not reach significance after adjustment for stroke severity. Our study found no statistically significant effect of HT on outcome after adjustment for initial stroke severity. However, the innocuousness of HT is not certain, and only few studies have already highlighted the increased risk of dependency. Using 3-tesla MRI with SWI allows us to increase the detection rate of small hemorrhage. HT after thrombolysis is very frequent on SWI, but the initial stroke severity is an important predictor to assess the role of HT for patient outcome.

  13. Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

    Directory of Open Access Journals (Sweden)

    Hamed Asadi

    Full Text Available INTRODUCTION: Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. METHOD: We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. RESULTS: We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408. DISCUSSION: We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter

  14. Functional Outcome of Hemorrhagic Transformation after Thrombolysis for Ischemic Stroke: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Mariam Annan

    2015-10-01

    Full Text Available Background/Aims: Hemorrhagic transformation (HT is usually taken into account when symptomatic, but the role of asymptomatic HT is not well known. The aim of our study was to evaluate the link between HT after thrombolysis for ischemic stroke and functional outcome at 3 months, with particular emphasis on asymptomatic HT. Methods: Our study was performed prospectively between June 2012 and June 2013 in the Stroke Unit of the University Hospital Center of Tours (France. All patients treated with intravenous thrombolysis were consecutively included. HT was classified on susceptibility-weighted imaging (SWI with 3-tesla MRI at 7 ± 3 days after treatment. We evaluated functional outcome at 3 months using the modified Rankin Scale (mRS. Dependency was defined as an mRS score of ≥3. Results: After 1 year, 128 patients had received thrombolytic therapy for ischemic stroke, of whom 90 patients underwent both 3-tesla MRI and SWI at day 7. Fifty-two had HT, including 8 symptomatic cases. At 3 months, 68% of those patients were dependent compared to 31% of patients without HT [OR 4.6 (1.9-11.4, p = 0.001]. In asymptomatic HT, the rate was 62% [OR 3.5 (1.4-8.9, p = 0.007], but did not reach significance after adjustment for stroke severity. Discussion: Our study found no statistically significant effect of HT on outcome after adjustment for initial stroke severity. However, the innocuousness of HT is not certain, and only few studies have already highlighted the increased risk of dependency. Using 3-tesla MRI with SWI allows us to increase the detection rate of small hemorrhage. Conclusion: HT after thrombolysis is very frequent on SWI, but the initial stroke severity is an important predictor to assess the role of HT for patient outcome.

  15. Exemplary Care as a Mediator of the Effects of Caregiver Subjective Appraisal and Emotional Outcomes

    OpenAIRE

    Harris, Grant M.; Durkin, Daniel W.; Allen, Rebecca S.; DeCoster, Jamie; Burgio, Louis D.

    2011-01-01

    Purpose: Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of care by investigating EC within a diverse sample of dementia CGs. Design and Methods: We examined the relation between CG subjective appraisal (dai...

  16. Coexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke.

    Science.gov (United States)

    Adams, Robert J; Cox, Margueritte; Ozark, Shelly D; Kanter, Julie; Schulte, Phillip J; Xian, Ying; Fonarow, Gregg C; Smith, Eric E; Schwamm, Lee H

    2017-03-01

    The recommended treatment for ischemic stroke is tPA (tissue-type plasminogen activator). Although sickle cell disease (SCD) represents no known contraindication to tPA, National Heart Lung and Blood Institute of the National Institutes of Health recommended acute exchange transfusion for stroke in SCD, not tPA. Data on safety and outcomes of tPA in patients are needed to guide tPA use in SCD. We matched patients from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke registry with SCD to patients without SCD and compared usage, complications, and discharge outcomes after tPA. Multivariable logistic regression models using generalized estimating equations were used to assess outcomes. From 2 016 652 stroke patients admitted to Get With The Guidelines-Stroke sites in the United States, 832 SCD and 3328 non-SCD controls with no differences in admission National Institutes of Health Stroke Scale or blood pressure were identified. Neither the fraction receiving thrombolytic therapy (8.2% for SCD versus 9.4% non-SCD) nor symptomatic intracranial hemorrhage (4.9% of SCD versus 3.2% non-SCD; P =0.4502) was different. There was no difference in a prespecified set of outcome measures for those with SCD compared with controls. Coexistent SCD had no significant impact on the safety or outcome of thrombolytic therapy in acute ischemic stroke. Although the sample size is relatively small, these data suggest that adults with SCD and acute ischemic stroke should be treated with thrombolysis, if they otherwise qualify. Addition studies, however, should track the intracranial hemorrhage rate and provide information on other SCD-related care such as transfusion. © 2017 American Heart Association, Inc.

  17. Presenting Symptoms and Dysphagia Screen Predict Outcome in Mild and Rapidly Improving Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Gadodia, Gaurav; Rizk, Nibal; Camp, Deborah; Bryant, Katja; Zimmerman, Susan; Brasher, Cynthia; Connelly, Kerrin; Dunn, Joshua; Frankel, Michael; Ido, Moges Seymour; Lugtu, James; Nahab, Fadi

    2016-12-01

    There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes. Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home. There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Stroke care programme in Aragon (PAIA): strategy and outcomes for the period 2009-2014.

    Science.gov (United States)

    Marta Moreno, J; Bestué Cardiel, M; Giménez Muñoz, A; Palacín Larroy, M

    2016-06-14

    In 2008, stroke mortality, morbidity, and disability rates in Aragon were higher than the average in Spain. These data underscored the need to develop a stroke care programme (PAIA). We present the dynamics of planning, implementation, evaluation, and improvement developed between 2009 and 2014 as well as the results of the PAIA after that 5-year period. Structure, processes, and outcomes have improved with reference to the key indicators of healthcare (audit: 2008, 2010, 2012) among others: stroke rate in 2013 was 2.07 (2.36 in 2008); 78% of strokes were managed in stroke units in 2014 (30% in 2008); rate of fibrinolysis was 8.3% in 2014 (4.4% in 2010); fibrinolysis was administered in secondary hospitals (30% of the total); fibrinolysis was administered by Telestroke in 9%; stroke mortality decreased (38%); 67.7 years of potential life lost (YPLL) in 2013 (144 in 2008); nurse training; development of neurosonology; networking; sharing protocols and best practices between health sectors, etc. Integrated process management and multidisciplinary teams distributed and deployed over an entire territory with established protocols, references, evaluations, and continuous development, have been proven powerful tools to ensure both quality and equality. The PAIA is a good example of clinical governance and networking due to its dynamic and sustained improvement and cooperation between clinicians. Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Post-stroke apathy and hypersomnia lead to worse outcomes from acute rehabilitation

    Science.gov (United States)

    Harris, Ari L.; Elder, Jessica; Schiff, Nicholas D.; Victor, Jonathan D.; Goldfine, Andrew M.

    2014-01-01

    Apathy and hypersomnia occur after stroke and, by definition, reduce participation in rehabilitation, but their effect on outcome from acute rehabilitation is not known. We performed a retrospective review of 213 patients admitted to a stroke-specialized acute rehabilitation unit in the United States. All patients had ischemic or hemorrhagic stroke, and no dementia or dependence on others pre-stroke. We diagnosed apathy and hypersomnia using standardized documentation by treating therapists. We used multiple regression analysis to control for overall impairment (combination of strength, cognitive and sensory measures), age, time since stroke, and stroke type (ischemic or hemorrhagic). 44 (21%) of patients had persistent apathy, and 12 (5.6%) had persistent hypersomnia. Both groups were more impaired in cognition, sustained attention, and more likely to be treated for depression. Patients with apathy were 2.4 times more likely to go to a nursing home, and had discharge FIM scores 12 points below the mean. Patients with hypersomnia were 10 times more likely to go to a nursing home, and had discharge FIM scores 16 points below the mean. These findings indicate that studies to prospectively define these clinical factors and potential confounds using standardized tools are indicated, and if confirmed, justify studies to identify these patients early and develop targeted interventions. PMID:24323716

  20. Post-stroke apathy and hypersomnia lead to worse outcomes from acute rehabilitation.

    Science.gov (United States)

    Harris, Ari L; Elder, Jessica; Schiff, Nicholas D; Victor, Jonathan D; Goldfine, Andrew M

    2014-04-01

    Apathy and hypersomnia occur after stroke and, by definition, reduce participation in rehabilitation, but their effect on outcome from acute rehabilitation is not known. We performed a retrospective review of 213 patients admitted to a stroke-specialized acute rehabilitation unit in the United States. All patients had ischemic or hemorrhagic stroke, and no dementia or dependence on others pre-stroke. We diagnosed apathy and hypersomnia using standardized documentation by treating therapists. We used multiple regression analysis to control for overall impairment (combination of strength, cognitive and sensory measures), age, time since stroke, and stroke type (ischemic or hemorrhagic). Forty-four (21%) of the patients had persistent apathy, and 12 (5.6%) had persistent hypersomnia. Both groups were more impaired in cognition, sustained attention, and more likely to be treated for depression. Patients with apathy were 2.4 times more likely to go to a nursing home, and had discharge FIM scores 12 points below the mean. Patients with hypersomnia were ten times more likely to go to a nursing home, and had discharge FIM scores 16 points below the mean. These findings indicate that studies to prospectively define these clinical factors and potential confounds using standardized tools are indicated, and if confirmed, justify studies to identify these patients early and develop targeted interventions.

  1. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

    NARCIS (Netherlands)

    M. Geurts (Marjolein); Scheijmans, F.E.V. (Féline E.V.); T. van Seeters (Tom); G.J. Biessels; L.J. Kappelle (Jaap); B.K. Velthuis (Birgitta K.); H.B. van der Worp (Bart); C.B. Majoie (Charles); Y.B.W.E.M. Roos (Yvo); L.E.M. Duijm (Lucien); K. Keizer (Koos); A. van der Lugt (Aad); D.W.J. Dippel (Diederik); Greve, D. (Droogh-de); H.P. Bienfait (Henri); M.A.A. van Walderveen (Marianne); M.J.H. Wermer (Marieke); G.J. Lycklama à Nijeholt (Geert); J. Boiten (Jelis); A. Duyndam (Anita); V.I.H. Kwa; F.J. Meijer (F.); E.J. van Dijk (Ewoud); A.M. Kesselring (Anouk); J. Hofmeijer; J.A. Vos (Jan Albert); W.J. Schonewille (Wouter); W.J. van Rooij (W.); P.L.M. de Kort (Paul); C.C. Pleiter (C.); S.L.M. Bakker (Stef); Bot, J.; M.C. Visser (Marieke); B.K. Velthuis (Birgitta); I.C. van der Schaaf (Irene); J.W. Dankbaar (Jan); W.P. Mali (Willem); van Seeters, T.; A.D. Horsch (Alexander D.); J.M. Niesten (Joris); G.J. Biessels (Geert Jan); L.J. Kappelle (Jaap); J.S.K. Luitse; Y. van der Graaf (Yolanda)

    2016-01-01

    textabstractBackground: High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute

  2. Early Prediction of Outcome of Activities of Daily Living After Stroke A Systematic Review

    NARCIS (Netherlands)

    Veerbeek, Janne M.; Kwakkel, Gert; van Wegen, Erwin E. H.; Ket, Johannes C. F.; Heymans, Martijn W.

    Background and Purpose-Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables

  3. What predicts a poor outcome in older stroke survivors? A systematic review of the literature

    NARCIS (Netherlands)

    van Almenkerk, S.; Smalbrugge, M.; Depla, M.F.I.A.; Eefsting, J.A.; Hertogh, C.M.P.M.

    2013-01-01

    Purpose: To identify factors in the early post-stroke period that have a predictive value for a poor outcome, defined as institutionalization or severe disability. Methods: MEDLINE, PSYCINFO, EMBASE and CINAHL were systematically searched for observational cohort studies in which adult and/or

  4. Early prediction of outcome of activities of daily living after stroke: a systematic review

    NARCIS (Netherlands)

    Veerbeek, J.M.; Kwakkel, G.; van Wegen, E.E.H.; Ket, J.C.F.; Heijmans, M.W.

    2011-01-01

    BACKGROUND AND PURPOSE-Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables

  5. Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke: A Thailand National Database Study.

    Science.gov (United States)

    Wood, Adrian D; Mannu, Gurdeep S; Clark, Allan B; Tiamkao, Somsak; Kongbunkiat, Kannikar; Bettencourt-Silva, Joao H; Sawanyawisuth, Kittisak; Kasemsap, Narongrit; Barlas, Raphae S; Mamas, Mamas; Myint, Phyo Kyaw

    2016-11-01

    Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (Pstroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01-1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46-6.14]), respiratory failure (2.70 [1.91-3.79]), and pneumonia (2.42 [1.88-3.11]). RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke. © 2016 American Heart Association, Inc.

  6. Aspirin Versus Clopidogrel for Type 2 Diabetic Patients with First-Ever Noncardioembolic Acute Ischemic Stroke: Ten-Year Survival Data from the Athens Stroke Outcome Project.

    Science.gov (United States)

    Milionis, Haralampos; Ntaios, George; Papavasileiou, Vasileios; Spengos, Konstantinos; Manios, Efstathios; Elisaf, Moses; Vemmos, Konstantinos

    2017-12-01

    Diabetes mellitus is associated with an increased risk of stroke and poor outcome following a stroke event. We assessed the impact of discharge treatment with aspirin versus clopidogrel on the 10-year survival of patients with type 2 diabetes after a first-ever noncardioembolic acute ischemic stroke (AIS). This was a post hoc analysis of the Athens Stroke Outcome Project. Study outcomes included death, stroke recurrence, and a composite cardiovascular disease (CVD) end point (recurrent stroke, myocardial infarction, unstable angina, coronary revascularization, aortic aneurysm rupture, or sudden death). Kaplan-Meier survival curve and Cox regression analyses were performed. A total of 304 (93 women) diabetic patients receiving either aspirin (n = 197) or clopidogrel (n = 107) were studied. The 10-year survival was better in clopidogrel-treated patients than in aspirin-treated patients (19 deaths [17.7%] for clopidogrel versus 55 deaths [27.9%] for aspirin; log-rank test: 4.91, P = .027). Similarly, clopidogrel was associated with a favorable impact on recurrent stroke (12 events [11.2%] for clopidogrel versus 39 events [19.7%] for aspirin; log-rank test: 4.46, P = .035) and on the composite CVD end point (21 events [19.6%] for clopidogrel versus 54 events [27.4%] for aspirin; log-rank test: 4.17, P = .041). In the multivariable analysis, the beneficial effect of clopidogrel over aspirin on both primary and secondary end points was independent of age, gender, the presence of CVD or CVD risk factors, and stroke severity. Our findings indicate a favorable effect of clopidogrel at discharge compared with aspirin in preventing death, recurrent stroke, and CVD events in diabetic patients with a first-ever noncardioembolic AIS. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Caregiver Stress

    Science.gov (United States)

    ... Home A-Z Health Topics Caregiver stress Caregiver stress > A-Z Health Topics Caregiver fact sheet (PDF, ... receive Publications email updates Enter email Submit Caregiver stress Caregivers care for someone with an illness, injury, ...

  8. INFLAMMATORY MARKERS IN ACUTE ISCHAEMIC STROKE IN RELATION TO CLINICAL SEVERITY AND EARLY OUTCOME

    Directory of Open Access Journals (Sweden)

    S. Gopi

    2018-01-01

    Full Text Available BACKGROUND Biochemical markers of inflammation could be useful to predict severity of stroke in acute phase. Stroke is the third cause of mortality and the first cause of disability. Recent literature have demonstrated that inflammation contributes to all phases of atherosclerosis. The results of researchers suggest that atherosclerosis is an inflammatory disease. The aim of the study is to assess the1. Level of peripheral inflammatory markers in acute ischaemic stroke and their relation to severity of acute stroke. 2. Value of inflammatory markers in predicting the short-term outcome and disability at the end of six months. MATERIALS AND METHODS This is a prospective case control study for 6 months done from September 2014 to August 2016 in 100 patients of acute ischaemic stroke within first 5 days of symptom onset in comparison >18 years of age with 50 age and sex matched controls. Blood samples for all cases and controls were sent for erythrocyte sedimentation rate, Neutrophil-to-Lymphocyte Ratio (NLR, hs-C-reactive protein, mean platelet volume, serum ferritin, serum albumin and S. gamma-glutamyl transferase at admission. RESULTS The mean values of ESR, NLR, hs-CRP in all the cases are higher when compared to the controls and are statistically significant, whereas the mean values of MPV, S. ferritin, S. albumin and GGT in cases are lower when compared to controls, but are within normal range and difference is statistically significant except ferritin. ESR, hs-CRP has significant correlation with severity of acute ischaemic stroke. The mean values of these markers increased with increase in severity. Serum albumin has significant correlation with severity of acute ischaemic stroke with mean values of these markers decreasing with increase in severity of stroke. There is no significant correlation of the inflammatory markers in present study with the short-term outcome. CONCLUSION Inflammation plays an important role in the pathogenesis of non

  9. Long-term outcome after arterial ischemic stroke in children and young adults.

    Science.gov (United States)

    Goeggel Simonetti, Barbara; Cavelti, Ariane; Arnold, Marcel; Bigi, Sandra; Regényi, Mária; Mattle, Heinrich P; Gralla, Jan; Fluss, Joel; Weber, Peter; Hackenberg, Annette; Steinlin, Maja; Fischer, Urs

    2015-05-12

    To compare long-term outcome of children and young adults with arterial ischemic stroke (AIS) from 2 large registries. Prospective cohort study comparing functional and psychosocial long-term outcome (≥2 years after AIS) in patients who had AIS during childhood (1 month-16 years) or young adulthood (16.1-45 years) between January 2000 and December 2008, who consented to follow-up. Data of children were collected prospectively in the Swiss Neuropediatric Stroke Registry, young adults in the Bernese stroke database. Follow-up information was available in 95/116 children and 154/187 young adults. Median follow-up of survivors was 6.9 years (interquartile range 4.7-9.4) and did not differ between the groups (p = 0.122). Long-term functional outcome was similar (p = 0.896): 53 (56%) children and 84 (55%) young adults had a favorable outcome (modified Rankin Scale 0-1). Mortality in children was 14% (13/95) and in young adults 7% (11/154) (p = 0.121) and recurrence rate did not differ (p = 0.759). Overall psychosocial impairment and quality of life did not differ, except for more behavioral problems among children (13% vs 5%, p = 0.040) and more frequent reports of an impact of AIS on everyday life among adults (27% vs 64%, p Stroke Scale/NIH Stroke Scale score was the most important predictor of favorable outcome (p young adults for mortality, disability, quality of life, psychological, or social variables. © 2015 American Academy of Neurology.

  10. Prediction of functional outcomes in stroke patients: the role of motor patterns according to limb synergies.

    Science.gov (United States)

    Gialanella, Bernardo; Santoro, Raffaele

    2015-10-01

    To address the relationships among motor patterns evaluated according to the limb synergies and functional outcomes in stroke patients and clarify which motor pattern was the most important predictor of functional outcomes. The study was conducted on 208 patients with primary diagnosis of stroke admitted for in-hospital rehabilitation. At entry, the Fugl-Meyer Scale was administered to assess motor function according to limb synergies. Pearson's correlation was used to assess the relationship between variables, and backward stepwise regression analysis was used to identify the outcome determinants. Final functional independence measure (FIM) scores and length of in-hospital stay were the outcome measures. At the end of rehabilitation, motor-FIM scores of patients with extensor and flexor synergies, mixing synergies, and no dependence from the synergies were higher than those of no movements and flexor synergy. Multivariate regression analysis showed that extensor synergy of upper limb was an independent predictor of final motor-FIM, personal care and mobility, extensor synergy of lower limb of locomotion, while mixing synergies of upper limb was an independent predictor of length of in-hospital stay. In stroke rehabilitation, the patients' motor patterns according to the synergies strongly relate with functional outcomes and are important outcome predictors.

  11. Life satisfaction two-years after stroke onset: the effects of gender, sex occupational status, memory function and quality of life among stroke patients (Newsqol and their family caregivers (Whoqol-bref in Luxembourg

    Directory of Open Access Journals (Sweden)

    Baumann Michèle

    2012-09-01

    Full Text Available Abstract Background Life satisfaction (LS of cerebrovascular disease survivors and their family caregivers may relate to socioeconomic factors, impaired functions, health-related quality of life (QoL, but their respective influences remain unclear. This study assessed, two years post-stroke onset, the effects of these factors on patients’ LS and family caregivers’ LS in Luxembourg. Methods All stroke patients admitted to all hospitals in Luxembourg were identified by the ‘Inspection Général de la Sécurité Sociale’ using the only national system database for care expenditure reimbursement. Their diagnosis was confirmed by medical investigator. The sample included ninety four patients living at home having given consent (mean age 65.5 years and sixty two main caregivers (mean age 59.3 years. Questionnaires were completed during face-to-face interviews. LS was assessed via European single question (range 1–10, survivors’ QoL via Newsqol (11 dimensions, and caregivers’ QoL via Whoqol-bref (4 domains (range 0–100. Data were analysed using multiple regression models. Results Two years after stroke onset, 44.7% of patients suffered from impaired sensory function, 35.1% from impaired motor function, and 31.9% from impaired memory function. Mean patient’ LS was 7.1/10 (SD 1.9. It was higher in women (+12.4 and lower among unemployed socioeconomically active patients (−13.1, vs. retired people. Adjusted for sex, occupation, impaired motor and memory functions, LS positively correlated with scores of Newsqol feelings, sleep, emotion, cognition and pain dimensions (slopes 0.20 to 0.31, but did not correlate with those of caregivers’ Whoqol-bref domains. Family caregiver’ LS was 7.2 (SD 1.7. It was lower in those with patients suffering from impaired memory function (−12.8 as well as from feelings and emotion issues (slopes 0.22. It was associated with all caregivers’ Whoqol-bref domains (physical health, psychological health

  12. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review.

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    Leire Santisteban

    Full Text Available Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time.Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included.In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMTwas the most commonly used measure (in 36% of studies. Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72% combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL, the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus.The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.

  13. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review

    Science.gov (United States)

    Santisteban, Leire; Térémetz, Maxime; Bleton, Jean-Pierre; Baron, Jean-Claude; Maier, Marc A.; Lindberg, Påvel G.

    2016-01-01

    Background Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians. Objective In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time. Methods Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included. Results In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus. Conclusions The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke. PMID:27152853

  14. Temporal profile of body temperature in acute ischemic stroke: relation to infarct size and outcome.

    Science.gov (United States)

    Geurts, Marjolein; Scheijmans, Féline E V; van Seeters, Tom; Biessels, Geert J; Kappelle, L Jaap; Velthuis, Birgitta K; van der Worp, H Bart

    2016-11-21

    High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute ischemic stroke. In 419 patients with acute ischemic stroke we assessed the relation between body temperature on admission and during the first 3 days with both infarct size and functional outcome. Infarct size was measured in milliliters on CT or MRI after 3 days. Poor functional outcome was defined as a modified Rankin Scale score ≥3 at 3 months. Body temperature on admission was not associated with infarct size or poor outcome in adjusted analyses. By contrast, each additional 1.0 °C in body temperature on day 1 was associated with 0.31 ml larger infarct size (95% confidence interval (CI) 0.04-0.59), on day 2 with 1.13 ml larger infarct size(95% CI, 0.83-1.43), and on day 3 with 0.80 ml larger infarct size (95% CI, 0.48-1.12), in adjusted linear regression analyses. Higher peak body temperatures on days two and three were also associated with poor outcome (adjusted relative risks per additional 1.0 °C in body temperature, 1.52 (95% CI, 1.17-1.99) and 1.47 (95% CI, 1.22-1.77), respectively). Higher peak body temperatures during the first days after ischemic stroke, rather than on admission, are associated with larger infarct size and poor functional outcome. This suggests that prevention of high temperatures may improve outcome if continued for at least 3 days.

  15. Decannulation and Functional Outcome After Tracheostomy in Patients with Severe Stroke (DECAST): A Prospective Observational Study.

    Science.gov (United States)

    Schneider, Hauke; Hertel, Franziska; Kuhn, Matthias; Ragaller, Maximilian; Gottschlich, Birgit; Trabitzsch, Anne; Dengl, Markus; Neudert, Marcus; Reichmann, Heinz; Wöpking, Sigrid

    2017-08-01

    Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients. A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation. We included 53 ventilated stroke patients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.

  16. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol.

    Science.gov (United States)

    van Seeters, Tom; Biessels, Geert Jan; van der Schaaf, Irene C; Dankbaar, Jan Willem; Horsch, Alexander D; Luitse, Merel J A; Niesten, Joris M; Mali, Willem P T M; Kappelle, L Jaap; van der Graaf, Yolanda; Velthuis, Birgitta K

    2014-02-25

    Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated. The DUST is a prospective multi-centre cohort study in 1500 patients with suspected acute ischaemic stroke. All patients undergo non-contrast CT, CT perfusion and CT angiography within 9 hours after onset of the neurological deficits, and, if possible, follow-up imaging after 3 days. The primary outcome is a dichotomised score on the modified Rankin Scale, assessed at 90 days. A score of 0-2 represents good outcome, and a score of 3-6 represents poor outcome. Three logistic regression models will be developed, including patient characteristics and non-contrast CT (model A), with addition of CT angiography (model B), and CT perfusion parameters (model C). Model derivation will be performed in 60% of the study population, and model validation in the remaining 40% of the patients. Additional prognostic value of the models will be determined with the area under the curve (AUC) from the receiver operating characteristic (ROC) curve, calibration plots, assessment of goodness-of-fit, and likelihood ratio tests. This study will provide insight in the added prognostic value of CTP and CTA parameters in outcome prediction of acute stroke patients. The prediction models that will be developed in this study may help guide future treatment decisions in the acute stage of

  17. What Are Some Common Outcomes of Stroke and Some Common Treatments for These Outcomes?

    Science.gov (United States)

    ... Research Information Find a Study Resources and Publications Pediatric Injury Condition Information NICHD Research Information Find a ... functions damaged by the stroke. These therapies include: Physical therapy A physical therapist uses training and exercises to ...

  18. What Are Some Common Outcomes of Stroke and Some Common Treatments for These Outcomes?

    Science.gov (United States)

    ... Research Information Find a Study Resources and Publications Pelvic Floor Disorders Condition Information NICHD Research Information Find a ... functions damaged by the stroke. These therapies include: Physical therapy A physical therapist uses training and exercises to ...

  19. Shared heart failure knowledge and self-care outcomes in patient-caregiver dyads.

    Science.gov (United States)

    Bidwell, Julie T; Higgins, Melinda K; Reilly, Carolyn M; Clark, Patricia C; Dunbar, Sandra B

    Patient's knowledge about heart failure (HF) contributes to successful HF self-care, but less is known about shared patient-caregiver knowledge. The purpose of this analysis was to: 1) identify configurations of shared HF knowledge in patient-caregiver dyads; 2) characterize dyads within each configuration by comparing sociodemographic factors, HF characteristics, and psychosocial factors; and 3) quantify the relationship between configurations and patient self-care adherence to managing dietary sodium and HF medications. This was a secondary analysis of cross-sectional data (N = 114 dyads, 53% spousal). Patient and caregiver HF knowledge was measured with the Atlanta Heart Failure Knowledge Test. Patient dietary sodium intake was measured by 3-day food record and 24 h urine sodium. Medication adherence was measured by Medication Events Monitoring System caps. Patient HF-related quality of life was measured by the Minnesota Heart Failure Questionnaire; caregiver health-related quality of life was measured by the Short Form-12 Physical Component Summary. Patient and caregiver depression were measured with the Beck Depression Inventory-II. Patient and caregiver perceptions of caregiver-provided autonomy support to succeed in heart failure self-care were measured by the Family Care Climate Questionnaire. Multilevel and latent class modeling were used to identify dyadic knowledge configurations. T-tests and chi-square tests were used to characterize differences in sociodemographic, clinical, and psychosocial characteristics by configuration. Logistic/linear regression were used to quantify relationships between configurations and patient dietary sodium and medication adherence. Two dyadic knowledge configurations were identified: "Knowledgeable Together" (higher dyad knowledge, less incongruence; N = 85, 75%) and "Knowledge Gap" (lower dyad knowledge, greater incongruence; N = 29, 25%). Dyads were more likely to be in the "Knowledgeable Together" group if they

  20. Characteristics and outcome of stroke patients with cerebrovascular accident at the intensive care unit of a tertiary hospital in Nigeria.

    Science.gov (United States)

    Tobi, Ku; Okojie, Nq

    2013-01-01

    Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial. Aim & Objectives: To determine the characteristics and outcome of patients with cerebrovascular accident managed at the Intensive Care Unit of University of Benin Teaching Hospital. Demographic characteristics, clinical features and course, treatment options and outcome of all stroke patients admitted in ICU from January 2002 to January 2012 were retrieved from the hospital records and analyzed. A patient before and after each stroke patient were selected as controls for the study. Primary outcome variable was ICU mortality, type of stroke whether ischemic or haemorrhagic, duration of stay, whether patients were transferred from the medical/stroke ward or from the accident and emergency department of the hospital. A total of thirty six (36) stroke patients were admitted into the ICU within the study period accounting for 5.6% of the total ICU admissions. The male: female ratio is 2:1 and patients aged >60 years accounted for 55.6%. Stroke patients admitted into ICU had a mortality rate of 77.8%. Patients with severe stroke admitted into the ICU were 4 times more likely to die compared to non-stroke patients in the ICU (p=0.002, OR=4.472). However, severe stroke had no significant impact on duration of ICU stay (p=0.454, OR=1.464). Stroke patients have a high mortality in the intensive care unit that is independent on the type and route of admission. Provision of the support equipment and instruments required for high dependency service in the intensive care unit and early admission should improve the outcome.

  1. Measure of functional independence dominates discharge outcome prediction after inpatient rehabilitation for stroke.

    Science.gov (United States)

    Brown, Allen W; Therneau, Terry M; Schultz, Billie A; Niewczyk, Paulette M; Granger, Carl V

    2015-04-01

    Identifying clinical data acquired at inpatient rehabilitation admission for stroke that accurately predict key outcomes at discharge could inform the development of customized plans of care to achieve favorable outcomes. The purpose of this analysis was to use a large comprehensive national data set to consider a wide range of clinical elements known at admission to identify those that predict key outcomes at rehabilitation discharge. Sample data were obtained from the Uniform Data System for Medical Rehabilitation data set with the diagnosis of stroke for the years 2005 through 2007. This data set includes demographic, administrative, and medical variables collected at admission and discharge and uses the FIM (functional independence measure) instrument to assess functional independence. Primary outcomes of interest were functional independence measure gain, length of stay, and discharge to home. The sample included 148,367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission (r(2)=0.107). No important additional effect for any other variable was detected when added to this model. This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set. © 2015 American Heart Association, Inc.

  2. Uric Acid Therapy Improves Clinical Outcome in Women With Acute Ischemic Stroke.

    Science.gov (United States)

    Llull, Laura; Laredo, Carlos; Renú, Arturo; Pérez, Belén; Vila, Elisabet; Obach, Víctor; Urra, Xabier; Planas, Anna; Amaro, Sergio; Chamorro, Ángel

    2015-08-01

    It is unknown whether women and men with acute ischemic stroke respond similar to an antioxidant regimen administered in combination with thrombolysis. Here, we investigated the independent effect of sex on the response to uric acid (UA) therapy in patients with acute stroke treated with alteplase. In the Efficacy Study of Combined Treatment With Uric Acid and rtPA in Acute Ischemic Stroke (URICO-ICTUS) trial, 206 women and 205 men were randomized to UA 1000 mg or placebo. In this reanalysis of the trial, the primary outcome was the rate of excellent outcome at 90 days (modified Rankin Scale, 0-1, or 2, if premorbid score of 2) in women and men using regression models adjusted for confounders associated with sex. The interaction of UA levels by treatment on infarct growth was assessed in selected patients. Excellent outcome occurred in 47 of 111 (42%) women treated with UA, and 28 of 95 (29%) treated with placebo, and in 36 of 100 (36%) men treated with UA and 38 of 105 (34%) treated with placebo. Treatment and sex interacted significantly with excellent outcome (P=0.045). Thus, UA therapy doubled the effect of placebo to attain an excellent outcome in women (odd ratio [95% confidence interval], 2.088 [1.050-4.150]; P=0.036), but not in men (odd ratio [95% confidence interval], 0.999 [0.516-1.934]; P=0.997). The interactions between treatment and serum UA levels (P<0.001) or allantoin/UA ratio (P<0.001) on infarct growth were significant only in women. In women with acute ischemic stroke treated with alteplase, the administration of UA reduced infarct growth in selected patients and was better than placebo to reach excellent outcome. URL: https://clinicaltrials.gov. Unique identifier: NCT00860366. © 2015 American Heart Association, Inc.

  3. An Intervention to Maximize Medication Management by Caregivers of Persons with Memory Loss: Intervention Overview and Two-Month Outcomes

    Science.gov (United States)

    Lingler, Jennifer H.; Arida, Janet; Houze, Martin; Kaufman, Robert; Knox, Melissa; Sereika, Susan M.; Tamres, Lisa; Erlen, Judith; Amspaugh, Carolyn; Tang, Fengyan; Happ, Mary Beth

    2016-01-01

    Overseeing medication-taking is a critical aspect of dementia caregiving. This randomized controlled trial examined the efficacy of a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventionists and addressed basic aspects of managing medications, plus tailored problem solving for specific challenges. The outcome of medication management practices was assessed using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and an investigator-developed Medication Deficiency Checklist (MDC). Linear mixed modeling showed both the intervention and usual care groups had decreases in medication management problems as measured by the MedMaIDE (F=6.91, p<.01) and MDC (F=9.72, p<.01) at 2 months post-intervention. The phenomenon of reduced medication deficiencies in both groups suggests that when nurses or social workers merely raise awareness of the importance of medication adherence, there may be benefit. PMID:26804450

  4. Clustered stroke patients on a general medical unit: what nursing skills and knowledge contribute to optimal patient outcomes?

    Science.gov (United States)

    Clayton, Brenda

    2014-01-01

    The purpose of this paper is to explore the nurse's role in caring for adult stroke patients, both ischemic and hemorrhagic, who are clustered on general medical units. There is evidence in the literature that having patients cared for in a dedicated stroke unit improves patient outcomes by decreasing disability and mortality rates for stroke survivors. However having a dedicated stroke unit may not be practical or feasible because of the population distribution, particularly for smaller urban and rural communities. Therefore, training nurses on the general medical units to provide care to clustered stroke patients requires specific skill training. This will decrease hospital stays and improve patient outcomes, as a result of specialized trained health care workers. A review of the literature indicates that there are specific skills and knowledge the nurse requires to perform evidence-based best practice therapy and have optimal patient outcomes when caringfor patients on general medical units.

  5. Caregiver Engagement: Advancing Academic and Behavioral Outcomes for Culturally and Linguistically Diverse Students in Special Education

    Science.gov (United States)

    Whitford, Denise K.; Addis, Aaron K.

    2017-01-01

    The Every Student Succeeds Act encourages home, school, and community partnerships as a method for improving academic achievement. Districts who seek federal funding must provide outreach to all caregivers within the district, making meaningful efforts to attract those with the greatest barriers to engagement. This review provides a thematic…

  6. Determining the needs, priorities, and desired rehabilitation outcomes of young adults who have had a stroke.

    Science.gov (United States)

    Lawrence, Maggie; Kinn, Sue

    2012-01-01

    Background. Guidelines state that young adults' (aged 18-55 years) rehabilitation needs and priorities following stroke are different from older adults'. However, there is a lack of evidence regarding young adults' perspectives of their needs and priorities. Aim. To gain an understanding of young adults' experience of stroke and associated rehabilitation needs, priorities, and desired outcomes. Methods. A qualitative approach was adopted, based on the phenomenology of Merleau-Ponty. Longitudinal data were gathered using unstructured interviews and analysed using phenomenological reduction. Results. Ten young adults took part in up to four interviews over two years. An overarching theme, Embodied Disorientation, and three subthemes: Mortal Body, Situated Body, and Embodied Perception of Difference, described the young adults' experience. A subsequent iterative process enabled tabulation of patient-centred rehabilitation needs, priorities, and outcomes. Conclusion. Rehabilitation professionals can use the evidence-based outcomes table to work with young adults to develop meaningful patient-centred goals and select appropriate interventions which align with identified needs and outcomes throughout the stroke recovery trajectory.

  7. Determining the Needs, Priorities, and Desired Rehabilitation Outcomes of Young Adults Who Have Had a Stroke

    Directory of Open Access Journals (Sweden)

    Maggie Lawrence

    2012-01-01

    Full Text Available Background. Guidelines state that young adults' (aged 18–55 years rehabilitation needs and priorities following stroke are different from older adults'. However, there is a lack of evidence regarding young adults' perspectives of their needs and priorities. Aim. To gain an understanding of young adults' experience of stroke and associated rehabilitation needs, priorities, and desired outcomes. Methods. A qualitative approach was adopted, based on the phenomenology of Merleau-Ponty. Longitudinal data were gathered using unstructured interviews and analysed using phenomenological reduction. Results. Ten young adults took part in up to four interviews over two years. An overarching theme, Embodied Disorientation, and three subthemes: Mortal Body, Situated Body, and Embodied Perception of Difference, described the young adults' experience. A subsequent iterative process enabled tabulation of patient-centred rehabilitation needs, priorities, and outcomes. Conclusion. Rehabilitation professionals can use the evidence-based outcomes table to work with young adults to develop meaningful patient-centred goals and select appropriate interventions which align with identified needs and outcomes throughout the stroke recovery trajectory.

  8. White Matter Hyperintensity Volume and Outcome of Mechanical Thrombectomy With Stentriever in Acute Ischemic Stroke.

    Science.gov (United States)

    Atchaneeyasakul, Kunakorn; Leslie-Mazwi, Thabele; Donahue, Kathleen; Giese, Anne-Katrin; Rost, Natalia S

    2017-10-01

    Finding of white matter hyperintensity (WMH) has been associated with an increased risk of parenchymal hematoma and poor clinical outcomes after mechanical thrombectomy using old-generation endovascular devices. Currently, no data exist with regard to the risk of mechanical thrombectomy using stentriever devices in patients with significant WMH. We hypothesized that WMH volume will not affect the hemorrhagic and clinical outcome in patients with acute ischemic stroke undergoing thrombectomy using new-generation devices. A retrospective cohort of consecutive acute ischemic stroke patients >18-year-old receiving mechanical thrombectomy with stentriever devices at a single academic center was examined. WMH volume was assessed by a semiautomated volumetric analysis on T2 fluid attenuated inversion recovery-magnetic resonance imaging. Outcomes included the rate of any intracerebral hemorrhage, 90-day modified Rankin Score (mRS), the rate of good outcome (discharge mRS ≤2), and the rate of successful reperfusion (thrombolysis in cerebral ischemia score 2b or 3). Between June 2012 and December 2015, 56 patients with acute ischemic stroke met the study criteria. Median WMH volume was 6.76 cm 3 (4.84-16.09 cm 3 ). Increasing WMH volume did not significantly affect the odds of good outcome (odds ratio [OR], 0.811; 95% confidence interval [CI], 0.456-1.442), intracerebral hemorrhage (OR, 1.055; 95% CI, 0.595-1.871), parenchymal hematoma (OR, 0.353; 95% CI, 0.061-2.057), successful recanalization (OR, 1.295; 95% CI, 0.704-2.383), or death (OR, 1.583; 95% CI, 0.84-2.98). Mechanical thrombectomy using stentrievers seems to be safe in selected patients with acute ischemic stroke with large vessel occlusion, nonwithstanding the severity of WMH burden in this population. Larger prospective studies are warranted to validate these findings. © 2017 American Heart Association, Inc.

  9. Collateral flow as causative of good outcomes in endovascular stroke therapy.

    Science.gov (United States)

    Sheth, Sunil A; Sanossian, Nerses; Hao, Qing; Starkman, Sidney; Ali, Latisha K; Kim, Doojin; Gonzalez, Nestor R; Tateshima, Satoshi; Jahan, Reza; Duckwiler, Gary R; Saver, Jeffrey L; Vinuela, Fernando; Liebeskind, David S

    2016-01-01

    Endovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome. Demographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010. Higher collateral grade as assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading scheme on angiography at the time of presentation was associated with improved reperfusion rates after endovascular intervention, decreased post-procedural hemorrhage, smaller infarcts on presentation and discharge, as well as improved neurological function on arrival to the hospital, discharge, and 90 days later. Patients matched by vessel occlusion, age, and time of onset demonstrated smaller strokes on presentation and better functional and radiographic outcome if found to have superior collateral flow. In multivariate analysis, lower collateral grade independently predicted higher NIHSS on arrival. Improved collateral flow in patients with AIS undergoing endovascular therapy was associated with improved radiographic and clinical outcomes. Independent of age, vessel occlusion and time, in patients with comparable ischemic burdens, changes in collateral grade alone led to significant differences in initial stroke severity as well as ultimate clinical outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Lipoic Acid Use and Functional Outcomes after Thrombolysis in Patients with Acute Ischemic Stroke and Diabetes.

    Directory of Open Access Journals (Sweden)

    Kang-Ho Choi

    Full Text Available Alpha-lipoic acid (aLA is a strong antioxidant commonly used for treating diabetic polyneuropathy. Previously, we demonstrated the neurorestorative effects of aLA after cerebral ischemia in rats. However, its effects on patients with stroke remain unknown. We investigated whether patients treated with aLA have better functional outcomes after acute ischemic stroke (AIS and reperfusion therapy than patients not receiving aLA.In this retrospective study of 172 prospectively registered patients with diabetes and AIS treated with tissue plasminogen activator (tPA, we investigated the relationship between aLA use and functional outcome both after 3 months and after 1 year. The functional outcomes included occurrence of hemorrhagic transformation (HT, early neurological deterioration (END, and early clinical improvement (ECI. Favorable outcomes were defined as modified Rankin Scale (mRS scores of 0-2.Of the 172 patients with AIS and diabetes, 47 (27.3% used aLA. In the entire cohort, favorable outcomes occurred at significantly higher rates both at 3 months and at 1 year in those treated with aLA. The risks for END and HT were lower and the occurrence of ECI was higher in patients treated with aLA. In multivariable analysis, aLA use was associated with favorable outcomes both at 3 months and at 1 year. Age, HT, and increased National Institutes of Health Stroke Scale scores were negative predictors of a favorable outcome.The use of aLA in patients with AIS and diabetes who are treated with tPA is associated with favorable outcomes. These results indicate that aLA could be a useful intervention for the treatment of AIS after reperfusion therapy.

  11. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.

    Science.gov (United States)

    Saver, Jeffrey L; Carroll, John D; Thaler, David E; Smalling, Richard W; MacDonald, Lee A; Marks, David S; Tirschwell, David L

    2017-09-14

    Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomization. The results of the analysis of the primary outcome from the original trial period have been reported previously; the current analysis of data from the extended follow-up period was considered to be exploratory. We enrolled 980 patients (mean age, 45.9 years) at 69 sites. Patients were followed for a median of 5.9 years. Treatment exposure in the two groups was unequal (3141 patient-years in the PFO closure group vs. 2669 patient-years in the medical-therapy group), owing to a higher dropout rate in the medical-therapy group. In the intention-to-treat population, recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient-years, respectively (hazard ratio with PFO closure vs. medical therapy, 0.55; 95% confidence interval [CI], 0.31 to 0.999; P=0.046 by the log-rank test). Recurrent ischemic stroke of undetermined cause occurred in 10 patients in the PFO closure group and in 23 patients in the medical-therapy group (hazard ratio, 0.38; 95% CI, 0.18 to 0.79; P=0.007). Venous thromboembolism (which comprised events of pulmonary embolism and deep-vein thrombosis) was more common in the PFO closure group

  12. Caregiver outcomes of partners in dementia care: effect of a care coordination program for veterans with dementia and their family members and friends.

    Science.gov (United States)

    Bass, David M; Judge, Katherine S; Snow, A Lynn; Wilson, Nancy L; Morgan, Robert; Looman, Wendy J; McCarthy, Catherine A; Maslow, Katie; Moye, Jennifer A; Randazzo, Ronda; Garcia-Maldonado, Maurilio; Elbein, Richard; Odenheimer, Germaine; Kunik, Mark E

    2013-08-01

    The objective is to test the effectiveness of Partners in Dementia Care (PDC), a care-coordination program that integrates and improves access to medical and nonmedical services, while strengthening the informal care network and providing information, coaching, and emotional support. PDC was delivered via a partnership between Veterans Affairs (VA) Medical Centers (VAMCs) and Alzheimer's Association chapters, for caregivers of veterans with dementia living in the community and receiving primary care from the VA. The initial sample was 486 caregivers of 508 veterans with diagnosed dementia. Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up, respectively. PDC had a standardized protocol that included assessment and reassessment, action planning, and ongoing monitoring. It was delivered by telephone and e-mail for cost efficiency and the ability to handle caseloads of 100 to 125. Care coordinators from VAMCs and Alzheimer's Association chapters worked as a team using a shared computerized record. A variety of caregiver outcomes was measured after 6 and 12 months. Intervention group caregivers had significant improvements in outcomes representing unmet needs, three types of caregiver strains, depression, and two support resources. Most improvements were evident after 6 months, with more-limited improvements from Months 6 to 12. Some outcomes improved for all caregivers, whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments. PDC is a promising model that improves linkages between healthcare services and community services, which is a goal of several new national initiatives such as the National Plan to Address Alzheimer's Disease and a proposed amendment to the Older Americans Act. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  13. Alberta Stroke Program Early CT Score-Time Score Predicts Outcome after Endovascular Therapy in Patients with Acute Ischemic Stroke: A Retrospective Single-Center Study.

    Science.gov (United States)

    Todo, Kenichi; Sakai, Nobuyuki; Kono, Tomoyuki; Hoshi, Taku; Imamura, Hirotoshi; Adachi, Hidemitsu; Yamagami, Hiroshi; Kohara, Nobuo

    2018-04-01

    Clinical outcomes after successful endovascular therapy in patients with acute ischemic stroke are associated with several factors including onset-to-reperfusion time (ORT), the National Institute of Health Stroke Scale (NIHSS) score, and the Alberta Stroke Program Early CT Score (ASPECTS). The NIHSS-time score, calculated as follows: [NIHSS score] × [onset-to-treatment time (h)] or [NIHSS score] × [ORT (h)], has been reported to predict clinical outcomes after intravenous recombinant tissue plasminogen activator therapy and endovascular therapy for acute stroke. The objective of the current study was to assess whether the combination of the ASPECTS and the ORT can predict the outcomes after endovascular therapy. The charts of 117 consecutive ischemic stroke patients with successful reperfusion after endovascular therapy were retrospectively reviewed. We analyzed the association of ORT, ASPECTS, and ASPECTS-time score with clinical outcome. ASPECTS-time score was calculated as follows: [11 - ASPECTS] × [ORT (h)]. Rates of good outcome for patients with ASPECTS-time scores of tertile values, scores 5.67 or less, scores greater than 5.67 to 10.40 or less, and scores greater than 10.40, were 66.7%, 56.4%, and 33.3%, respectively (P < .05). Ordinal logistic regression analysis showed that the ASPECTS-time score (per category increase) was an independent predictor for better outcome (common odds ratio: .374; 95% confidence interval: .150-0.930; P < .05). A lower ASPECTS-time score may predict better clinical outcomes after endovascular treatment. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians

    Directory of Open Access Journals (Sweden)

    Awosanya Gbolahan O

    2008-07-01

    Full Text Available Abstract Background Hyperhomocysteinemia is a potentially modifiable risk factor for stroke, and may have a negative impact on the course of ischaemic stroke. The role of hyperhomocysteinemia as it relates to stroke in Africans is still uncertain. The objective of this study was to determine the prevalence and short-term impact of hyperhomocysteinemia in Nigerians with acute ischaemic stroke. We hypothesized that Hcy levels are significantly higher than in normal controls, worsen stroke severity, and increase short-term case fatality rates following acute ischaemic stroke. Methods The study employed both a case-control and prospective follow-up design to study hospitalized adults with first – ever acute ischaemic stroke presenting within 48 hours of onset. Clinical histories, neurological evaluation (including National Institutes of Health Stroke Scale (NIHSS scores on admission were documented. Total plasma Hcy was determined on fasting samples drawn from controls and stroke cases (within 24 hours of hospitalization. Outcome at 4 weeks was assessed in stroke patients using the Glasgow Outcome Scale (GOS. Results We evaluated 155 persons (69 acute ischaemic stroke and 86 healthy controls. The mean age ± SD of the cases was 58.8 ± 9.8 years, comparable to that of controls which was 58.3 ± 9.9 years (T = 0.32; P = 0.75. The mean duration of stroke (SD prior to hospitalization was 43.5 ± 38.8 hours, and mean admission NIHSS score was 10.1 ± 7.7. Total fasting Hcy in stroke patients was 10.2 ± 4.6 umol/L and did not differ significantly from controls (10.1 ± 3.6 umol/L; P = 0.88. Hyperhomocysteinemia, defined by plasma Hcy levels > 90th percentile of controls (>14.2 umol/L in women and >14.6 umol/L in men, was present in 7 (10.1% stroke cases and 11 (12.8% controls (odds ratio 0.86, 95% confidence interval 0.31 – 2.39; P > 0.05. In multiple regression analysis admission NIHSS score (but not plasma Hcy was a significant determinant of 4

  15. Outcome and Risk Factors Presented in Old Patients Above 80 Years of Age Versus Younger Patients After Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, Line; Christensen, Louisa; Christensen, Anders

    2014-01-01

    patients received stroke unit care in accordance with the guidelines. The population was dichotomized into patients aged less than 80 years and 80 years of age or older. Modified Rankin Scale (mRS) score and Barthel Index (BI) were used to assess 3-month and 1-year outcome. RESULTS: Patients 80 years...... of age or older presented with significantly more severe strokes than younger patients, median Scandinavian Stroke Scale score 39 vs 42 (P = .003). Median mRS score before stroke was significantly higher in patients aged 80 years or older (P

  16. Incidence of Depression After Stroke, and Associated Risk Factors and Mortality Outcomes, in a Large Cohort of Danish Patients

    DEFF Research Database (Denmark)

    Jørgensen, Terese S. H.; Wium-Andersen, Ida K.; Wium-Andersen, Marie K.

    2016-01-01

    Importance: More than 30 million people live with a stroke diagnosis worldwide. Depression after stroke is frequent, and greater knowledge of associated risk factors and outcomes is needed to understand the etiology and implications of this disabling complication. Objectives: To examine whether......, history of depression, and stroke severity (in patients with stroke). The associations were strongest for the reference population. In both populations, depressed individuals, especially those with new onset, had increased all-cause mortality (hazard ratio for new-onset depression, 1.89 [95% CI, 1...

  17. Burden of Intracranial Atherosclerosis Is Associated With Long-Term Vascular Outcome in Patients With Ischemic Stroke.

    Science.gov (United States)

    Kim, Byung-Su; Chung, Pil-Wook; Park, Kwang-Yeol; Won, Hong-Hee; Bang, Oh Young; Chung, Chin-Sang; Lee, Kwang Ho; Kim, Gyeong-Moon

    2017-10-01

    Ischemic stroke patients often have intracranial atherosclerosis (ICAS), despite heterogeneity in the cause of stroke. We tested the hypothesis that ICAS burden can independently reflect the risk of long-term vascular outcome. This was a retrospective cohort study analyzing data from a prospective stroke registry enrolling consecutive patients with acute ischemic stroke or transient ischemic attack. A total of 1081 patients were categorized into no ICAS, single ICAS, and advanced ICAS (ICAS ≥2 different intracranial arteries) groups. Primary and secondary end points were time to occurrence of recurrent ischemic stroke and composite vascular outcome, respectively. Study end points by ICAS burden were compared using Cox proportional hazards models in overall and propensity-matched patients. ICAS was present in 405 patients (37.3%). During a median 5-year follow-up, recurrent stroke and composite vascular outcome occurred in 6.8% and 16.8% of patients, respectively. As the number of ICAS increased, the risk for study end points increased after adjustment of potential covariates (hazard ratio per 1 increase in ICAS, 1.19; 95% confidence interval, 1.01-1.42 for recurrent ischemic stroke and hazard ratio, 1.18; 95% confidence interval, 1.05-1.33 for composite vascular outcome). The hazard ratios (95% confidence interval) for recurrent stroke and composite vascular outcome in patients with advanced ICAS compared with those without ICAS were 1.56 (0.88-2.74) and 1.72 (1.17-2.53), respectively, in the overall patients. The corresponding values in the propensity-matched patients were 1.28 (0.71-2.30) and 1.95 (1.27-2.99), respectively. ICAS burden was independently associated with the risk of subsequent composite vascular outcome in patients with ischemic stroke. These findings suggest that ICAS burden can reflect the risk of long-term vascular outcome. © 2017 American Heart Association, Inc.

  18. Age-dependent exacerbation of white matter stroke outcomes: a role for oxidative damageand inflammatory mediators

    Science.gov (United States)

    Rosenzweig, Shira; Carmichael, S. Thomas

    2013-01-01

    Background and Purpose Subcortical white matter stroke (WMS) constitutes up to 30% of all stroke subtypes. Mechanisms of oligodendrocyte and axon injury and repair play a central role in the damage and recovery following this type of stroke, and a comprehensive study of these processes requires a specialized experimental model that is different from common large artery, “gray matter” stroke models. Diminished recovery from stroke in aged patients implies that damage and repair processes are affected by advanced age, but such effects have not been studied in WMS. Methods WMS was produced with focal microinjection of the vasoconstrictor L-NIO into the subcortical white matter ventral to the mouse forelimb motor cortex in young adult (2 months), middle aged (15 months) and aged mice (24 months). Results WMS produced localized oligodendrocyte cell death with higher numbers of apoptotic cells and greater oxidative damage in aged brains than in young-adult brains. Increased expression of MCP1 and TNFα in motor cortex neurons correlated with a more distributed microglial activation in aged brains 7 days after WMS. At 2 months aged mice displayed increased white matter atrophy and greater loss of corticostriatal connections compared to young-adult mice. Behavioral testing revealed an age-dependent exacerbation of forelimb motor deficits caused by the stroke, with decreased long-term functional recovery in aged animals. Conclusions Age has a profound effect on the outcome of WMS, with more prolonged cell death and oxidative damage, increased inflammation, greater secondary white matter atrophy and a worse behavioral effect in aged vs young-adult mice. PMID:23868277

  19. Hyperdense basilar artery sign diagnoses acute posterior circulation stroke and predicts short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Xiaoping [Affiliated Hospital of China Medical University at Shenyang, Department of Neurology, Shengjing Hospital, Shenyang (China); Guo, Yang [Shengjing Hospital, Department of Neurology, Shenyang (China)

    2010-12-15

    It is well established that the hyperdense middle cerebral artery sign is a specific marker for early ischemia in anterior circulation. However, little is known about the hyperdense basilar artery sign (HDBA) in posterior circulation. Our aim was to determine whether the HDBA sign has utility in early diagnosis of acute posterior circulation stroke and prediction of short-term outcome. Three-blinded readers examined unenhanced computed tomography scans for the HDBA sign, and materials were classified into two groups according to this sign. Vascular risk factors, admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, short-term outcome, and radiological findings between the two groups were compared. One hundred and twenty-six cases of acute posterior circulation stroke (PCS) were included in the study. No statistically significant differences were found in risk factors of ischemic stroke, except atrial fibrillation (P = 0.025). Admission and discharge NIHSS scores for the positive HDBA group were significantly higher than scores for the negative HDBA group (P = 0.001, 0.002, respectively). The infarction territory for the positive HDBA group was mainly multi-region in nature (51.6%, P < 0.001), while the negative HDBA group showed mainly middle territory infarction. Significant independent predictors of short-term outcome included the HDBA sign (P < 0.001) and admission NIHSS scores (P < 0.001). Approximately half of the HDBA patients showed multi-region infarction and a serious neurological symptom. Based on our results, this sign might not only be helpful in early diagnosis of acute PCS but also be able to correlate with a poor short-term outcome. (orig.)

  20. Chronic kidney disease and poor outcomes in ischemic stroke: is impaired cerebral autoregulation the missing link?

    Science.gov (United States)

    Castro, Pedro; Azevedo, Elsa; Rocha, Isabel; Sorond, Farzaneh; Serrador, Jorge M

    2018-03-02

    Chronic kidney disease increases stroke incidence and severity but the mechanisms behind this cerebro-renal interaction are mostly unexplored. Since both vascular beds share similar features, microvascular dysfunction could be the possible missing link. Therefore, we examined the relationship between renal function and cerebral autoregulation in the early hours post ischemia and its impact on outcome. We enrolled 46 ischemic strokes (middle cerebral artery). Dynamic cerebral autoregulation was assessed by transfer function (coherence, phase and gain) of spontaneous blood pressure oscillations to blood flow velocity within 6 h from symptom-onset. Estimated glomerular filtration rate (eGFR) was calculated. Hemorrhagic transformation (HT) and white matter lesions (WML) were collected from computed tomography performed at presentation and 24 h. Outcome was evaluated with modified Rankin Scale at 3 months. High gain (less effective autoregulation) was correlated with lower eGFR irrespective of infarct side (p functional outcome [ipsilateral OR = 4.39 (CI95% 3.15-25.6), p = 0.019; contralateral OR = 8.15 (CI95% 4.15-15.6), p = 0.002] and increased risk of HT [ipsilateral OR = 3.48 (CI95% 0.60-24.0), p = 0.132; contralateral OR = 6.43 (CI95% 1.40-32.1), p = 0.034]. Lower renal function correlates with less effective dynamic cerebral autoregulation in acute ischemic stroke, both predicting a bad outcome. The evaluation of serum biomarkers of renal dysfunction could have interest in the future for assessing cerebral microvascular risk and relationship with stroke complications.

  1. Outcome of strategy training in stroke patients with apraxia: a phase II study.

    OpenAIRE

    Heugten, C.M. van; Dekker, J.; Deelman, B.G.; Dijk, A.J. van; Stehmann-Saris, J.C.; Kinebanian, A.

    1998-01-01

    Objective: Evaluation of a therapy programme for srorke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. Design: The outcome was studied in de pre-post design. Measurements were conducted at baseline and 12 weeks later. Subjects: Thirty-three stroke patients with apraxia were treated at occupational therapy departments in general hospital...

  2. Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation.

    Science.gov (United States)

    Kabra, Rajesh; Cram, Peter; Girotra, Saket; Vaughan Sarrazin, Mary

    2015-07-15

    Atrial fibrillation (AF) is associated with stroke and death. We sought to determine whether there are any racial differences in the outcomes of death and stroke in patients with AF. We used Medicare administrative data from January 1, 2010, to December 31, 2011, to identify 517,941 patients with newly diagnosed AF. Of these, 452,986 patients (87%) were non-Hispanic white, 36,425 (7%) were black, and 28,530 (6%) were Hispanic. The association between race and outcomes of death and stroke were measured using Cox proportional hazard models. Over a median follow-up period of 20.3 months, blacks had a significantly higher hazard of death (hazard ratio [HR] = 1.46; 95% confidence interval [CI] 1.43 to 1.48; p HR = 1.66; 95% CI 1.57 to 1.75; p controlling for pre-existing co-morbidities, the higher hazard of death in blacks was eliminated (HR 0.95; 95% CI 0.93 to 0.96; p HR = 1.46; 95% CI 1.38 to 1.55; p HR = 1.11; 95% CI 1.09 to 1.14; p HR = 1.21; 95% CI 1.13 to 1.29; p HR 0.82; 95% CI 0.80 to 0.84; p controlling for pre-existing co-morbidities, and the relative hazard of stroke was also attenuated (HR = 1.11; 95% CI 1.03 to 1.18; p 65 years with newly diagnosed AF, the risks of death and stroke are higher in blacks and Hispanics compared with whites. The increased risk was eliminated or significantly reduced after adjusting for pre-existing co-morbidities. AF may be a marker for underlying co-morbidities in black and Hispanic patients who may be at a higher mortality risk. Published by Elsevier Inc.

  3. Gait Change Is Associated with Cognitive Outcome after an Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Sharmila Sagnier

    2017-05-01

    Full Text Available Background: Cognition and gait have often been studied separately after stroke whereas it has been suggested that these two domains could interact through a cognitive-motor interference.Objective: To evaluate the influence of gait changes on cognitive outcome after an ischemic stroke (IS.Methods: We conducted a prospective and monocentric study including patients admitted for an acute supratentorial IS with a National Institute of Health Stroke Score ≤ 15. Cognition, gait and motor disability were evaluated at baseline, 3 months and 1 year post-stroke, using the Montreal Cognitive Assessment (MoCA, the 10-m walking test (10-MWT and the Fugl-Meyer motor assessment (FMMA. The effect of changes in 10-MWT over the year of follow-up on MoCA changes was estimated using a generalized linear mixed model with FMMA, age and gender as covariates.Results: Two hundred and Twelve patients were included (71% male, age 64 ± 13 years old. 10-MWT improved from baseline to 1 year (p < 0.001, as did MoCA (p < 0.001 and FMMA (p < 0.001 scores. Ninety-nine patients (47% had a MoCA <26 at 1 year. Changes in 10-MWT were independently associated with changes in MoCA (β = −0.2, 95% CI −0.24 to −0.07, Bonferroni-corrected p-value = 0.002. Analyses of MoCA sub-scores suggested that changes in gait performance was associated with changes in executive functions and recall.Conclusion: Gait performance is associated with cognitive outcome after a mild to moderate IS, suggesting that they should be managed together to improve post-stroke independence.

  4. Collateral circulation is an independent radiological predictor of outcome after thrombolysis in acute ischaemic stroke

    International Nuclear Information System (INIS)

    Kucinski, T.; Koch, C.; Eckert, B.; Grzyska, U.; Freitag, H.J.; Zeumer, H.; Becker, V.; Kroemer, H.; Heesen, C.; Roether, J.

    2003-01-01

    We tested the hypothesis that the type of vascular occlusion, recanalisation and collateralisation are predictive of outcome after thrombolytic therapy in acute ischaemic stroke. We carried out angiography and local intra-arterial (97) or systemic (14) thrombolysis within 6 h of the onset in patients with an ischaemic stroke in the territory of the internal carotid artery. Early ischaemic signs (EIS) on pretreatment CT and angiographic findings were classified and analysed in relation to clinical outcome at 3 months. A favourable outcome (Barthel index [BI]≥ 90) was found in 40% of patients with an occlusion of the middle cerebral artery trunk whereas intracranial occlusion of the internal carotid artery (''carotid T occlusion'') was followed by death or severe disability (BI<50) in 87%. Significant univariate predictors of favourable outcome were occlusion type (P<0.01), recanalisation (P<0.01) and collateralisation (P<0.01). However, multivariate analysis revealed a significant relationship only between collateralisation and favourable outcome (odds ratio 5.9, 95% confidence interval 1.3-26.7, P=0.02). EIS were not predictive in either case. Occlusion type and recanalisation, are related to outcome only if adequate collateralisation prevents infarction until recanalisation occurs. (orig.)

  5. Homoarginine Levels are Regulated by L-Arginine:Glycine Amidinotransferase and Affect Stroke Outcome: Results from Human and Murine Studies

    NARCIS (Netherlands)

    Choe, C.-U.; Atzler, D.; Wild, P.S.; Carter, A.M.; B\\"oger, R.H.; Ojeda, F.; Simova, O.; Stockebrand, M.; Lackner, K.; Nabuurs, C.; Marescau, B.; Streichert, T.; M\\"uller, C.; L\\"uneburg, N.; Deyn, P.P. de; Benndorf, R.A.; Baldus, S.; Gerloff, C.; Blankenberg, S.; Heerschap, A.; Grant, P.J.; Magnus, T.; Zeller, T.; Isbrandt, D.; Schwedhelm, E.

    2013-01-01

    Endogenous arginine homologues, including homoarginine, have been identified as novel biomarkers for cardiovascular disease and outcomes. Our studies of human cohorts and a confirmatory murine model associated the arginine homologue homoarginine and its metabolism in stroke pathology and

  6. Acute Ischemic Stroke and Long-Term Outcome After Thrombolysis: Nationwide Propensity Score-Matched Follow-Up Study

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Z; Hundborg, Heidi

    2014-01-01

    BACKGROUND AND PURPOSE: Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding......, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used...... to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long...

  7. Neurosurgical outcomes after intracerebral hemorrhage: results of the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST).

    Science.gov (United States)

    Steiner, Thorsten; Vincent, Catherine; Morris, Stephen; Davis, Stephen; Vallejo-Torres, Laura; Christensen, Michael C

    2011-01-01

    The value of neurosurgical interventions after spontaneous intracerebral hemorrhage (SICH) is uncertain. We evaluated clinical outcomes in patients diagnosed with SICH within 3 hours of symptom onset who underwent hematoma evacuation or external ventricular drainage (EVD) of the hematoma in the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST). FAST was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. Neurosurgical procedures (hematoma evacuation and external ventricular drainage) performed at any point after hospital admission were prospectively recorded. Clinical outcomes evaluated were post-SICH disability, as assessed by the modified Rankin Scale; neurologic impairment, as assessed by the National Institutes of Health Stroke Scale; and mortality at 90 days after SICH onset. The impact of neurosurgical procedures on clinical outcomes was evaluated using multivariate logistic regression analysis, controlling for relevant baseline characteristics. Fifty-five of 821 patients underwent neurosurgery. Patients who underwent hematoma evacuation or EVD were on average younger, had greater baseline neurologic impairment, and lower levels of consciousness compared with patients who did not undergo neurosurgery. After adjusting for these differences and other relevant baseline characteristics, we found that neurosurgery was generally associated with unfavorable outcomes at day 90. Among the patients who underwent hematoma evacuation, those with lobar ICH had less ICH expansion than those with deep gray matter ICH, and the smaller expansion was associated with lower mortality. ICH volume was substantially decreased in patients who underwent hematoma evacuation between 24 and 72 hours after hospital admission, and this was associated with better clinical outcome. In conclusion, a small number of patients who underwent neurosurgery in FAST exhibited no overall clinical benefit

  8. Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Janita Pak Chun Chau

    2018-01-01

    Full Text Available BackgroundPoststroke shoulder pain limits stroke survivors’ physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain.MethodsFourteen English and Chinese databases were searched for data from January 2009 to August 2017. The review included adult participants with a clinical diagnosis of ischemic or hemorrhagic stroke who had developed shoulder pain and had undergone conventional acupuncture, electroacupuncture, fire needle acupuncture, or warm needle acupuncture. The participants in the comparison group received the usual stroke care only.ResultsTwenty-nine randomized controlled trials were included. Most studies were assessed as having a substantial risk of bias. Moreover, due to the high heterogeneity of the acupuncture therapies examined, pooling the results in a meta-analysis was not appropriate. A narrative summary of the results is thus presented. The review showed that conventional acupuncture can be associated with benefits in reducing pain and edema and improving upper extremity function and physical function. The effects of conventional acupuncture on improving shoulder range of motion (ROM are in doubt because this outcome was only examined in two trials. Electroacupuncture might be effective in reducing shoulder pain and improving upper extremity function, and conclusions on the effects of electroacupuncture on edema, shoulder ROM, and physical function cannot be drawn due to the limited number of eligible trials. The evidence to support the use of fire needle or warm needle acupuncture in stroke survivors with shoulder pain is also

  9. Dissociations of action means and outcome processing in left-hemisphere stroke.

    Science.gov (United States)

    Kalénine, Solène; Shapiro, Allison D; Buxbaum, Laurel J

    2013-06-01

    Previous evidence suggests that distinct fronto-parietal regions may be involved in representing action kinematics (means) and action results (outcome) during action observation. However, the evidence is contradictory with respect to the precise regions that are critical for each type of representation. Additionally unknown is the degree to which ability to detect action means and outcome during observation is related to action production performance. We used a behavioral task to evaluate the ability of healthy and left-hemisphere stroke participants to detect differences between pairs of videos that dissociated object-related action means (e.g., wiping with circular or straight movement) and/or outcome (e.g., applying or removing detergent). We expected that deficits in detecting action means would be associated with spatiomotor gesture production deficits, whereas deficits in detecting action outcome would predict impairments in complex naturalistic action. We also hypothesized a posterior to anterior gradient in the regions critical for each type of representation, disproportionately affecting means and outcome encoding, respectively. Results indicated that outcome--but not means--detection predicted naturalistic action performance in stroke participants. Regression and voxel lesion-symptom mapping analyses of lesion data revealed that means--but not outcome--coding relies on the integrity of the left inferior parietal lobe, whereas no selective critical brain region could be identified for outcome detection. Thus, means and outcome representations are dissociable at both the behavioral and neuroanatomical levels. Furthermore, the data are consistent with a degree of parallelism between action perception and production tasks. Finally, they reinforce the evidence for a critical role of the left inferior parietal lobule in the representation of action means, whereas action outcome may rely on a more distributed neural circuit. Copyright © 2013 Elsevier Ltd. All

  10. A Prospective Profile of Visual Field Loss following Stroke: Prevalence, Type, Rehabilitation, and Outcome

    Science.gov (United States)

    Rowe, Fiona J.; Wright, David; Brand, Darren; Jackson, Carole; Harrison, Shirley; Maan, Tallat; Vogwell, Linda; Peel, Sarah; Akerman, Nicola; Shipman, Tracey; Sperring, Una; MacDiarmid, Sonia; Freeman, Cicely

    2013-01-01

    Aims. To profile site of stroke/cerebrovascular accident, type and extent of field loss, treatment options, and outcome. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol of visual parameters. Results. 915 patients were recruited with a mean age of 69 years (SD 14). 479 patients (52%) had visual field loss. 51 patients (10%) had no visual symptoms. Almost half of symptomatic patients (n = 226) complained only of visual field loss: almost half (n = 226) also had reading difficulty, blurred vision, diplopia, and perceptual difficulties. 31% (n = 151) had visual field loss as their only visual impairment: 69% (n = 328) had low vision, eye movement deficits, or visual perceptual difficulties. Occipital and parietal lobe strokes most commonly caused visual field loss. Treatment options included visual search training, visual awareness, typoscopes, substitutive prisms, low vision aids, refraction, and occlusive patches. At followup 15 patients (7.5%) had full recovery, 78 (39%) had improvement, and 104 (52%) had no recovery. Two patients (1%) had further decline of visual field. Patients with visual field loss had lower quality of life scores than stroke patients without visual impairment. Conclusions. Stroke survivors with visual field loss require assessment to accurately define type and extent of loss, diagnose coexistent visual impairments, and offer targeted treatment. PMID:24089687

  11. A Prospective Profile of Visual Field Loss following Stroke: Prevalence, Type, Rehabilitation, and Outcome

    Directory of Open Access Journals (Sweden)

    Fiona J. Rowe

    2013-01-01

    Full Text Available Aims. To profile site of stroke/cerebrovascular accident, type and extent of field loss, treatment options, and outcome. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol of visual parameters. Results. 915 patients were recruited with a mean age of 69 years (SD 14. 479 patients (52% had visual field loss. 51 patients (10% had no visual symptoms. Almost half of symptomatic patients (n=226 complained only of visual field loss: almost half (n=226 also had reading difficulty, blurred vision, diplopia, and perceptual difficulties. 31% (n=151 had visual field loss as their only visual impairment: 69% (n=328 had low vision, eye movement deficits, or visual perceptual difficulties. Occipital and parietal lobe strokes most commonly caused visual field loss. Treatment options included visual search training, visual awareness, typoscopes, substitutive prisms, low vision aids, refraction, and occlusive patches. At followup 15 patients (7.5% had full recovery, 78 (39% had improvement, and 104 (52% had no recovery. Two patients (1% had further decline of visual field. Patients with visual field loss had lower quality of life scores than stroke patients without visual impairment. Conclusions. Stroke survivors with visual field loss require assessment to accurately define type and extent of loss, diagnose coexistent visual impairments, and offer targeted treatment.

  12. Risk Factors, Vascular Lesion Distribution, Outcome and Recurrence of Strokes Due to Intracranial Atherosclerosis: One Year Data from Hyderabad Stroke Registry.

    Science.gov (United States)

    Ram, Raghu; Kaul, Subhash; Alladi, Suvarna; Afshan, Jabeen S; Prabha, T Surya; Kohat, Abhijeet; Tandra, Swetha; Rani, Jyotsna Y

    2017-01-01

    Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke in Asian countries and probably in India. The aim of this study was to describe the risk factors, distribution of vascular lesions, recurrence and outcome of stroke due to ICAS. A total of 100 consecutive patients of ischemic stroke due to ICAS were enrolled prospectively from January 1, 2015, to December 31, 2015, and followed for 1 year for treatment compliance and recurrence. The details about demographics, risk factors, and vascular lesions were noted. There were 68 males and 32 females. Hypertension (HTN), diabetes, alcohol, smoking, hyperlipidemia, and hyperhomocysteinemia was present in 82%, 52%, 34%, 33%, 28%, and 23%, respectively. The number of arteries involved were middle cerebral artery, 53 (37.3%); posterior cerebral artery, 24 (16.9%); internal cerebral artery, 21 (14.8%); vertebral artery, 18 (12.7%); basilar artery, 6 (4.2%); and anterior cerebral artery, 6 (4.2%). Seventeen (17%) patients had a recurrent stroke during 1 year follow-up. The presence of uncontrolled HTN and diabetes mellitus after discharge were significantly associated with stroke recurrence ( P < 0.05). The use of dual antiplatelet agents and statins was found to have a significant effect in the prevention of recurrent stroke ( P < 0.05). Severe stroke at presentation and presence of hemiparesis were the predictors for unfavorable outcome at 3 months ( P < 0.05). Risk factors, distribution of vascular lesions and high recurrence of stroke due to ICAS in this study is similar to that reported from other Asian countries. Aggressive medical management and risk factor control remains the best strategy for preventing recurrence.

  13. Development of a caregiver-reported measure to support systematic assessment of people with dementia in long-term care: The Integrated Palliative care Outcome Scale for Dementia.

    Science.gov (United States)

    Ellis-Smith, Clare; Evans, Catherine J; Murtagh, Fliss Em; Henson, Lesley A; Firth, Alice M; Higginson, Irene J; Daveson, Barbara A

    2017-07-01

    Symptom burden is common for long-term care residents with dementia which if untreated compromises quality of life. Measurement tools can support assessment of symptoms and problems but are not widely used in long-term care settings. We developed the Integrated Palliative care Outcome Scale for Dementia derived from the Palliative care Outcome Scale, Palliative care Outcome Scale-Symptom and Integrated Palliative care Outcome Scale. To examine the content validity, acceptability and comprehension of Integrated Palliative care Outcome Scale for Dementia for routine use in long-term care settings for people with dementia and to refine Integrated Palliative care Outcome Scale for Dementia. A multi-method qualitative study consisting of focus groups, semi-structured interviews and cognitive interviews. Three residential long-term care settings in London, UK. Focus group and semi-structured interview participants included caregiver staff, family, general practitioners and district nurses. Caregiver staff were sampled purposively for cognitive interviews. A total of 26 respondents participated in the focus groups ( n = 21) or semi-structured interviews ( n = 5) and 10 caregiver staff completed cognitive interviews. Additional symptoms and problems included agitation, wandering, sleep problems, communication problems and diarrhoea. Refinements or lay terms were required to improve comprehension and consistency of item response for nausea, drowsiness, delusions/hallucinations, agitation, loss of interest, communication problems and interaction. A video presentation was required to support comprehension of instructions and assessment of verbally compromised residents. Integrated Palliative care Outcome Scale for Dementia is a comprehensive and acceptable caregiver-reported measure to detect symptoms and problems in dementia. It is suitable for caregiver staff without professional training as it has been refined and tailored to maximise caregiver expertise, ready for

  14. Hip Hop Stroke: Study Protocol for a Randomized Controlled Trial to Address Stroke Literacy.

    Science.gov (United States)

    Williams, Olajide; Leighton-Herrmann, Ellyn; DeSorbo, Alexandra; Hecht, Mindy; Hedmann, Monique; Huq, Saima; Gerin, William; Chinchilli, Vernon; Ogedegbe, Gbenga; Noble, James

    2015-10-01

    Stroke is the fifth leading cause of death and the leading cause of serious long-term adult disability in the US. Acute stroke treatments with intravenous thrombolysis and endovascular therapy are proven to reduce disability, however a critical limitation on their effectiveness is the narrow time window for administration, which is 4.5 hours and 6 hours respectively from the onset of symptoms. Our overarching goal is to reduce pre-hospital delays to acute stroke treatments in economically disadvantaged minority communities where the greatest delays exist, using Hip Hop Stroke. Hip Hop Stroke (HHS) is a school-based, child-mediated, culturally-tailored stroke communication multimedia intervention developed using validated models of behavior change and designed to improve stroke literacy (knowledge of stroke symptoms, the urgent need to call 911, and prevention measures) of 4 th , 5 th and 6 th grade students and their parents residing in poor urban communities. Children in the intervention arm will receive the HHS intervention, while those in the attentional control arm will receive standardized nutrition education based on the USDA's MyPyramid program. Children will be trained and motivated to share stroke information with their parents or other adult caregiver. Both children and parents will complete a stroke knowledge assessment at baseline, immediately following the program, and at 3-months post-program. The primary outcome is the effect of the child mediation on parental stroke literacy. Stroke literate children, a captive audience in school systems, may represent a viable channel for spreading stroke information into households of poor urban communities where mass media stroke campaigns have shown the lowest penetration. These children may also call 911 when witnessing a stroke in their homes or communities. The HHS program may highlight the potential role of children in the chain of stroke recovery as a strategy for reducing prehospital delays to acute stroke

  15. Comparison of statistical and clinical predictions of functional outcome after ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Douglas D Thompson

    Full Text Available To determine whether the predictions of functional outcome after ischemic stroke made at the bedside using a doctor's clinical experience were more or less accurate than the predictions made by clinical prediction models (CPMs.A prospective cohort study of nine hundred and thirty one ischemic stroke patients recruited consecutively at the outpatient, inpatient and emergency departments of the Western General Hospital, Edinburgh between 2002 and 2005. Doctors made informal predictions of six month functional outcome on the Oxford Handicap Scale (OHS. Patients were followed up at six months with a validated postal questionnaire. For each patient we calculated the absolute predicted risk of death or dependence (OHS≥3 using five previously described CPMs. The specificity of a doctor's informal predictions of OHS≥3 at six months was good 0.96 (95% CI: 0.94 to 0.97 and similar to CPMs (range 0.94 to 0.96; however the sensitivity of both informal clinical predictions 0.44 (95% CI: 0.39 to 0.49 and clinical prediction models (range 0.38 to 0.45 was poor. The prediction of the level of disability after stroke was similar for informal clinical predictions (ordinal c-statistic 0.74 with 95% CI 0.72 to 0.76 and CPMs (range 0.69 to 0.75. No patient or clinician characteristic affected the accuracy of informal predictions, though predictions were more accurate in outpatients.CPMs are at least as good as informal clinical predictions in discriminating between good and bad functional outcome after ischemic stroke. The place of these models in clinical practice has yet to be determined.

  16. CAREGIVER-CHILD INTERACTION, CAREGIVER TRANSITIONS, AND GROUP SIZE AS MEDIATORS BETWEEN INTERVENTION CONDITION AND ATTACHMENT AND PHYSICAL GROWTH OUTCOMES IN INSTITUTIONALIZED CHILDREN.

    Science.gov (United States)

    Warner, Hilary A; McCall, Robert B; Groark, Christina J; Kim, Kevin H; Muhamedrahimov, Rifkat J; Palmov, Oleg I; Nikiforova, Natalia V

    2017-09-01

    This report describes a secondary analysis of data from a comprehensive intervention project which included training and structural changes in three Baby Homes in St. Petersburg, Russian Federation. Multiple mediator models were tested according to the R.M. Baron and D.A. Kenny () causal-steps approach to examine whether caregiver-child interaction quality, number of caregiver transitions, and group size mediated the effects of the intervention on children's attachment behaviors and physical growth. The study utilized a subsample of 163 children from the original Russian Baby Home project, who were between 11 and 19 months at the time of assessment. Results from comparisons of the training and structural changes versus no intervention conditions are presented. Caregiver-child interaction quality and number of caregiver transitions fully mediated the association between intervention condition and attachment behavior. No other mediation was found. Results suggest that the quality of interaction between caregivers and children in institutional care is of primary importance to children's development, but relationship context may play a less direct mediational role, supporting caregiver-child interactions. © 2017 Michigan Association for Infant Mental Health.

  17. Outcomes of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers: a goal-oriented approach

    Directory of Open Access Journals (Sweden)

    Chew J

    2015-10-01

    Full Text Available Justin Chew, Mei-Sian Chong, Yoke-Leng Fong, Laura Tay Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore Background: Nonpharmacological interventions such as exercise and cognitive rehabilitation programs have shown promise in reducing the impact of dementia on the individual and the caregiver. In this study, we examine the effect of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers using conventional measures of cognition, behavior, quality of life (QoL, and caregiver burden together with goal attainment scaling (GAS, an individualized outcome measure.Methods: Goals were set at baseline, and GAS score was calculated at the end of the program. Participants were also assessed with the Chinese Mini-Mental State Examination, functional and behavioral scales (Barthel Index, Instrumental Activities of Daily Living, Neuropsychiatric Inventory Questionnaire, QoL, and caregiver burden using EuroQol-five dimension questionnaire and Zarit Burden Interview (ZBI. Differences in median scores postintervention were obtained. Further analysis of caregiver burden was undertaken utilizing the multidimensional classification of burden on the ZBI.Results: Thirty-four (61.8% patients were assessed to have met their goals (GAS score ≥50. Mean (standard deviation GAS score was 48.6 (6.5. Cognition goals were set in only 20.6%, followed by goals to improve engagement and socialization; reduce caregiver stress; and improve physical function, behavior, and mood. Median scores in the cognitive, functional, and QoL measures did not differ significantly pre- and postintervention. The intervention had a positive impact on role strain, a unique dimension of caregiver burden.Conclusion: This study provides evidence that a multimodal approach combining physical exercise and cognitive rehabilitation improves goal attainment and caregiver burden

  18. PROMIS GH (Patient-Reported Outcomes Measurement Information System Global Health) Scale in Stroke: A Validation Study.

    Science.gov (United States)

    Katzan, Irene L; Lapin, Brittany

    2018-01-01

    The International Consortium for Health Outcomes Measurement recently included the 10-item PROMIS GH (Patient-Reported Outcomes Measurement Information System Global Health) scale as part of their recommended Standard Set of Stroke Outcome Measures. Before collection of PROMIS GH is broadly implemented, it is necessary to assess its performance in the stroke population. The objective of this study was to evaluate the psychometric properties of PROMIS GH in patients with ischemic stroke and intracerebral hemorrhage. PROMIS GH and 6 PROMIS domain scales measuring same/similar constructs were electronically collected on 1102 patients with ischemic and hemorrhagic strokes at various stages of recovery from their stroke who were seen in a cerebrovascular clinic from October 12, 2015, through June 2, 2017. Confirmatory factor analysis was performed to evaluate the adequacy of 2-factor structure of component scores. Test-retest reliability and convergent validity of PROMIS GH items and component scores were assessed. Discriminant validity and responsiveness were compared between PROMIS GH and PROMIS domain scales measuring the same or related constructs. Analyses were repeated stratified by stroke subtype and modified Rankin Scale score component scores (root mean square error of approximation, 0.11). Convergent validity was good with significant correlations between all PROMIS GH items and PROMIS domain scales ( P component scores across modified Rankin Scale levels. Good responsiveness (effect size, >0.5) was demonstrated for 8 of the 10 PROMIS GH items. Reliability and validity remained consistent across stroke subtype and disability level (modified Rankin Scale, <2 versus ≥2). PROMIS GH exhibits acceptable performance in patients with stroke. Our findings support International Consortium for Health Outcomes Measurement recommendation to use PROMIS GH as part of the standard set of outcome measures in stroke. © 2017 American Heart Association, Inc.

  19. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial.

    Science.gov (United States)

    Liebeskind, David S; Tomsick, Thomas A; Foster, Lydia D; Yeatts, Sharon D; Carrozzella, Janice; Demchuk, Andrew M; Jovin, Tudor G; Khatri, Pooja; von Kummer, Ruediger; Sugg, Rebecca M; Zaidat, Osama O; Hussain, Syed I; Goyal, Mayank; Menon, Bijoy K; Al Ali, Firas; Yan, Bernard; Palesch, Yuko Y; Broderick, Joseph P

    2014-03-01

    Endovascular strategies provide unique opportunity to correlate angiographic measures of collateral circulation at the time of endovascular therapy. We conducted systematic analyses of collaterals at conventional angiography on recanalization, reperfusion, and clinical outcomes in the endovascular treatment arm of the Interventional Management of Stroke (IMS) III trial. Prospective evaluation of angiographic collaterals was conducted via central review of subjects treated with endovascular therapy in IMS III (n=331). Collateral grade before endovascular therapy was assessed with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale, blinded to all other data. Statistical analyses investigated the association between collaterals with baseline clinical variables, angiographic measures of recanalization, reperfusion and clinical outcomes. Adequate views of collateral circulation to the ischemic territory were available in 276 of 331 (83%) subjects. Collateral grade was strongly related to both recanalization of the occluded arterial segment (P=0.0016) and downstream reperfusion (P<0.0001). Multivariable analyses confirmed that robust angiographic collateral grade was a significant predictor of good clinical outcome (modified Rankin Scale score≤2) at 90 days (P=0.0353), adjusted for age, history of diabetes mellitus, National Institutes of Health Stroke Scale strata, and Alberta Stroke Program Early CT Score. The relationship between collateral flow and clinical outcome may depend on the degree of reperfusion. More robust collateral grade was associated with better recanalization, reperfusion, and subsequent better clinical outcomes. These data, from the largest endovascular trial to date, suggest that collaterals are an important consideration in future trial design. http://www.clinicaltrials.gov. Unique identifier: NCT00359424.

  20. High serum uric acid levels are a protective factor against unfavourable neurological functional outcome in patients with ischaemic stroke.

    Science.gov (United States)

    Wang, Yu-Fang; Li, Jiao-Xing; Sun, Xun-Sha; Lai, Rong; Sheng, Wen-Li

    2018-01-01

    Objective We aimed to evaluate the association between serum uric acid levels at the onset and prognostic outcome in patients with acute ischaemic stroke. Methods We retrospectively analysed the outcomes of 1166 patients with ischaemic stroke who were hospitalized in our centre during August 2008 to November 2012. Correlations of serum uric acid levels and prognostic outcomes were analysed. Results Men had higher serum uric acid levels and better neurological functional outcomes compared with women. There was a strong negative correlation between serum uric acid levels and unfavourable neurological functional outcomes. Generalized estimated equation analysis showed that a higher serum uric acid level (>237 µmol/L) was a protective factor for neurological functional outcome in male, but not female, patients. Among five trial of ORG 10172 in acute stroke treatment classification subtypes, only patients with the large-artery atherosclerosis subtype had a significant protective effect of serum uric acid levels on neurological outcome. Conclusions Our study shows that high serum uric acid levels are a significant protective factor in men and in the large-artery atherosclerosis subtype in patients with ischaemic stroke. This is helpful for determining the prognostic value of serum uric acid levels for neurological outcome of acute ischaemic stroke.

  1. Prediction of Clinical Outcome in Acute Hemorrhagic Stroke from a Single CT Scan on Admission.

    Science.gov (United States)

    Nag, Chiranjib; Das, Kamalesh; Ghosh, Mrinalkanti; Khandakar, M R

    2012-10-01

    From a single CT scan in primary intracerebral hemorrhage (ICH), clinical outcome can be assessed on admission by using the CT scan parameters. The study aims to find out how hematoma volume, location of stroke, midline shift, intraventricular extension of bleed and ventricle compression influence the clinical outcome in patients with acute ICH. Non-contrast CT scan was done on admission in hospital for every patient with acute hemorrhagic stroke and was analyzed accordingly. Clinical assessments were done in National Institute of Health Stroke Scale (NIHSS). Chi-square test and multiple logistic regression analysis were used for statistical analysis. Mean hematoma volume associated with death before 30 days is 33.16 cm(3) (P 30 cm(3) (OR = 27.857), brain stem hemorrhage (OR = 6.000), intraventricular extension of bleed from other location (OR = 7.846), presence of ventricular compression alone (OR = 2.700) and in combination with midline shift of ≥ 5 mm (OR = 2.124). From a single CT scan during hospital admission, mortality and morbidity in next 30 days can be predicted. A hematoma volume >30 cm(3), brain stem hematoma, intraventricular extension of bleed and ventricular compression along and with midline shift are associated with early mortality in ICH.

  2. Gait outcome following outpatient physiotherapy based on the Bobath concept in people post stroke.

    Science.gov (United States)

    Lennon, Sheila; Ashburn, Ann; Baxter, David

    The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept. Nine patients, at least 6 weeks post stroke and recently discharged from a stroke unit, were measured before and after a period of outpatient physiotherapy (mean duration = 17.4 weeks). Therapy was documented using a treatment checklist for each patient. The primary outcome measures were a number of gait variables related to the therapists' treatment hypothesis, recorded during the gait cycle using the CODA motion analysis system. Other secondary outcome measures were the Motor Assessment Scale, Modified Ashworth Scale, subtests of the Sodring Motor Evaluation Scale, the Step test, a 10-m walk test, the Barthel Index and the London Handicap Score. Recovery of more normal gait patterns in the gait cycle (using motion analysis) did not occur. Significant changes in temporal parameters (loading response, single support time) for both legs, in one kinematic (dorsiflexion during stance) and one kinetic variable on the unaffected side (hip flexor moment), and most of the clinical measures of impairment, activity and participation (with the exception of the Modified Ashworth Scale and the 10-m walk) were noted. Study findings did not support the hypothesis that the Bobath approach restored more normal movement patterns to the gait cycle. Further research is required to investigate the treatment techniques that are effective at improving walking ability in people after stroke.

  3. Relationship between Kidney Dysfunction and Ischemic Stroke Outcomes: Albuminuria, but Not Estimated Glomerular Filtration Rate, Is Associated with the Risk of Further Vascular Events and Mortality after Stroke.

    Science.gov (United States)

    Lee, Seung-Jae; Lee, Dong-Geun

    2016-01-01

    Estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes. In this study, we investigated the longitudinal relationships of the two markers with mortality, vascular events and functional outcomes in a stroke cohort. A total of 295 patients with acute ischemic stroke were prospectively recruited in a single center between May 2012 and February 2015. Renal dysfunction was defined as a decreased eGFR (albuminuria (urine albumin-to-creatinine ratio ≥ 30 mg/g). Good functional outcome at 6 months was defined as a modified Rankin scale score ≤ 2, and the occurrence of major vascular events (stroke, acute coronary syndrome or peripheral artery occlusion) or death was monitored. The associations between renal dysfunction and mortality, major vascular events, and 6-month functional outcome were evaluated by the Cox proportional hazards model and logistic regression analysis. Unadjusted and adjusted hazards ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were obtained. A Kaplan-Meier survival curve for composite adverse events (major vascular events or death) was also computed according to the presence or absence of albuminuria. Albuminuria, not eGFR, was significantly associated with mortality (P = 0.028; HR 2.15; 95% CI 1.09-4.25) and major vascular events (P = 0.044; HR 2.24; 95% CI 1.02-4.94) in the multivariate Cox proportional hazards models adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history, initial National Institutes of Health Stroke Scale (NIHSS) score and eGFR. In addition, albuminuria was negatively associated with 6-month functional outcome in the multivariate logistic regression analysis adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history and eGFR (P = 0.001; OR 0.36; 95% CI 0.20-0.65), but the association disappeared when NIHSS score was

  4. Do Commonly Used Functional Outcome Measures Capture Activities that Are Relevant for People with Stroke in India?

    Science.gov (United States)

    Prakash, V; Ganesan, Mohan; Vasanthan, R; Hariohm, K

    2017-04-01

    In India, post-stroke outcomes are determined using functional outcome measures (FOMs), the contents of which have not been validated for their relevance to the Indian population. In this study, we aimed to evaluate the cultural validity of five frequently used stroke-specific FOMs by comparing their contents with the problems reported by patients with stroke in India. Face-to-face structured interviews were conducted with 152 patients diagnosed with stroke in India. Problems and goals identified by the patients were compared to each item included in the FOMs used in stroke rehabilitation. The Stroke Impact Scale (SIS) and the Frenchay Activities Index (FAI) include items related to the most frequently identified problems. However, neither covers problems related to the need for squatting and sitting on the floor. Use of public transport and community walking are not included in the SIS. Leisure and recreational activities (e.g. gardening, reading books), cognitive and speech functions (e.g. memory, thinking) and bowel and bladder dysfunctions were the common items identified as "not a problem" or "not relevant" by the patients. Our findings suggest that the SIS and FAI are the most appropriate FOMs for patients with stroke in India as they include items related to the majority of problems identified by study participants. Many items on both measures, however, were identified as not a problem or not relevant. There is a need for developing culture-specific FOMs that incorporate all major concerns expressed by patients with stroke in India.

  5. Correlation of the L-Arginine Pathway with Thrombo-Inflammation May Contribute to the Outcome of Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Molnar, Tihamer; Pusch, Gabriella; Nagy, Lajos

    2016-01-01

    BACKGROUND: Immune responses contribute to secondary injury after acute ischemic stroke (AIS), and metabolites of the L-arginine pathway are associated with stroke outcome. Here, we analyzed the relationship of the L-arginine pathway with thrombo-inflammatory biomarkers in AIS and their additive...... and independent associations to outcome. METHODS: Serial changes in P-selectin, tPA, MCP-1, sCD40L, IL-6, IL-8, L-arginine, and asymmetric and symmetric dimethylarginine (ADMA, SDMA) were investigated in 55 patients with AIS and without infection within 6 and 72 hours after stroke onset. Outcomes were assessed...... as National Institutes of Health Stroke Scale (NIHSS) worsening by 24 hours, poststroke infection, and death by 1 month. RESULTS: Serum levels of L-arginine showed negative correlation, whereas ADMA and SDMA showed positive correlation with thrombo-inflammatory biomarkers in the hyperacute phase. Most...

  6. Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy.

    Science.gov (United States)

    Yoo, Albert J; Zaidat, Osama O; Chaudhry, Zeshan A; Berkhemer, Olvert A; González, R Gilberto; Goyal, Mayank; Demchuk, Andrew M; Menon, Bijoy K; Mualem, Elan; Ueda, Dawn; Buell, Hope; Sit, Siu Po; Bose, Arani

    2014-03-01

    The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT. The study cohort was derived from multicenter trials of the Penumbra System. Inclusion criteria were anterior circulation proximal occlusion, evaluable pretreatment NCCT, and known time to reperfusion. Ischemic change was quantified using the Alberta Stroke Program Early CT Score (ASPECTS) and stratified into 3 prespecified groups for comparison: 0 to 4 (most ischemic change) versus 5 to 7 versus 8 to 10 (least ischemic change). A total of 249 patients were analyzed: 40 with ASPECTS 0 to 4, 83 with ASPECTS 5 to 7, and 126 with ASPECTS 8 to 10. For ASPECTS 0 to 4, 5 to 7, and 8 to 10, respectively, good outcome (modified Rankin Scale score, 0-2) rates were 5%, 38.6%, and 46% (P<0.0001), and mortality rates were 55%, 28.9%, and 19% (P=0.0001). The only significant pairwise differences were between ASPECTS 0 to 4 and other groups. Symptomatic hemorrhage was more common with lower ASPECTS (P=0.02). Shorter time to reperfusion was significantly associated with better outcomes among patients with ASPECTS 8 to 10 (P=0.01). A similar relationship was seen for ASPECTS 5 to 7 but was not statistically significant. No such relationship was seen for ASPECTS 0 to 4. NCCT seems useful for excluding patients with the greatest burden of ischemic damage from futile intra-arterial treatment, which is unlikely to result in patient functional independence and increases the risk of hemorrhage.

  7. Development of a patient-centred, patient-reported outcome measure (PROM) for post-stroke cognitive rehabilitation: qualitative interviews with stroke survivors to inform design and content.

    Science.gov (United States)

    Patchick, Emma L; Horne, Maria; Woodward-Nutt, Kate; Vail, Andy; Bowen, Audrey

    2015-12-01

    Improving cognition is service users' top research priority for life after stroke, and future research should include outcomes that they deem important. Patient perspectives on outcomes are collected using patient-reported outcome measures (PROMs). There is currently no patient-centred PROM specific for cognitive rehabilitation trials. Inform PROM development by exploring stroke survivor perspectives on the important, measurable impacts of persisting post-stroke cognitive problems. Qualitative semi-structured interviews in participants' homes. Purposive sample of 16 cognitively impaired stroke survivors at least six months post-stroke. Interviews used a schedule and communication aids developed through patient consultation. Interviews were transcribed verbatim with non-verbal communication recorded using field notes. Data were analysed using a framework approach to find commonalities to shape the focus and content of an outcome measure. Participants identified important impacts of their 'invisible' cognitive problems, outside of other stroke-related impairments. Cognitive problems exacerbated emotional issues and vice versa. Changes in self-identity and social participation were prominent. Impact was not spoken about in terms of frequency but rather in terms of the negative affect associated with problems; terms like 'bothered' and 'frustration' were often used. The results support the development of a PROM specifically designed to address the impact of cognitive problems. It should: include items addressing a comprehensive range of cognitive skills; ask questions about mood, self-identity and social participation; use accessible wording that respondents understand and endorse; measure impact rather than frequency; and explore perceived impact on carers. © 2014 John Wiley & Sons Ltd.

  8. Effect of subtypes of neglect on functional outcome in stroke patients.

    Science.gov (United States)

    Spaccavento, Simona; Cellamare, Fara; Falcone, Rosanna; Loverre, Anna; Nardulli, Roberto

    2017-11-01

    Because of the loss of autonomy in daily-life activities, spatial neglect after stroke is one of the main causes of disability. According to the spatial domains, neglect can be divided into personal (body), peripersonal (reaching) and extrapersonal (far) space. We evaluated the effect of these subtypes of neglect on functional outcome of rehabilitation in stroke patients. A total of 1350 stroke patients were consecutively admitted into our neurorehabilitation unit from 2002 to 2016. We analyzed data for patients with a first ischemic or hemorrhagic right-hemispheric stroke in this observational retrospective study. The presence of neglect was evaluated by using structured tests for specific spatial domains. Patients underwent individual physical and occupational therapy, and those with neglect received specific therapy for 8 consecutive weeks consisting of visual scanning, reading and copying, copying line drawings on a dot matrix and describing scenes. The Functional Independence Measure (FIM) instrument was administered at both admission and discharge to assess functional autonomy. Rehabilitation effectiveness for FIM (percentage of potential improvement achieved) was calculated. Multiple regression analyses were performed. Among 359 patients with right-brain damage, 130 showed left neglect, or unilateral spatial neglect (USN), and 229 only left hemiparesis, without neglect. Overall, 90 patients (69%) with USN showed peripersonal neglect, 89 (68%) extrapersonal neglect and 60 (46%) personal neglect. Functional motor and cognitive impairment was greater with than without USN as measured by FIM at admission and discharge and the rehabilitation hospital stay was longer. USN affected functional status at admission and rehabilitation effectiveness for FIM. Extrapersonal and peripersonal neglect significantly affected both function at admission and effectiveness. Our data confirm the negative prognostic effect of neglect on functional outcome in a large sample. We also

  9. Does English proficiency impact on health outcomes for inpatients undergoing stroke rehabilitation?

    Science.gov (United States)

    Davies, Sarah E; Dodd, Karen J; Tu, April; Zucchi, Emiliano; Zen, Stefania; Hill, Keith D

    2016-07-01

    To determine whether English proficiency and/or the frequency of interpreter use impacts on health outcomes for inpatient stroke rehabilitation. Retrospective case-control study. People admitted for inpatient stroke rehabilitation. A high English proficiency group comprised people with native or near native English proficiency (n = 80), and a low English proficiency group comprised people who preferred a language other than English (n = 80). Length of stay (LOS), discharge destination and Functional Independence Measure (FIM). The low English proficiency group showed a greater improvement in FIM from admission to discharge (p = 0.04). No significant differences were found between groups in LOS, discharge destination and number of encounters with allied health professionals. Increased interpreter usage improved FIM efficiency but did not significantly alter other outcomes. English proficiency does not appear to impact on health outcomes in inpatient rehabilitation with a primarily in-house professional interpreter service. However, there is a need for a larger powered study to confirm these findings. Implications for rehabilitation People with low English proficiency undergoing inpatient stroke rehabilitation in a setting with a primarily in-house professional interpreter service, achieved similar outcomes to those with high English proficiency irrespective of frequency of interpreter usage. A non-significant increase of 4 days length of stay was observed in the low English proficiency group compared to the high English proficiency group. For patients with low English proficiency, greater change in Functional Independence Measure efficiency scores was observed for those with higher levels of interpreter use relative to those with low interpreter use. Clinicians should optimise use of interpreters with patients with low English proficiency when possible.

  10. Perceived value of stroke outcome measures across the post-acute care continuum: a qualitative case study.

    Science.gov (United States)

    Danzl, Megan M; Hunter, Elizabeth G

    2013-04-01

    Connecting the continuum of post-acute care stroke services may be important for easing patients' transition between settings and facilitating recovery and community reintegration. The use of outcome measures is suggested as one means of connecting the continuum. The purpose of this qualitative case study is to describe administrators' and physiotherapists' perceived value of an outcomes program across the post-acute care stroke continuum at a rehabilitation hospital. Data were collected through individual interviews and focus groups with 18 participants. Three themes emerged on the value of the outcomes program: 1) enhanced communication; 2) supports clinical decision-making; and 3) value of objective data. These findings lend support for the use of standardized outcome measures by physiotherapists in stroke rehabilitation. Findings from this study may be useful for organizations and physiotherapists who wish to integrate outcome measures into practice.

  11. Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke.

    Science.gov (United States)

    Medford-Davis, Laura N; Fonarow, Gregg C; Bhatt, Deepak L; Xu, Haolin; Smith, Eric E; Suter, Robert; Peterson, Eric D; Xian, Ying; Matsouaka, Roland A; Schwamm, Lee H

    2016-11-14

    Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke. Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination. We included 589 320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines-Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (rehab (stroke, time to presentation for acute treatment, access to rehabilitation, and in-hospital mortality differ by patient insurance status. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  12. Determinants of caregiving experiences and mental health of partners of cancer patients

    NARCIS (Netherlands)

    Nijboer, C; Triemstra, M; Sanderman, R; van den Bos, GAM

    1999-01-01

    BACKGROUND. Research regarding informal caregiving showed considerable individual variation in responses to cancer caregiving. The current longitudinal study examined determinants of caregiver outcomes in terms of caregiver experiences at 3 months and caregiver's mental health at 6 months after

  13. Determinants of caregiving experiences and mental health of partners of cancer patients

    NARCIS (Netherlands)

    Nijboer, C.; Triemstra, M.; Tempelaar, R.; Sanderman, R.; van den Bos, G. A.

    1999-01-01

    Research regarding informal caregiving showed considerable individual variation in responses to cancer caregiving. The current longitudinal study examined determinants of caregiver outcomes in terms of caregiver experiences at 3 months and caregiver's mental health at 6 months after hospital

  14. Web-based health interventions for family caregivers of elderly individuals: A Scoping Review.

    Science.gov (United States)

    Wasilewski, Marina B; Stinson, Jennifer N; Cameron, Jill I

    2017-07-01

    For the growing proportion of elders globally, aging-related illnesses are primary causes of morbidity causing reliance on family members for support in the community. Family caregivers experience poorer physical and mental health than their non-caregiving counterparts. Web-based interventions can provide accessible support to family caregivers to offset declines in their health and well-being. Existing reviews focused on web-based interventions for caregivers have been limited to single illness populations and have mostly focused on the efficacy of the interventions. We therefore have limited insight into how web-based interventions for family caregiver have been developed, implemented and evaluated across aging-related illness. To describe: a) theoretical underpinnings of the literature; b) development, content and delivery of web-based interventions; c) caregiver usage of web-based interventions; d) caregiver experience with web-based interventions and e) impact of web-based interventions on caregivers' health outcomes. We followed Arksey and O'Malley's methodological framework for conducting scoping reviews which entails setting research questions, selecting relevant studies, charting the data and synthesizing the results in a report. Fifty-three publications representing 32 unique web-based interventions were included. Over half of the interventions were targeted at dementia caregivers, with the rest targeting caregivers to the stroke, cancer, diabetes and general frailty populations. Studies used theory across the intervention trajectory. Interventions aimed to improve a range of health outcomes for caregivers through static and interactive delivery methods Caregivers were satisfied with the usability and accessibility of the websites but usage was generally low and declined over time. Depression and caregiver burden were the most common outcomes evaluated. The interventions ranged in their impact on health and social outcomes but reductions in perception of

  15. Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Yu CS

    2016-03-01

    Full Text Available Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline m

  16. ‘I felt pain. Deep pain…’: Experiences of primary caregivers of stroke survivors with aphasia in a South African township

    Directory of Open Access Journals (Sweden)

    Khetsiwe P. Masuku

    2018-03-01

    Conclusions: Contextual factors of caregivers in Tembisa have an influence on the experiences between caregivers and PWA, the feelings of individuals and families and health-seeking behaviours of individuals and families.

  17. Confounding by Pre-Morbid Functional Status in Studies of Apparent Sex Differences in Severity and Outcome of Stroke.

    Science.gov (United States)

    Renoux, Christel; Coulombe, Janie; Li, Linxin; Ganesh, Aravind; Silver, Louise; Rothwell, Peter M

    2017-10-01

    Several studies have reported unexplained worse outcomes after stroke in women but none included the full spectrum of symptomatic ischemic cerebrovascular events while adjusting for prior handicap. Using a prospective population-based incident cohort of all transient ischemic attack/stroke (OXVASC [Oxford Vascular Study]) recruited between April 2002 and March 2014, we compared pre-morbid and post-event modified Rankin Scale score (mRS) in women and men and change in mRS score 1 month, 6 months, 1 year, and 5 years after stroke. Baseline stroke-related neurological impairment was measured with the National Institutes of Health Stroke Scale. Among 2553 patients (50.6% women) with a first transient ischemic attack/ischemic stroke, women had a worse handicap 1 month after ischemic stroke (age-adjusted odds ratio for mRS score, 1.35; 95% confidence interval, 1.12-1.63). However, women also had a higher pre-morbid mRS score compared with men (age-adjusted odds ratio, 1.58; 95% confidence interval, 1.36-1.84). There was no difference in stroke severity when adjusting for age and pre-morbid mRS (odds ratio, 1.10; 95% confidence interval, 0.90-1.35) and no difference in the pre-/poststroke change in mRS at 1 month (age-adjusted odds ratio, 1.00; 95% confidence interval, 0.82-1.21), 6 months, 1 year, and 5 years. Women had a lower mortality rate, and there was no sex difference in risk of recurrent stroke. We found no evidence of a worse outcome of stroke in women when adjusting for age and pre-morbid mRS. Failure to account for sex differences in pre-morbid handicap could explain contradictory findings in previous studies. Properties of the mRS may also contribute to these inconsistencies. Copyright © 2017 The Author(s).

  18. Alberta Stroke Program Early CT Scale evaluation of multimodal computed tomography in predicting clinical outcomes of stroke patients treated with aspiration thrombectomy.

    Science.gov (United States)

    Psychogios, Marios-Nikos; Schramm, Peter; Frölich, Andreas Maximilian; Kallenberg, Kai; Wasser, Katrin; Reinhardt, Lars; Kreusch, Andreas S; Jung, Klaus; Knauth, Michael

    2013-08-01

    Patient selection is crucial in the endovascular treatment of acute ischemic stroke patients. Baseline computed tomographic (CT) images, evaluated with the Alberta Stroke Program Early CT Scale (ASPECTS), are considered significant predictors of outcome. In this study, we evaluated CT images and perfusion parameters, analyzed with ASPECTS, as final outcome predictors after endovascular stroke treatment. We analyzed a cohort of patients with acute ischemic stroke and endovascular treatment. Patients with an occlusion of the M1 segment and multimodal CT imaging were included. CT perfusion data were reconstructed using commercial software. Two experienced neuroradiologists separately reviewed and scored CT and CT perfusion images with the ASPECTS score. Parameters were compared between patients with poor and with favorable follow-up outcome. Significantly different variables were further analyzed by forward stepwise logistic regression. Fifty-one patients were included in our study. Baseline characteristics did not differ between patients with favorable and poor outcomes. No significant difference in recanalization status, the various times, or CT ASPECTS was demonstrated between these 2 groups. Significant differences were demonstrated for age (P=0.0049), cerebral blood volume ASPECTS (P=0.0007), and between cerebral blood volume and cerebral blood flow ASPECTS (P=0.0045). Cerebral blood volume ASPECTS>7 demonstrated the highest sensitivity and specificity for favorable outcome with 84% and 79%, respectively. CT perfusion parameters, evaluated with ASPECTS, are optimal predictors of outcome and are more sensitive and specific than CT ASPECTS in the prediction of favorable outcome. Use of these parameters in treatment decisions could reduce futile recanalizations.

  19. Outcome of aerobic exercises on 6-minute walk test in post-stroke patients

    International Nuclear Information System (INIS)

    Andleeb, U.; Qamar, M.M.; Afridi, M.S.; Asim, H.M.; Basharat, A.

    2017-01-01

    Objectives: To determine the outcome of aerobic exercises on 6MWT in stroke survivors Methodology: This study is quasi-experimental done in a tertiary care hospital and included a total of 104 ambulatory stroke patients. Subjects walked on self-selected speed on a treadmill along a prescribed course for 10 weeks. Results: The ratio of male patients was more as compared to females (67.31% vs. 32.69). Only 3 out of total 104 patients were lost to follow-up. No difference was observed post exercise in the mean HR beats/minute (P=0.432). Moreover, no difference was observed in the mean systolic (P=0.543) and diastolic BP of the patients with treadmill training (P=0.367). However, aerobic exercises improved walking and endurance in stroke survivors from 196+-120m at baseline to 230 +-132m after aerobic training (P=0.001). Conclusions: Treadmill walking improved patients walking ability for long distances and if they retain and improve it further, they can ambulate functionally and independently. (author)

  20. Development and Validation of a Predictive Model for Functional Outcome After Stroke Rehabilitation: The Maugeri Model.

    Science.gov (United States)

    Scrutinio, Domenico; Lanzillo, Bernardo; Guida, Pietro; Mastropasqua, Filippo; Monitillo, Vincenzo; Pusineri, Monica; Formica, Roberto; Russo, Giovanna; Guarnaschelli, Caterina; Ferretti, Chiara; Calabrese, Gianluigi

    2017-12-01

    Prediction of outcome after stroke rehabilitation may help clinicians in decision-making and planning rehabilitation care. We developed and validated a predictive tool to estimate the probability of achieving improvement in physical functioning (model 1) and a level of independence requiring no more than supervision (model 2) after stroke rehabilitation. The models were derived from 717 patients admitted for stroke rehabilitation. We used multivariable logistic regression analysis to build each model. Then, each model was prospectively validated in 875 patients. Model 1 included age, time from stroke occurrence to rehabilitation admission, admission motor and cognitive Functional Independence Measure scores, and neglect. Model 2 included age, male gender, time since stroke onset, and admission motor and cognitive Functional Independence Measure score. Both models demonstrated excellent discrimination. In the derivation cohort, the area under the curve was 0.883 (95% confidence intervals, 0.858-0.910) for model 1 and 0.913 (95% confidence intervals, 0.884-0.942) for model 2. The Hosmer-Lemeshow χ 2 was 4.12 ( P =0.249) and 1.20 ( P =0.754), respectively. In the validation cohort, the area under the curve was 0.866 (95% confidence intervals, 0.840-0.892) for model 1 and 0.850 (95% confidence intervals, 0.815-0.885) for model 2. The Hosmer-Lemeshow χ 2 was 8.86 ( P =0.115) and 34.50 ( P =0.001), respectively. Both improvement in physical functioning (hazard ratios, 0.43; 0.25-0.71; P =0.001) and a level of independence requiring no more than supervision (hazard ratios, 0.32; 0.14-0.68; P =0.004) were independently associated with improved 4-year survival. A calculator is freely available for download at https://goo.gl/fEAp81. This study provides researchers and clinicians with an easy-to-use, accurate, and validated predictive tool for potential application in rehabilitation research and stroke management. © 2017 American Heart Association, Inc.

  1. Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

    DEFF Research Database (Denmark)

    Maribo, Thomas; Nielsen, Claus Vinther

    Relevance: Stroke is one of the major chronic diseases leading to long-term disability. Stroke treatment has improved and in-hospital stays have been reduced, leading to increasing emphasis on home-based rehabilitation. The transition from hospital to home-based rehabilitation is critical, as vital...... are vague. Purpose: The purpose was to examine the use of outcome measures used in clinical practice in the transition from hospital to home-based rehabilitation. Methods/Analysis: A questionnaire were sent to the heads of 26 hospitals discharging patients with stroke and 52 municipalities' health services...... rehabilitation, especially in the transition between hospital and home-based rehabilitation. A nationwide, interprofessional and intersectional group is currently discussing recommendations for the use of outcome measures in stroke rehabilitation. Results from this group will be presented at the conference...

  2. Intracerebral Hemorrhage and Outcome After Thrombolysis in Stroke Patients Using Selective Serotonin-Reuptake Inhibitors.

    Science.gov (United States)

    Scheitz, Jan F; Turc, Guillaume; Kujala, Linda; Polymeris, Alexandros A; Heldner, Mirjam R; Zonneveld, Thomas P; Erdur, Hebun; Curtze, Sami; Traenka, Christopher; Brenière, Céline; Wiest, Roland; Rocco, Andrea; Sibolt, Gerli; Gensicke, Henrik; Endres, Matthias; Martinez-Majander, Nicolas; Béjot, Yannick; Nederkoorn, Paul J; Oppenheim, Catherine; Arnold, Marcel; Engelter, Stefan T; Strbian, Daniel; Nolte, Christian H

    2017-12-01

    Selective serotonin-reuptake inhibitors (SSRIs) impair platelet function and have been linked to a higher risk of spontaneous intracerebral hemorrhage-an association that may be augmented by oral anticoagulants (OAC). We aimed to assess whether preadmission treatment with SSRIs in patients with acute ischemic stroke is associated with post-thrombolysis symptomatic intracerebral hemorrhage (sICH) and functional outcome. A multicenter retrospective analysis was conducted in prospective registries of patients treated by thrombolysis within 4.5 hours of stroke onset. The association between preadmission treatment with SSRIs and sICH (ECASS II definition [European Cooperative Acute Stroke Study]) or unfavorable 3-month outcome (modified Rankin Scale >2) was assessed by logistic regression, taking into account potential interaction with concomitant use of antithrombotics. Six thousand two hundred forty-two patients were included (mean age, 70.1±14.0 years; median National Institutes of Health Stroke Scale, 9 [5-16]). Preadmission treatment with SSRIs was present in 4.3% (n=266) of patients. Overall, SICH rate was 3.9% (95% confidence interval [CI], 3.5%-4.4%; n=244), and SSRI use was not significantly associated with sICH in unadjusted (odds ratio [OR], 1.28; 95% CI, 0.72-2.27) or adjusted (OR, 1.30; 95% CI, 0.71-2.40) analysis. However, there was a significant interaction of concomitant use of OACs (international normalized ratio <1.7) and SSRI for occurrence of sICH ( P =0.01). SICH was significantly more frequent in patients taking both OAC and SSRI (23.1%; 95% CI, 8.2%-50.3%) than in patients taking OAC but not SSRI (adjusted OR, 9.04; 95% CI, 1.95-41.89). Preadmission use of SSRI was associated with unfavorable 3-month outcome (unadjusted OR, 1.90; 95% CI, 1.48-2.46; adjusted OR, 1.59; 95% CI, 1.15-2.19). Preadmission treatment with SSRIs was not significantly associated with an increased risk of post-thrombolysis sICH in this cohort study. However, subgroup

  3. Hospital arrival time and functional outcome after acute ischaemic stroke: results from the PREMIER study.

    Science.gov (United States)

    León-Jiménez, C; Ruiz-Sandoval, J L; Chiquete, E; Vega-Arroyo, M; Arauz, A; Murillo-Bonilla, L M; Ochoa-Guzmán, A; Carrillo-Loza, K; Ramos-Moreno, A; Barinagarrementeria, F; Cantú-Brito, C

    2014-05-01

    Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  4. The impact of `admit no bed` and long boarding times in the emergency department on stroke outcome.

    Science.gov (United States)

    Al-Khathaami, Ali M; Abulaban, Ahmad A; Mohamed, Gamal E; Alamry, Ahmed M; Kojan, Suleiman M; Aljumah, Mohammed A

    2014-09-01

    To examine and test the possible association between boarding time and stroke patients` outcome. This study is a retrospective review of stroke patients presenting to the Emergency Department (ED) of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia from 2007-2010. We excluded thrombolysis cases and those deemed critically ill. We collected time of stroke onset, ED arrival, decision to admit, and arrival to ward. Boarding time (BT) was defined as time of arrival to ward minus time of decision to admit. Primary outcome (PO) was defined as a composite of mortality, and/or any of post-stroke complications. We included 300 patients with a mean age +/- standard deviation of 69 +/- 12 years, and 66.3% were men. The PO occurred in 37.7%. There was no association between BT and PO (odds ratio [OR]=0.9, p=0.3), or any of the secondary outcomes, such as, death (OR=0.97, p=0.5), severe disability (OR=0.97, p=0.3), pneumonia (OR=1, p=0.9), urinary tract infection (OR=1, p=0.9), or neurological deterioration (OR=0.8, p=0.1). Multivariate analysis included gender, age, stroke severity, subtype, hypertension, diabetes, coronary disease, atrial fibrillation, heart failure (HF), onset to ED, BT and ED wait time; only moderate to severe stroke, HF, and previous stroke predicted poor outcome. Although `admit no bed` was not associated with adverse effects, the results should be interpreted with caution, and early admission to the stroke unit should be encouraged.

  5. Optimizing cutoff scores for the Barthel Index and the modified Rankin Scale for defining outcome in acute stroke trials

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten; Stewart, Roy E; Vroomen, Patrick C A J; De Keyser, Jacques; Luijckx, Gert-Jan

    Background and Purpose - There is little agreement on how to assess outcome in acute stroke trials. Cutoff scores for the Barthel Index (BI) and modified Rankin Scale (mRS) are frequently arbitrarily chosen to dichotomize favorable and unfavorable outcome. We investigated sensitivity and specificity

  6. How are household economic circumstances affected after a stroke? The Psychosocial Outcomes In StrokE (POISE) Study.

    Science.gov (United States)

    Essue, Beverley M; Hackett, Maree L; Li, Qiang; Glozier, Nick; Lindley, Richard; Jan, Stephen

    2012-11-01

    Stroke is associated with severe economic consequences. This is the first study to investigate in younger survivors the household economic burden of stroke. A multicenter, 3-year prospective cohort study was conducted of younger (18-65 years) survivors in Australia. Pre- and poststroke patterns of income and hardship were evaluated and multivariable logistic regression identified the predictors of economic hardship after stroke. Four hundred fourteen participants were followed up over 12 months after stroke. The variables that independently predicted economic hardship after stroke were: female (OR, 2.94; 95% CI, 1.52-5.70), hazardous alcohol consumption (OR, 2.28; 95% CI, 1.00-5.20), manual occupation (OR, 1.88; 95% CI, 1.07-3.30), lack of health insurance (OR, 2.01; 95% CI, 1.12-3.60), and prior hardship (OR, 3.93; 95% CI, 2.12-7.29), whereas concessional status (OR, 0.50; 95% CI, 0.26-0.95) and more social contacts per week (OR, 0.99; 95% CI, 0.98-1.00) reduced hardship likelihood. Higher prestroke income did not buffer hardship after stroke nor did clinical, health service, or disability factors. Policies to reduce inequalities after stroke would be best aimed at socioeconomic targets.

  7. Community-dwelling patients with dementia and their informal caregivers with and without case management: 2-year outcomes of a pragmatic trial

    NARCIS (Netherlands)

    Macneil Vroomen, Janet; Bosmans, Judith E.; van de Ven, Peter M.; Joling, Karlijn J.; van Mierlo, Lisa D.; Meiland, Franka J. M.; Moll van Charante, Eric P.; van Hout, Hein P. J.; de Rooij, Sophia E.

    2015-01-01

    To evaluate outcomes for persons with dementia and primary informal caregivers of 2 types of implemented case management (intensive case management [ICMM] and linkage [LM] models) with no case management (control group). A pragmatic trial using a prospective, observational, controlled, cohort study.

  8. Similarities amid the Difference: Caregiving Burden and Adaptation Outcomes in Dyads of Parents and Their Children with and without Cerebral Palsy

    Science.gov (United States)

    Carona, C.; Crespo, C.; Canavarro, M. C.

    2013-01-01

    This study had two main objectives: first, to examine the direct and indirect effects, via social support, of caregiving burden on the adaptation outcomes of children/adolescents with cerebral palsy and their parents; and second, to assess the invariance of such models in clinical vs. healthy subsamples. Participants were 210 dyads of…

  9. Community-Dwelling Patients With Dementia and Their Informal Caregivers With and Without Case Management : 2-Year Outcomes of a Pragmatic Trial

    NARCIS (Netherlands)

    Vroomen, Janet MacNeil; Bosmans, Judith E.; van de Ven, Peter M.; Joling, Karlijn J.; van Mierlo, Lisa D.; Meiland, Franka J. M.; van Charante, Eric P. Moll; van Hout, Hein P. J.; de Rooij, Sophia E.

    2015-01-01

    Objective: To evaluate outcomes for persons with dementia and primary informal caregivers of 2 types of implemented case management (intensive case management [ICMM] and linkage [LM] models) with no case management (control group). Design: A pragmatic trial using a prospective, observational,

  10. Somatosensory and Brainstem Auditory Evoked Potentials Assessed between 4 and 7 Days after Severe Stroke Onset Predict Unfavorable Outcome

    Directory of Open Access Journals (Sweden)

    Yan Zhang

    2015-01-01

    Full Text Available Our objective was to explore the best predictive timing of short-latency somatosensory evoked potentials (SLSEP and brainstem auditory evoked potentials (BAEP for unfavorable outcomes in patients with early stage severe stroke. One hundred fifty-six patients with acute severe supratentorial stroke were monitored according to SLSEP, BAEP, and the Glasgow Coma Scale (GCS at 1–3 days and 4–7 days after the onset of stroke. All patients were followed up for outcomes at 6 months after onset using the modified Rankin Scale (mRS, with a score of 5-6 considered unfavorable. The predictive values of SLSEP, BAEP, and the GCS at 1–3 days were compared with 4–7 days after onset. Our results show that, according to the analysis of prognostic authenticity, the predictive values of SLSEP and BAEP at 4–7 days after stroke onset improved when compared with the values at 1–3 days for unfavorable outcomes. Most of the patients with change of worsening evoked potentials from 1–3 days to 4–7 days after onset had unfavorable outcomes. In conclusion, SLSEP and BAEP assessed at 4–7 days after onset predicted unfavorable outcomes for acute severe stroke patients. The worsening values of SLSEP and BAEP between 1–3 days and 4–7 days also present a prognostic value.

  11. Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries.

    Science.gov (United States)

    Garcia-Ptacek, Sara; Contreras Escamez, Beatriz; Zupanic, Eva; Religa, Dorota; von Koch, Lena; Johnell, Kristina; von Euler, Mia; Kåreholt, Ingemar; Eriksdotter, Maria

    2018-02-01

    To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age. Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry. A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke. Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors). Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death. Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  12. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Ansaar T., E-mail: ansaar.rai@gmail.com; Jhadhav, Yahodeep; Domico, Jennifer [West Virginia University Health Sciences Center, Interventional Neuroradiology (United States); Hobbs, Gerald R. [West Virginia University Health Sciences Center, Department of Community Medicine (United States)

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  13. Caregiver Depression

    Science.gov (United States)

    ... will not sell or share your name. Caregiver Depression Tweet Bookmark this page | Email | Print Many caregivers ... depression See your doctor Treatment Coping Symptoms of depression Caregiving is hard — and can lead to feelings ...

  14. Challenges in the diagnosis and treatment of pediatric stroke

    Science.gov (United States)

    Jordan, L. C.; Hillis, A. E.

    2012-01-01

    The onset of stroke in children rarely owes to traditional stroke risk factors such as hypertension or diabetes. Rather, stroke in this patient group typically results from the simultaneous occurrence of multiple stroke risk factors, the presence of which necessitates a thorough evaluation. Several challenges exist in the care of children with stroke. Of note, recognition of pediatric stroke onset by parents and caregivers is often delayed, highlighting the need for increased awareness of and education regarding this condition. In terms of diagnostic challenges, various neurological conditions resemble stroke in pediatric patients and definite diagnosis of stroke will require MRI; adding to the challenge, young children may need to be sedated to undergo acute MRI. Perhaps the most significant challenge is the need for clinical research studies focusing on pediatric stroke treatment, so as to allow evidence-based treatment decision-making. A final challenge is standardizing outcome assessment after stroke across a wide range of ages and developmental levels. In this Review, we examine recent findings and diagnostic issues pertaining to both arterial ischemic stroke and hemorrhagic stroke in children. PMID:21386815

  15. Depletion of Cultivatable Gut Microbiota by Broad-Spectrum Antibiotic Pretreatment Worsens Outcome After Murine Stroke

    Science.gov (United States)

    Winek, Katarzyna; Engel, Odilo; Koduah, Priscilla; Heimesaat, Markus M.; Fischer, André; Bereswill, Stefan; Dames, Claudia; Kershaw, Olivia; Gruber, Achim D.; Curato, Caterina; Oyama, Naoki; Meisel, Christian; Meisel, Andreas

    2016-01-01

    Background and Purpose— Antibiotics disturbing microbiota are often used in treatment of poststroke infections. A bidirectional brain–gut microbiota axis was recently suggested as a modulator of nervous system diseases. We hypothesized that gut microbiota may be an important player in the course of stroke. Methods— We investigated the outcome of focal cerebral ischemia in C57BL/6J mice after an 8-week decontamination with quintuple broad-spectrum antibiotic cocktail. These microbiota-depleted animals were subjected to 60 minutes middle cerebral artery occlusion or sham operation. Infarct volume was measured using magnetic resonance imaging, and mice were monitored clinically throughout the whole experiment. At the end point, tissues were preserved for further analysis, comprising histology and immunologic investigations using flow cytometry. Results— We found significantly decreased survival in the middle cerebral artery occlusion microbiota-depleted mice when the antibiotic cocktail was stopped 3 days before surgery (compared with middle cerebral artery occlusion specific pathogen-free and sham-operated microbiota-depleted mice). Moreover, all microbiota-depleted animals in which antibiotic treatment was terminated developed severe acute colitis. This phenotype was rescued by continuous antibiotic treatment or colonization with specific pathogen-free microbiota before surgery. Further, infarct volumes on day one did not differ between any of the experimental groups. Conclusions— Conventional microbiota ensures intestinal protection in the mouse model of experimental stroke and prevents development of acute and severe colitis in microbiota-depleted mice not given antibiotic protection after cerebral ischemia. Our experiments raise the clinically important question as to whether microbial colonization or specific microbiota are crucial for stroke outcome. PMID:27056982

  16. Caregiver Action Network

    Science.gov (United States)

    ... Disease Caregivers Caring for those with rare diseases Alzheimer's Caregivers Caring for loved ones with Alzheimer's disease Cancer ... Caregiver Stories Caregiver Videos Caregiver Statistics Take Care! Alzheimer's Caregivers COPD Caregivers 10 Tips for Family Caregivers Media ...

  17. Quality-of-life and psychosocial outcome following childhood arterial ischaemic stroke.

    Science.gov (United States)

    O'Keeffe, Fiadhnait; Ganesan, Vijeya; King, John; Murphy, Tara

    2012-01-01

    This study investigates psychosocial outcome and quality-of-life in children who have experienced arterial ischaemic stroke (AIS), using a multidimensional and multi-perspective approach. It also examines the predictors of quality-of-life following childhood AIS. Forty-nine children between 6-18 years of age were recruited from a specialist childhood stroke clinic. Children, their parents and their teachers rated the child's quality-of-life. Questionnaires rating the child's self-esteem, behaviour and emotions were administered. Each child also underwent a neuropsychological assessment. The findings show that child-, parent- and teacher-rated health-related quality-of-life (HRQoL) is significantly lower than comparative norms following childhood AIS, across all domains (physical, emotional, social, school and cognitive functioning). Predictors of HRQoL include neurological severity, executive function, self-esteem and family functioning. Improved screening, services and interventions are necessary to monitor longer-term outcome and provide support for children who have experienced AIS and their families.

  18. Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation.

    Science.gov (United States)

    Tu, Hans T H; Campbell, Bruce C V; Christensen, Soren; Desmond, Patricia M; De Silva, Deidre A; Parsons, Mark W; Churilov, Leonid; Lansberg, Maarten G; Mlynash, Michael; Olivot, Jean-Marc; Straka, Matus; Bammer, Roland; Albers, Gregory W; Donnan, Geoffrey A; Davis, Stephen M

    2015-06-01

    Atrial fibrillation is associated with greater baseline neurological impairment and worse outcomes following ischemic stroke. Previous studies suggest that greater volumes of more severe baseline hypoperfusion in patients with history of atrial fibrillation may explain this association. We further investigated this association by comparing patients with and without atrial fibrillation on initial examination following stroke using pooled multimodal magnetic resonance imaging and clinical data from the Echoplanar Imaging Thrombolytic Evaluation Trial and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution studies. Echoplanar Imaging Thrombolytic Evaluation Trial was a trial of 101 ischemic stroke patients randomized to intravenous tissue plasminogen activator or placebo, and Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution was a prospective cohort of 74 ischemic stroke patients treated with intravenous tissue plasminogen activator at three to six hours following symptom onset. Patients underwent multimodal magnetic resonance imaging before treatment, at three to five days and three-months after stroke in Echoplanar Imaging Thrombolytic Evaluation Trial; before treatment, three to six hours after treatment and one-month after stroke in Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution. Patients were assessed with the National Institutes of Health Stroke Scale and the modified Rankin scale before treatment and at three-months after stroke. Patients were categorized into definite atrial fibrillation (present on initial examination), probable atrial fibrillation (history but no atrial fibrillation on initial examination), and no atrial fibrillation. Perfusion data were reprocessed with automated magnetic resonance imaging analysis software (RAPID, Stanford University, Stanford, CA, USA). Hypoperfusion volumes were defined using time to maximum delays in two-second increments from >4 to

  19. Clinical Outcome And Arginine Serum of Acute Ischemic Stroke Patients Supplemented by Snakehead Fish Extract

    Science.gov (United States)

    Pudjonarko, Dwi; Retnaningsih; Abidin, Zainal

    2018-02-01

    Background: Levels of arginine associated with clinical outcome in acute ischemic stroke (AIS). Arginine is a protein needed to synthesis nitric oxide (NO), a potential vasodilator and antioxidant. Snakehead fish is a source of protein which has antioxidant activity. Snakehead fish contains mineral, vitamin, and amino acids. One of the amino acids that were found quite high in snakehead fish extract is arginine. The aim of this study was done to determine the effect of snakehead fish extracts (SFE) on serum arginin levels and clinical outcome of AIS patients. Methods: It was double-blind randomized pretest-posttest control group design, with. AIS patients were divided into two groups i.e. snakehead fish extracts (SFE) and control. SFE group were administered 15 grams SFE for 7 days . Arginine serum levels and clinical outcome (measured by National Institute of Health Stroke Scale = NIHSS) were measured before and after treatment, other related factors were also analyzed in Logistic regression. Results: A total of 42 subjects who were performed random allocation as SFE or control group. There was no differences in subject characteristics between the two groups. There was a differences Δ arginine serum levels between SFE and control (33.6±19.95 μmol/L 0.3±2.51 μmol/L p<0.001). Change in NIHSS score in SFE improved significantly compared to the control group (4.14 ± 2.03; 2.52 ± 1.81;p=0.009 ). Logistic regression analysis showed only female gender factor that affected on improvement of NIHSS (OR=7; p=0,01). Conclusion: There is Clinical outcome improvement and enhancement of arginine serum levels in AIS patient with snakehead fish extract supplementation.

  20. Automated prediction of tissue outcome after acute ischemic stroke in computed tomography perfusion images

    Science.gov (United States)

    Vos, Pieter C.; Bennink, Edwin; de Jong, Hugo; Velthuis, Birgitta K.; Viergever, Max A.; Dankbaar, Jan Willem

    2015-03-01

    Assessment of the extent of cerebral damage on admission in patients with acute ischemic stroke could play an important role in treatment decision making. Computed tomography perfusion (CTP) imaging can be used to determine the extent of damage. However, clinical application is hindered by differences among vendors and used methodology. As a result, threshold based methods and visual assessment of CTP images has not yet shown to be useful in treatment decision making and predicting clinical outcome. Preliminary results in MR studies have shown the benefit of using supervised classifiers for predicting tissue outcome, but this has not been demonstrated for CTP. We present a novel method for the automatic prediction of tissue outcome by combining multi-parametric CTP images into a tissue outcome probability map. A supervised classification scheme was developed to extract absolute and relative perfusion values from processed CTP images that are summarized by a trained classifier into a likelihood of infarction. Training was performed using follow-up CT scans of 20 acute stroke patients with complete recanalization of the vessel that was occluded on admission. Infarcted regions were annotated by expert neuroradiologists. Multiple classifiers were evaluated in a leave-one-patient-out strategy for their discriminating performance using receiver operating characteristic (ROC) statistics. Results showed that a RandomForest classifier performed optimally with an area under the ROC of 0.90 for discriminating infarct tissue. The obtained results are an improvement over existing thresholding methods and are in line with results found in literature where MR perfusion was used.

  1. Tissue at risk in the deep middle cerebral artery territory is critical to stroke outcome

    Energy Technology Data Exchange (ETDEWEB)

    Rosso, Charlotte; Samson, Yves [Pitie-Salpetriere Hospital, AP-HP, Urgences Cerebro-Vasculaires, Paris (France); UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris (France); Colliot, Olivier [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris (France); Valabregue, Romain [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, Centre for NeuroImaging Research (CENIR), Paris (France); Crozier, Sophie [Pitie-Salpetriere Hospital, AP-HP, Urgences Cerebro-Vasculaires, Paris (France); Dormont, Didier [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, COGIMAGE, Paris (France); Pitie-Salpetriere Hospital, AP-HP, Department of Neuroradiology, Paris (France); Lehericy, Stephane [UPMC, Univ Paris 06, Paris (France); Centre de Recherche de l' Institut du Cerveau et de la Moelle epiniere, ICM, UPMC Paris 6, Inserm, U975, CNRS, UMR 7225, Centre for NeuroImaging Research (CENIR), Paris (France); Pitie-Salpetriere Hospital, AP-HP, Department of Neuroradiology, Paris (France)

    2011-10-15

    The clinical efficacy of thrombolysis in stroke patients is explained by the increased rate of recanalization, which limits infarct growth. However, the efficacy could also be explained by the protection of specific sites of the brain. Here, we investigate where is this outcome-related tissue at risk using voxel-based analysis. We included 68 acute stroke patients with middle cerebral artery (MCA) occlusion on the admission MRI performed within 6 h of symptoms onset (H6) and 16 controls. MCA recanalization was assessed using the magnetic resonance angiography performed at day 1 (D1). Apparent diffusion coefficient (ADC) changes were analyzed using a voxel-based method between patients vs. controls group at admission (H6) in non-recanalized vs. recanalized and in 3-month poor vs. good outcome patients at D1. Complete or partial MCA recanalization was observed in 52 of 68 patients. Good outcome at 3 months occurred in 40 patients (59%). In non-recanalized patients, ADC was decreased in the deep MCA and watershed arterial territory (the lenticular nucleus, internal capsule, and the overlying periventricular white matter). This decrease was not observed in recanalized patients at D1 or patients at H6. Fiber tracking suggested that the area is crossed by the cortico-spinal, cerebellar, and intra-hemispheric association tracts. Finally, this area almost co-localized with the area associated with poor outcome. A clinically relevant area of tissue at risk may occur in patients with MCA infarcts at the level of deep white matter fiber tracts. These findings suggest that neuroprotection research should be refocused on white matter. (orig.)

  2. Uric acid therapy improves the outcomes of stroke patients treated with intravenous tissue plasminogen activator and mechanical thrombectomy.

    Science.gov (United States)

    Chamorro, Ángel; Amaro, Sergio; Castellanos, Mar; Gomis, Meritxell; Urra, Xabier; Blasco, Jordi; Arenillas, Juan F; Román, Luis S; Muñoz, Roberto; Macho, Juan; Cánovas, David; Marti-Fabregas, Joan; Leira, Enrique C; Planas, Anna M

    2017-06-01

    Background Numerous neuroprotective drugs have failed to show benefit in the treatment of acute ischemic stroke, making the search for new treatments imperative. Uric acid is an endogenous antioxidant making it a drug candidate to improve stroke outcomes. Aim To report the effects of uric acid therapy in stroke patients receiving intravenous thrombolysis and mechanical thrombectomy. Methods Forty-five patients with proximal vessel occlusions enrolled in the URICO-ICTUS trial received intravenous recombinant tissue plasminogen activator within 4.5 h after stroke onset and randomized to intravenous 1000 mg uric acid or placebo (NCT00860366). These patients also received mechanical thrombectomy because a brain computed tomogaphy angiography confirmed the lack of proximal recanalization at the end of systemic thrombolysis. The primary outcome was good functional outcome at 90 days (modified Rankin Score 0-2). Safety outcomes included mortality, symptomatic intracerebral bleeding, and gout attacks. Results The rate of successful revascularization was >80% in the uric acid and the placebo groups but good functional outcome was observed in 16 out of 24 (67%) patients treated with uric acid and 10 out of 21 (48%) treated with placebo (adjusted Odds Ratio, 6.12 (95% CI 1.08-34.56)). Mortality was observed in two out of 24 (8.3%) patients treated with uric acid and one out of 21 (4.8%) treated with placebo (adjusted Odds Ratio, 3.74 (95% CI 0.06-226.29)). Symptomatic cerebral bleeding and gout attacks were similar in both groups. Conclusions Uric acid therapy was safe and improved stroke outcomes in stroke patients receiving intravenous thrombolysis followed by thrombectomy. Validation of this simple strategy in a larger trial is urgent.

  3. Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes.

    Science.gov (United States)

    Jones, Roy W; Lebrec, Jeremie; Kahle-Wrobleski, Kristin; Dell'Agnello, Grazia; Bruno, Giuseppe; Vellas, Bruno; Argimon, Josep M; Dodel, Richard; Haro, Josep Maria; Wimo, Anders; Reed, Catherine

    2017-01-01

    We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.

  4. Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS): The Impact on Costs and Caregiver Outcomes

    Science.gov (United States)

    Jones, Roy W.; Lebrec, Jeremie; Kahle-Wrobleski, Kristin; Dell'Agnello, Grazia; Bruno, Giuseppe; Vellas, Bruno; Argimon, Josep M.; Dodel, Richard; Haro, Josep Maria; Wimo, Anders; Reed, Catherine

    2017-01-01

    Background/Aims We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD) dementia were associated with increased societal costs and caregiver burden and time outcomes. Methods Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI); caregiver supervision and total hours were collected. Results Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61%) or cognitive decline (+27%) compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Conclusion Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia. PMID:28611822

  5. Disease Progression in Mild Dementia due to Alzheimer Disease in an 18-Month Observational Study (GERAS: The Impact on Costs and Caregiver Outcomes

    Directory of Open Access Journals (Sweden)

    Roy W. Jones

    2017-03-01

    Full Text Available Background/Aims: We assessed whether cognitive and functional decline in community-dwelling patients with mild Alzheimer disease (AD dementia were associated with increased societal costs and caregiver burden and time outcomes. Methods: Cognitive decline was defined as a ≥3-point reduction in the Mini-Mental State Examination and functional decline as a decrease in the ability to perform one or more basic items of the Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL or ≥20% of instrumental ADL items. Total societal costs were estimated from resource use and caregiver hours using 2010 costs. Caregiver burden was assessed using the Zarit Burden Interview (ZBI; caregiver supervision and total hours were collected. Results: Of 566 patients with mild AD enrolled in the GERAS study, 494 were suitable for the current analysis. Mean monthly total societal costs were greater for patients showing functional (+61% or cognitive decline (+27% compared with those without decline. In relation to a typical mean monthly cost of approximately EUR 1,400 at baseline, this translated into increases over 18 months to EUR 2,254 and 1,778 for patients with functional and cognitive decline, respectively. The number of patients requiring supervision doubled among patients showing functional or cognitive decline compared with those not showing decline, while caregiver total time increased by 70 and 33%, respectively and ZBI total score by 5.3 and 3.4 points, respectively. Conclusion: Cognitive and, more notably, functional decline were associated with increases in costs and caregiver outcomes in patients with mild AD dementia.

  6. Performance-based tests in subjects with stroke: outcome scores, reliability and measurement errors.

    Science.gov (United States)

    Faria, Christina D C M; Teixeira-Salmela, Luci F; Neto, Mansueto Gomes; Rodrigues-de-Paula, Fátima

    2012-05-01

    To assess the intra- and inter-rater reliabilities and measurement errors of seven widely applied performance-based tests for stroke subjects (comfortable/maximal gait speeds and both stair ascending/descending cadences, as well as the Timed 'Up and Go' test) and to verify whether the use of different types of outcome scores (one trial, the means of two and three trials, and the best and the worst values of the three trials) affected the score values, as well as their reliability and measurement errors. Intra- and inter-rater reliability study. Research laboratory. Sixteen stroke subjects with a mean age of 52 ± 17.9 years. Seven performance-based tests, over two sessions, seven days apart, evaluated by two independent examiners. A third examiner recorded all data. One-way ANOVAs, intra-class correlation coefficients (ICCs) and percentages of the standard errors of measurement (SEM%) were used for analyses. For all tests, similar results were found for all types of outcome scores (0.01 ≤ F ≤ 0.56; 0.34 ≤ p ≤ 0.99). For instance, at the comfortable gait speed, the means (SD) values for the first trial, the means of two and three trials and the best and worst of three trials were, respectively, 1.04 (0.25), 1.04(0.24), 1.05 (0.24), 1.10 (0.26), 1.02 (0.24) seconds. Significant and adequate values of intra- (0.75 ≤ ICC ≤ 0.96; p ≤ 0.002) and inter-rater (0.75 ≤ ICC ≤ 0.97; p ≤ 0.001) reliabilities were found for all tests and outcome scores. Measurement errors were considered low (5.01 ≤ SEM% ≤14.78) and were also similar between all outcome scores. For the seven tests, only one trial was necessary to provide consistent and reliable results regarding the functional performances of stroke subjects.

  7. An Intervention to Maximize Medication Management by Caregivers of Persons with Memory Loss: Intervention Overview and Two-Month Outcomes

    OpenAIRE

    Lingler, Jennifer H.; Arida, Janet; Houze, Martin; Kaufman, Robert; Knox, Melissa; Sereika, Susan M.; Tamres, Lisa; Erlen, Judith; Amspaugh, Carolyn; Tang, Fengyan; Happ, Mary Beth

    2016-01-01

    Overseeing medication-taking is a critical aspect of dementia caregiving. This randomized controlled trial examined the efficacy of a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventioni...

  8. Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis.

    Science.gov (United States)

    Carr, Susan J; Wang, Xia; Olavarria, Veronica V; Lavados, Pablo M; Rodriguez, Jorge A; Kim, Jong S; Lee, Tsong-Hai; Lindley, Richard I; Pontes-Neto, Octavio M; Ricci, Stefano; Sato, Shoichiro; Sharma, Vijay K; Woodward, Mark; Chalmers, John; Anderson, Craig S; Robinson, Thompson G

    2017-09-01

    Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8%) patients had moderate-to-severe RD (estimated glomerular filtration rate, 90 mL/min per 1.73 m 2 ), those with severe RD (stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95% confidence interval, 0.62-1.70; P =0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95% confidence interval, 0.72-2.01; P =0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades. RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01422616. © 2017 American Heart Association, Inc.

  9. Type of Preadmission Antidiabetic Treatment and Outcome among Patients with Ischemic Stroke: A Nationwide Follow-up Study

    DEFF Research Database (Denmark)

    Horsdal, Henriette Thisted; Mehnert, Frank; Rungby, Jørgen

    2012-01-01

    computed mortality rates and rates of readmission recurrent ischemic stroke or myocardial infarction according to type of treatment and used the Cox proportional hazards regression analysis to compute hazard ratios (HRs). RESULTS: We identified 4817 stroke patients with type 2 diabetes mellitus. We found...... hospitalized with ischemic stroke between 2003 and 2006 and who were registered in the Danish National Indicator Project. We obtained data on diabetes and type of antidiabetic treatment, patient characteristics, in-hospital quality of care, and mortality and readmissions by linking medical databases. We......, it did not reach statistical significance for all treatment groups. CONCLUSIONS: Preadmission use of sulfonylureas appeared not to be associated with an overall improved clinical outcome among type 2 diabetic patients admitted with ischemic stroke....

  10. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial.

    Science.gov (United States)

    Khatri, Pooja; Yeatts, Sharon D; Mazighi, Mikael; Broderick, Joseph P; Liebeskind, David S; Demchuk, Andrew M; Amarenco, Pierre; Carrozzella, Janice; Spilker, Judith; Foster, Lydia D; Goyal, Mayank; Hill, Michael D; Palesch, Yuko Y; Jauch, Edward C; Haley, E Clarke; Vagal, Achala; Tomsick, Thomas A

    2014-06-01

    The IMS III trial did not show a clinical benefit of endovascular treatment compared with intravenous alteplase (recombinant tissue plasminogen activator) alone for moderate or severe ischaemic strokes. Late reperfusion of tissue that was no longer salvageable could be one explanation, as suggested by previous exploratory studies that showed an association between time to reperfusion and good clinical outcome. We sought to validate this association in a preplanned analysis of data from the IMS III trial. We used data for patients with complete proximal arterial occlusions in the anterior circulation who received endovascular treatment and achieved angiographic reperfusion (score on Thrombolysis in Cerebral Infarction scale of grade 2-3) during the endovascular procedure (within 7 h of symptom onset). We used logistic regression to model good clinical outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) as a function of the time to reperfusion. We prespecified variables to be considered for adjustment, including age, baseline National Institutes of Health Stroke Scale score, sex, and baseline blood glucose concentration. Of 240 patients who were otherwise eligible for inclusion in our analysis, 182 (76%) achieved angiographic reperfusion. Mean time from symptom onset to reperfusion (ie, procedure end) was 325 min (SD 52). Increased time to reperfusion was associated with a decreased likelihood of good clinical outcome (unadjusted relative risk for every 30-min delay 0·85 [95% CI 0·77-0·94]; adjusted relative risk 0·88 [0·80-0·98]). Delays in time to angiographic reperfusion lead to a decreased likelihood of good clinical outcome in patients after moderate to severe stroke. Rapid reperfusion could be crucial for the success of future acute endovascular trials. US National Institutes of Health and National Institute of Neurological Disorders and Stroke. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Pre-hospital Delay as Determinant of Ischemic Stroke Outcome in an Italian Cohort of Patients Not Receiving Thrombolysis.

    Science.gov (United States)

    Denti, Licia; Artoni, Andrea; Scoditti, Umberto; Gatti, Elisa; Bussolati, Chiara; Ceda, Gian Paolo

    2016-06-01

    Pre-hospital delay in acute stroke is critical to the administration of thrombolysis and affects patients' clinical outcome. In this study, the impact of pre-hospital delay on the outcome of ischemic stroke was investigated in an Italian cohort of patients who did not receive thrombolysis. Data from a cohort of 1847 patients, suffering from first-ever ischemic stroke and referred to an in-hospital clinical pathway were analyzed retrospectively. The relationship between pre-hospital delay and 1-month mortality was assessed with adjustment for demographics, premorbid disability, and stroke severity, which was graded according to the Scandinavian Stroke Scale, with higher scores indicating less severity. Five hundred and twelve patients (27.7%) arrived at hospital within 2 hours of symptom onset. A significant correlation was found between early arrival and a reduced risk of 1-month mortality (hazard ratio .65; 95% confidence interval .48-.89; P = .02). There was a significant interaction (P = .01) between pre-hospital delay and the neurological score on mortality in the multivariate model, and the survival advantage of early admission was significant only for patients with scores on the Scandinavian Stroke Scale less than 18 (hazard ratio .54; 95% confidence interval .34-.85; P = .008). Our study suggests that reducing pre-hospital delay can increase the probability of survival in patients with ischemic stroke, especially those who are most severely affected. Even if the patients cannot benefit from thrombolysis, survival rates can be increased provided that they are managed according to standardized care processes. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Wechsler, Lawrence R; Demaerschalk, Bart M; Schwamm, Lee H; Adeoye, Opeolu M; Audebert, Heinrich J; Fanale, Christopher V; Hess, David C; Majersik, Jennifer J; Nystrom, Karin V; Reeves, Mathew J; Rosamond, Wayne D; Switzer, Jeffrey A

    2017-01-01

    Telestroke is one of the most frequently used and rapidly expanding applications of telemedicine, delivering much-needed stroke expertise to hospitals and patients. This document reviews the current status of telestroke and suggests measures for ongoing quality and outcome monitoring to improve performance and to enhance delivery of care. A literature search was undertaken to examine the current status of telestroke and relevant quality indicators. The members of the writing committee contributed to the review of specific quality and outcome measures with specific suggestions for metrics in telestroke networks. The drafts were circulated and revised by all committee members, and suggestions were discussed for consensus. Models of telestroke and the role of telestroke in stroke systems of care are reviewed. A brief description of the science of quality monitoring and prior experience in quality measures for stroke is provided. Process measures, outcomes, tissue-type plasminogen activator use, patient and provider satisfaction, and telestroke technology are reviewed, and suggestions are provided for quality metrics. Additional topics include licensing, credentialing, training, and documentation. © 2016 American Heart Association, Inc.

  13. Calculation of numbers-needed-to-treat in parallel group trials assessing ordinal outcomes: case examples from acute stroke and stroke prevention.

    Science.gov (United States)

    Bath, Philip; Hogg, Cheryl; Tracy, Michael; Pocock, Stuart

    2011-12-01

    Number-needed-to-treat describes the magnitude of the effect of an intervention, underpins health economic analyses, and is typically calculated for binary events. Ordered categorical outcomes provide more clinical information and their analysis using ordinal approaches is usually more efficient statistically. However, to date, techniques to calculate number-needed-to-treat based on ordinal outcomes for parallel group trials have had important limitations. Aims Numbers-needed-to-treat may be calculated for ordinal data from parallel group trials by using an unmatched comparison of all subjects or by generating matched pairs of patients nested within the study. The above approaches were assessed and compared with numbers-needed-to-treat calculated for binary outcomes using individual patient data from acute and prevention stroke trials testing the effect of interventions of varying utility and efficacy. Numbers-needed-to-treat were generally lower numerically for ordinal vs. binary, and matched vs. unmatched analyses, and the lowest in highly efficacious interventions: hemicraniectomy, ordinal matched 2.4 vs. ordinal unmatched 2.5 vs. binary matched 12 vs. binary unmatched 9 (one trial, 12 month outcome); alteplase, 4.5 vs. 6.6 vs. 8.4 vs. 8.4 (one trial with two parts, three-months); aspirin, 42 vs. 58 vs. 76 vs. 80 (one trial, six-months); and stroke units, 3.6-5.3 vs. 6.2 vs. 4.7-5.9 vs. 6.3-7.0 (two trials, three- to 60 months). Similar trends were seen for aspirin/dipyridamole vs. aspirin in secondary prevention, 22 vs. 20 vs. 31 vs. 31 (one trial, 24 months). Number-needed-to-treat may be calculated for ordinal outcome data derived from parallel group stroke trials; such numbers-needed-to-treat are lower than those calculated for binary outcomes. Their use complements the use of ordinal statistical approaches in the analysis of ordered categorical data. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

  14. Acute-phase predictors of 6-month functional outcome in Italian stroke patients eligible for In-Hospital Rehabilitation.

    Science.gov (United States)

    Franceschini, Marco; Fugazzaro, Stefania; Agosti, Maurizio; Sola, Carlotta; Di Carlo, Antonio; Cecconi, Lorenzo; Ferro, Salvatore

    2018-01-23

    to assess early post-stroke prognostic factors in patients admitted for post-acute phase rehabilitation. a one-year multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for post-acute rehabilitation. Clinical data were collected in the Stroke or Acute Care Units (acute phase), then in Rehabilitation Units (post-acute phase) and, subsequently, after a 6-month post-stroke period (follow-up). Clinical outcome measures were represented using the Barthel Index (BI) and the modified Rankin Scale (mRS). Univariate and multivariate analyses were performed to identify the most important prognostic index. mRS score, minor neurologic impairment and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to BI (power of prediction = 37%). Similarly, age, pre-morbid mRS score and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the mRS (power of prediction = 48%). BI at admission and certain comorbidities were also significant prognostic factors correlated with a better outcome. according to the BI and mRS, early mobilization is an early predictor of favorable outcome.

  15. Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke

    International Nuclear Information System (INIS)

    Park, Mina; Kim, Kyung-eun; Lee, Seung-Koo; Shin, Na-Young; Lim, Soo Mee; Song, Dongbeom; Heo, Ji Hoe; Kim, Jin Woo; Oh, Se Won

    2016-01-01

    The thrombus length may be overestimated on early arterial computed tomography angiography (CTA) depending on the collateral status. We evaluated the value of a grading system based on the thrombus length discrepancy on dual-phase CT in outcome prediction. Forty-eight acute ischemic stroke patients with M1 occlusion were included. Dual-phase CT protocol encompassed non-contrast enhanced CT, CTA with a bolus tracking technique, and delayed contrast enhanced CT (CECT) performed 40s after contrast injection. The thrombus length discrepancy between CTA and CECT was graded by using a three-point scale: G0 = no difference; G1 = no difference in thrombus length, but in attenuation distal to thrombus; G2 = difference in thrombus length. Univariate and multivariate analyses were performed to define independent predictors of poor clinical outcome at 3 months. The thrombus discrepancy grade showed significant linear relationships with both the collateral status (P = 0.008) and the presence of antegrade flow on DSA (P = 0.010) with good interobserver agreement (κ = 0.868). In a multivariate model, the presence of thrombus length discrepancy (G2) was an independent predictor of poor clinical outcome [odds ratio = 11.474 (1.350-97.547); P =0.025]. The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients. (orig.)

  16. Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke.

    Science.gov (United States)

    Smith, Eric E; Kent, David M; Bulsara, Ketan R; Leung, Lester Y; Lichtman, Judith H; Reeves, Mathew J; Towfighi, Amytis; Whiteley, William N; Zahuranec, Darin B

    2018-03-01

    Dysphagia screening protocols have been recommended to identify patients at risk for aspiration. The American Heart Association convened an evidence review committee to systematically review evidence for the effectiveness of dysphagia screening protocols to reduce the risk of pneumonia, death, or dependency after stroke. The Medline, Embase, and Cochrane databases were searched on November 1, 2016, to identify randomized controlled trials (RCTs) comparing dysphagia screening protocols or quality interventions with increased dysphagia screening rates and reporting outcomes of pneumonia, death, or dependency. Three RCTs were identified. One RCT found that a combined nursing quality improvement intervention targeting fever and glucose management and dysphagia screening reduced death and dependency but without reducing the pneumonia rate. Another RCT failed to find evidence that pneumonia rates were reduced by adding the cough reflex to routine dysphagia screening. A smaller RCT randomly assigned 2 hospital wards to a stroke care pathway including dysphagia screening or regular care and found that patients on the stroke care pathway were less likely to require intubation and mechanical ventilation; however, the study was small and at risk for bias. There were insufficient RCT data to determine the effect of dysphagia screening protocols on reducing the rates of pneumonia, death, or dependency after stroke. Additional trials are needed to compare the validity, feasibility, and clinical effectiveness of different screening methods for dysphagia. © 2018 American Heart Association, Inc.

  17. [Concept analysis of the nursing outcome Mobility in patients with stroke].

    Science.gov (United States)

    Moreira, Rafaella Pessoa; de Araujo, Thelma Leite; Cavalcante, Tahissa Frota; Guedes, Nirla Gomes; Lopes, Marcos Venicios de Oliveira; Chaves, Emília Soares

    2014-01-01

    This study aimed a concept analysis of the nursing outcome Mobility in patients with stroke. A literature review was conducted, through the online access to databases: Scopus, Pubmed, CINAHL, Cochrane, and Lilacs, using the descriptors: mobility, stroke, nursing and their synonyms in Portuguese and Spanish. 1.521 articles were identified, resulting in 49, after careful selection. Noteworthy are the articles published in Canada (26.7%), on 2001 (95.9%), by physiotherapists (34.6%), and in rehabilitation units (61.5%). The attributes identified for Mobility were: walking, standing, sitting, put the leg side to side, turn around, start and stop walking, stair climbing, motor function, and motor skill transfer. A model case and a contrary case were built, and identified, as antecedents: postural control and balance; and, as consequents: performs tasks inside and outside the house and wanders without difficulty. It was concluded that the concepts of Mobility found in this study need to be validated with experts in the field and in clinical practice.

  18. Outcome of strategy training in stroke patients with apraxia: a phase II study.

    Science.gov (United States)

    van Heugten, C M; Dekker, J; Deelman, B G; van Dijk, A J; Stehmann-Saris, J C; Kinebanian, A

    1998-08-01

    Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. The outcome was studied in a pre-post test design. Measurements were conducted at baseline and 12 weeks later. Thirty-three stroke patients with apraxia were treated at occupational therapy departments n general hospitals, rehabilitation centres and nursing homes. The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient. The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved. These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.

  19. Relationship between Barthel Index (BI and the Modified Rankin Scale (mRS Score in Assessing Functional Outcome in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    C S Mohanty

    2016-01-01

    Conclusion: Our study has demonstrated that stroke functional outcome can be predicted from the baseline BI and mRS scales. It is concluded thatBI and mRS Stroke scale can be used to prognosticate functional outcome at admission and at follow up.

  20. Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross-sectional study.

    Science.gov (United States)

    Liu, Hsin-Yun; Yang, Ching-Tzu; Wang, Yu-Nu; Hsu, Wen-Chuin; Huang, Tzu-Hsin; Lin, Yueh-E; Liu, Chin-Yi; Shyu, Yea-Ing L

    2017-12-01

    To examine the role of balancing competing needs in the relationship between caregiving demand and caregiving outcomes (caregivers' role strain and depressive symptoms). Caregivers who do not balance competing needs are more likely to experience negative caregiving outcomes, suggesting that balance mediates between caregiving demand and caregiving outcomes. Identifying a mediator of negative caregiving effects may help in developing tailored interventions for family caregivers of persons with dementia. A cross-sectional, correlational design. Data were collected from family caregivers' self-completed questionnaires between March 2013 - April 2014. A convenience sample of 120 family caregivers and care receivers with dementia was enrolled. We examined whether balance mediated the relationship between caregiving demand and caregiving outcomes (caregivers' role strain and depressive symptoms) by multiple regression analysis. To evaluate the significance of the indirect effect of caregiver balance, we used the Sobel test and Monte Carlo method, an alternative approach to testing mediation. Balancing competing needs completely mediated the association of caregiving demand with depressive symptoms and partially mediated the association of caregiving demand with role strain. Assessing caregivers' self-perceived sense of balance may help to identify caregivers at high risk for role strain and depressive symptoms. Interventions to enhance caregivers' perceived sense of balance between competing needs may provide a strategy for reducing the negative effects of caregiving. © 2017 John Wiley & Sons Ltd.

  1. Effect of different combinations of physiotherapy treatment approaches on functional outcomes in stroke patients: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Bryan Ping Ho Chung, MSc in Health Care

    2014-06-01

    Full Text Available This retrospective study compared the functional outcomes among stroke patients who had received rehabilitation based on different physiotherapy treatment approaches. The participants were divided into three groups according to the physiotherapist in charge of their treatment. The primary treatment approaches applied in Group A, Group B, and Group C were the functional approach, the Bobath approach, and the motor learning approach, respectively. For each participant, the Berg's Balance Scale score, the Modified Barthel Index, and the Modified Rivermead Mobility Index were compared among these three groups prior to and after the stroke rehabilitation programme. Within-group analysis showed that Group A, Group B, and Group C participants had a statistically significant improvement in their Modified Barthel Index (p  0.05. In summary, this study showed that different combinations of treatment approaches may induce similar improvement in functional outcomes after stroke rehabilitation.

  2. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

    NARCIS (Netherlands)

    Campbell, Bruce C. V.; van Zwam, Wim H.; Goyal, Mayank; Menon, Bijoy K.; Dippel, Diederik W. J.; Demchuk, Andrew M.; Bracard, Serge; White, Philip; Dávalos, Antoni; Majoie, Charles B. L. M.; van der Lugt, Aad; Ford, Gary A.; de la Ossa, Natalia Pérez; Kelly, Michael; Bourcier, Romain; Donnan, Geoffrey A.; Roos, Yvo B. W. E. M.; Bang, Oh Young; Nogueira, Raul G.; Devlin, Thomas G.; van den Berg, Lucie A.; Clarençon, Frédéric; Burns, Paul; Carpenter, Jeffrey; Berkhemer, Olvert A.; Yavagal, Dileep R.; Pereira, Vitor Mendes; Ducrocq, Xavier; Dixit, Anand; Quesada, Helena; Epstein, Jonathan; Davis, Stephen M.; Jansen, Olav; Rubiera, Marta; Urra, Xabier; Micard, Emilien; Lingsma, Hester F.; Naggara, Olivier; Brown, Scott; Guillemin, Francis; Muir, Keith W.; van Oostenbrugge, Robert J.; Saver, Jeffrey L.; Jovin, Tudor G.; Hill, Michael D.; Mitchell, Peter J.; Fransen, Puck Ss; Beumer, Debbie; Yoo, Albert J.; Schonewille, Wouter J.; Vos, Jan Albert; Nederkoorn, Paul J.; Wermer, Marieke Jh; van Walderveen, Marianne Aa; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A.; Lycklama à Nijeholt, Geert J.; Boiten, Jelis; Brouwer, Patrick A.; Emmer, Bart J.; de Bruijn, Sebastiaan F.; van Dijk, Lukas C.; Kappelle, Jaap; Lo, Rob H.; van Dijk, Ewoud J.; de Vries, Joost; de Kort, Paul L. M.; van Rooij, Willem Jan J.; van den Berg, Jan S. P.; van Hasselt, Boudewijn A. A. M.; Aerden, Leo A. M.; Dallinga, René J.; Visser, Marieke C.; Bot, Joseph C. J.; Vroomen, Patrick C.; Eshghi, Omid; Schreuder, Tobien H. C. M. L.; Heijboer, Roel J. J.; Keizer, Koos; Tielbeek, Alexander V.; den Hertog, Heleen M.; Gerrits, Dick G.; van den Berg-Vos, Renske M.; Karas, Giorgos B.; Steyerberg, Ewout W.; Flach, Zwenneke; Marquering, Henk A.; Sprengers, Marieke E. S.; Jenniskens, Sjoerd F. M.; Beenen, Ludo F. M.; van den Berg, René; Koudstaal, Peter J.; Brown, Martin M.; Liebig, Thomas; Stijnen, Theo; Andersson, Tommy; Mattle, Heinrich; Wahlgren, Nils; van der Heijden, Esther; Ghannouti, Naziha; Fleitour, Nadine; Hooijenga, Imke; Puppels, Corina; Pellikaan, Wilma; Geerling, Annet; Lindl-Velema, Annemieke; van Vemde, Gina; de Ridder, Ans; Greebe, Paut; de Bont-Stikkelbroeck, José; de Meris, Joke; Janssen, Kirsten; Struijk, Willy; Licher, Silvan; Boodt, Nikki; Ros, Adriaan; Venema, Esmee; Slokkers, Ilse; Ganpat, Raymie-Jayce; Mulder, Maxim; Saiedie, Nawid; Heshmatollah, Alis; Schipperen, Stefanie; Vinken, Stefan; van Boxtel, Tiemen; Koets, Jeroen; Boers, Merel; Santos, Emilie; Borst, Jordi; Jansen, Ivo; Kappelhof, Manon; Lucas, Marit; Geuskens, Ralph; Barros, Renan Sales; Dobbe, Roeland; Csizmadia, Marloes; Hill, M. D.; Goyal, M.; Demchuk, A. M.; Menon, B. K.; Eesa, M.; Ryckborst, K. J.; Wright, M. R.; Kamal, N. R.; Andersen, L.; Randhawa, P. A.; Stewart, T.; Patil, S.; Minhas, P.; Almekhlafi, M.; Mishra, S.; Clement, F.; Sajobi, T.; Shuaib, A.; Montanera, W. J.; Roy, D.; Silver, F. L.; Jovin, T. G.; Frei, D. F.; Sapkota, B.; Rempel, J. L.; Thornton, J.; Williams, D.; Tampieri, D.; Poppe, A. Y.; Dowlatshahi, D.; Wong, J. H.; Mitha, A. P.; Subramaniam, S.; Hull, G.; Lowerison, M. W.; Salluzzi, M.; Maxwell, M.; Lacusta, S.; Drupals, E.; Armitage, K.; Barber, P. A.; Smith, E. E.; Morrish, W. F.; Coutts, S. B.; Derdeyn, C.; Demaerschalk, B.; Yavagal, D.; Martin, R.; Brant, R.; Yu, Y.; Willinsky, R. A.; Weill, A.; Kenney, C.; Aram, H.; Stys, P. K.; Watson, T. W.; Klein, G.; Pearson, D.; Couillard, P.; Trivedi, A.; Singh, D.; Klourfeld, E.; Imoukhuede, O.; Nikneshan, D.; Blayney, S.; Reddy, R.; Choi, P.; Horton, M.; Musuka, T.; Dubuc, V.; Field, T. S.; Desai, J.; Adatia, S.; Alseraya, A.; Nambiar, V.; van Dijk, R.; Newcommon, N. J.; Schwindt, B.; Butcher, K. S.; Jeerakathil, T.; Buck, B.; Khan, K.; Naik, S. S.; Emery, D. J.; Owen, R. J.; Kotylak, T. B.; Ashforth, R. A.; Yeo, T. A.; McNally, D.; Siddiqui, M.; Saqqur, M.; Hussain, D.; Kalashyan, H.; Manosalva, A.; Kate, M.; Gioia, L.; Hasan, S.; Mohammad, A.; Muratoglu, M.; Cullen, A.; Brennan, P.; O'Hare, A.; Looby, S.; Hyland, D.; Duff, S.; McCusker, M.; Hallinan, B.; Lee, S.; McCormack, J.; Moore, A.; O'Connor, M.; Donegan, C.; Brewer, L.; Martin, A.; Murphy, S.; O'Rourke, K.; Smyth, S.; Kelly, P.; Lynch, T.; Daly, T.; O'Brien, P.; O'Driscoll, A.; Martin, M.; Collins, R.; Coughlan, T.; McCabe, D.; O'Neill, D.; Mulroy, M.; Lynch, O.; Walsh, T.; O'Donnell, M.; Galvin, T.; Harbison, J.; McElwaine, P.; Mulpeter, K.; McLoughlin, C.; Reardon, M.; Harkin, E.; Dolan, E.; Watts, M.; Cunningham, N.; Fallon, C.; Gallagher, S.; Cotter, P.; Crowe, M.; Doyle, R.; Noone, I.; Lapierre, M.; Coté, V. A.; Lanthier, S.; Odier, C.; DUROCHER, A.; Raymond, J.; Daneault, N.; Deschaintre, Y.; Jankowitz, B.; Baxendell, L.; Massaro, L.; Jackson-Graves, C.; DeCesare, S.; Porter, P.; Armbruster, K.; Adams, A.; Billigan, J.; Oakley, J.; Ducruet, A.; Jadhav, A.; Giurgiutiu, D.-V.; Aghaebrahim, A.; Reddy, V.; Hammer, M.; Starr, M.; Totoraitis, V.; Wechsler, L.; Streib, S.; Rangaraju, S.; Campbell, D.; Rocha, M.; Gulati, D.; Krings, T.; Kalman, L.; Cayley, A.; Williams, J.; Wiegner, R.; Casaubon, L. K.; Jaigobin, C.; del Campo, J. M.; Elamin, E.; Schaafsma, J. D.; Agid, R.; Farb, R.; ter Brugge, K.; Sapkoda, B. L.; Baxter, B. W.; Barton, K.; Knox, A.; Porter, A.; Sirelkhatim, A.; Devlin, T.; Dellinger, C.; Pitiyanuvath, N.; Patterson, J.; Nichols, J.; Quarfordt, S.; Calvert, J.; Hawk, H.; Fanale, C.; Bitner, A.; Novak, A.; Huddle, D.; Bellon, R.; Loy, D.; Wagner, J.; Chang, I.; Lampe, E.; Spencer, B.; Pratt, R.; Bartt, R.; Shine, S.; Dooley, G.; Nguyen, T.; Whaley, M.; McCarthy, K.; Teitelbaum, J.; Poon, W.; Campbell, N.; Cortes, M.; Lum, C.; Shamloul, R.; Robert, S.; Stotts, G.; Shamy, M.; Steffenhagen, N.; Blacquiere, D.; Hogan, M.; AlHazzaa, M.; Basir, G.; Lesiuk, H.; Iancu, D.; Santos, M.; Choe, H.; Weisman, D. C.; Jonczak, K.; Blue-Schaller, A.; Shah, Q.; MacKenzie, L.; Klein, B.; Kulandaivel, K.; Kozak, O.; Gzesh, D. J.; Harris, L. J.; Khoury, J. S.; Mandzia, J.; Pelz, D.; Crann, S.; Fleming, L.; Hesser, K.; Beauchamp, B.; Amato-Marzialli, B.; Boulton, M.; Lopez-Ojeda, P.; Sharma, M.; Lownie, S.; Chan, R.; Swartz, R.; Howard, P.; Golob, D.; Gladstone, D.; Boyle, K.; Boulos, M.; Hopyan, J.; Yang, V.; da Costa, L.; Holmstedt, C. A.; Turk, A. S.; Navarro, R.; Jauch, E.; Ozark, S.; Turner, R.; Phillips, S.; Shankar, J.; Jarrett, J.; Gubitz, G.; Maloney, W.; Vandorpe, R.; Schmidt, M.; Heidenreich, J.; Hunter, G.; Kelly, M.; Whelan, R.; Peeling, L.; Burns, P. A.; Hunter, A.; Wiggam, I.; Kerr, E.; Watt, M.; Fulton, A.; Gordon, P.; Rennie, I.; Flynn, P.; Smyth, G.; O'Leary, S.; Gentile, N.; Linares, G.; McNelis, P.; Erkmen, K.; Katz, P.; Azizi, A.; Weaver, M.; Jungreis, C.; Faro, S.; Shah, P.; Reimer, H.; Kalugdan, V.; Saposnik, G.; Bharatha, A.; Li, Y.; Kostyrko, P.; Marotta, T.; Montanera, W.; Sarma, D.; Selchen, D.; Spears, J.; Heo, J. H.; Jeong, K.; Kim, D. J.; Kim, B. M.; Kim, Y. D.; Song, D.; Lee, K.-J.; Yoo, J.; Bang, O. Y.; Rho, S.; Lee, J.; Jeon, P.; Kim, K. H.; Cha, J.; Kim, S. J.; Ryoo, S.; Lee, M. J.; Sohn, S.-I.; Kim, C.-H.; Ryu, H.-G.; Hong, J.-H.; Chang, H.-W.; Lee, C.-Y.; Rha, J.; Campbell, Bruce Cv; Churilov, Leonid; Yan, Bernard; Dowling, Richard; Yassi, Nawaf; Oxley, Thomas J.; Wu, Teddy Y.; Silver, Gabriel; McDonald, Amy; McCoy, Rachael; Kleinig, Timothy J.; Scroop, Rebecca; Dewey, Helen M.; Simpson, Marion; Brooks, Mark; Coulton, Bronwyn; Krause, Martin; Harrington, Timothy J.; Steinfort, Brendan; Faulder, Kenneth; Priglinger, Miriam; Day, Susan; Phan, Thanh; Chong, Winston; Holt, Michael; Chandra, Ronil V.; Ma, Henry; Young, Dennis; Wong, Kitty; Wijeratne, Tissa; Tu, Hans; MacKay, Elizabeth; Celestino, Sherisse; Bladin, Christopher F.; Loh, Poh Sien; Gilligan, Amanda; Ross, Zofia; Coote, Skye; Frost, Tanya; Parsons, Mark W.; Miteff, Ferdinand; Levi, Christopher R.; Ang, Timothy; Spratt, Neil; Kaauwai, Lara; Badve, Monica; Rice, Henry; de Villiers, Laetitia; Barber, P. Alan; McGuinness, Ben; Hope, Ayton; Moriarty, Maurice; Bennett, Patricia; Wong, Andrew; Coulthard, Alan; Lee, Andrew; Jannes, Jim; Field, Deborah; Sharma, Gagan; Salinas, Simon; Cowley, Elise; Snow, Barry; Kolbe, John; Stark, Richard; King, John; Macdonnell, Richard; Attia, John; D'Este, Cate; Diener, Hans Christoph; Levy, Elad I.; Bonafé, Alain; Mendes Pereira, Vitor; Jahan, Reza; Albers, Gregory W.; Cognard, Christophe; Cohen, David J.; Hacke, Werner; Mattle, Heinrich P.; Siddiqui, Adnan H.; von Kummer, Ruüdiger; Smith, Wade; Turjman, Francis; Hamilton, Scott; Chiacchierini, Richard; Amar, Arun; Sanossian, Nerses; Loh, Yince; Baxter, B.; Reddy, V. K.; Horev, A.; Star, M.; Siddiqui, A.; Hopkins, L. N.; Snyder, K.; Sawyer, R.; Hall, S.; Costalat, V.; Riquelme, C.; Machi, P.; Omer, E.; Arquizan, C.; Mourand, I.; Charif, M.; Ayrignac, X.; Menjot de Champfleur, N.; Leboucq, N.; Gascou, G.; Moynier, M.; du Mesnil de Rochemont, R.; Singer, O.; Berkefeld, J.; Foerch, C.; Lorenz, M.; Pfeilschifer, W.; Hattingen, E.; Wagner, M.; You, S. J.; Lescher, S.; Braun, H.; Dehkharghani, S.; Belagaje, S. R.; Anderson, A.; Lima, A.; Obideen, M.; Haussen, D.; Dharia, R.; Frankel, M.; Patel, V.; Owada, K.; Saad, A.; Amerson, L.; Horn, C.; Doppelheuer, S.; Schindler, K.; Lopes, D. K.; Chen, M.; Moftakhar, R.; Anton, C.; Smreczak, M.; Carpenter, J. S.; Boo, S.; Rai, A.; Roberts, T.; Tarabishy, A.; Gutmann, L.; Brooks, C.; Brick, J.; Domico, J.; Reimann, G.; Hinrichs, K.; Becker, M.; Heiss, E.; Selle, C.; Witteler, A.; Al'Boutros, S.; Danch, M.-J.; Ranft, A.; Rohde, S.; Burg, K.; Weimar, C.; Zegarac, V.; Hartmann, C.; Schlamann, M.; Göricke, S.; Ringlestein, A.; Wanke, I.; Mönninghoff, C.; Dietzold, M.; Budzik, R.; Davis, T.; Eubank, G.; Hicks, W. J.; Pema, P.; Vora, N.; Mejilla, J.; Taylor, M.; Clark, W.; Rontal, A.; Fields, J.; Peterson, B.; Nesbit, G.; Lutsep, H.; Bozorgchami, H.; Priest, R.; Ologuntoye, O.; Barnwell, S.; Dogan, A.; Herrick, K.; Takahasi, C.; Beadell, N.; Brown, B.; Jamieson, S.; Hussain, M. S.; Russman, A.; Hui, F.; Wisco, D.; Uchino, K.; Khawaja, Z.; Katzan, I.; Toth, G.; Cheng Ching, E.; Bain, M.; Man, S.; Farrag, A.; George, P.; John, S.; Shankar, L.; Drofa, A.; Dahlgren, R.; Bauer, A.; Itreat, A.; Taqui, A.; Cerejo, R.; Richmond, A.; Ringleb, P.; Bendszus, M.; Möhlenbruch, M.; Reiff, T.; Amiri, H.; Purrucker, J.; Herweh, C.; Pham, M.; Menn, O.; Ludwig, I.; Acosta, I.; Villar, C.; Morgan, W.; Sombutmai, C.; Hellinger, F.; Allen, E.; Bellew, M.; Gandhi, R.; Bonwit, E.; Aly, J.; Ecker, R. D.; Seder, D.; Morris, J.; Skaletsky, M.; Belden, J.; Baker, C.; Connolly, L. S.; Papanagiotou, P.; Roth, C.; Kastrup, A.; Politi, M.; Brunner, F.; Alexandrou, M.; Merdivan, H.; Ramsey, C.; Given Ii, C.; Renfrow, S.; Deshmukh, V.; Sasadeusz, K.; Vincent, F.; Thiesing, J. T.; Putnam, J.; Bhatt, A.; Kansara, A.; Caceves, D.; Lowenkopf, T.; Yanase, L.; Zurasky, J.; Dancer, S.; Freeman, B.; Scheibe Mirek, T.; Robison, J.; Roll, J.; Clark, D.; Rodriguez, M.; Fitzsimmons, B.-Fm; Zaidat, O.; Lynch, J. R.; Lazzaro, M.; Larson, T.; Padmore, L.; Das, E.; Farrow Schmidt, A.; Hassan, A.; Tekle, W.; Cate, C.; Jansen, O.; Cnyrim, C.; Wodarg, F.; Wiese, C.; Binder, A.; Riedel, C.; Rohr, A.; Lang, N.; Laufs, H.; Krieter, S.; Remonda, L.; Diepers, M.; Añon, J.; Nedeltchev, K.; Kahles, T.; Biethahn, S.; Lindner, M.; Chang, V.; Gächter, C.; Esperon, C.; Guglielmetti, M.; Arenillas Lara, J. F.; Martínez Galdámez, M.; Calleja Sanz, A. I.; Cortijo Garcia, E.; Garcia Bermejo, P.; Perez, S.; Mulero Carrillo, P.; Crespo Vallejo, E.; Ruiz Piñero, M.; Lopez Mesonero, L.; Reyes Muñoz, F. J.; Brekenfeld, C.; Buhk, J.-H.; Kruützelmann, A.; Thomalla, G.; Cheng, B.; Beck, C.; Hoppe, J.; Goebell, E.; Holst, B.; Grzyska, U.; Wortmann, G.; Starkman, S.; Duckwiler, G.; Jahan, R.; Rao, N.; Sheth, S.; Ng, K.; Noorian, A.; Szeder, V.; Nour, M.; McManus, M.; Huang, J.; Tarpley, J.; Tateshima, S.; Gonzalez, N.; Ali, L.; Liebeskind, D.; Hinman, J.; Calderon Arnulphi, M.; Liang, C.; Guzy, J.; Koch, S.; DeSousa, K.; Gordon Perue, G.; Elhammady, M.; Peterson, E.; Pandey, V.; Dharmadhikari, S.; Khandelwal, P.; Malik, A.; Pafford, R.; Gonzalez, P.; Ramdas, K.; Andersen, G.; Damgaard, D.; Von Weitzel Mudersbach, P.; Simonsen, C.; Ruiz de Morales Ayudarte, N.; Poulsen, M.; Sørensen, L.; Karabegovich, S.; Hjørringgaard, M.; Hjort, N.; Harbo, T.; Sørensen, K.; Deshaies, E.; Padalino, D.; Swarnkar, A.; Latorre, J. G.; Elnour, E.; El Zammar, Z.; Villwock, M.; Farid, H.; Balgude, A.; Cross, L.; Hansen, K.; Holtmannspötter, M.; Kondziella, D.; Hoejgaard, J.; Taudorf, S.; Soendergaard, H.; Wagner, A.; Cronquist, M.; Stavngaard, T.; Cortsen, M.; Krarup, L. H.; Hyldal, T.; Haring, H.-P.; Guggenberger, S.; Hamberger, M.; Trenkler, J.; Sonnberger, M.; Nussbaumer, K.; Dominger, C.; Bach, E.; Jagadeesan, B. D.; TAYLOR, R.; Kim, J.; Shea, K.; Tummala, R.; Zacharatos, H.; Sandhu, D.; Ezzeddine, M.; Grande, A.; Hildebrandt, D.; Miller, K.; Scherber, J.; Hendrickson, A.; Jumaa, M.; Zaidi, S.; Hendrickson, T.; Snyder, V.; Killer Oberpfalzer, M.; Mutzenbach, J.; Weymayr, F.; Broussalis, E.; Stadler, K.; Jedlitschka, A.; Malek, A.; Mueller Kronast, N.; Beck, P.; Martin, C.; Summers, D.; Day, J.; Bettinger, I.; Holloway, W.; Olds, K.; Arkin, S.; Akhtar, N.; Boutwell, C.; Crandall, S.; Schwartzman, M.; Weinstein, C.; Brion, B.; Prothmann, S.; Kleine, J.; Kreiser, K.; Boeckh Behrens, T.; Poppert, H.; Wunderlich, S.; Koch, M. L.; Biberacher, V.; Huberle, A.; Gora Stahlberg, G.; Knier, B.; Meindl, T.; Utpadel Fischler, D.; Zech, M.; Kowarik, M.; Seifert, C.; Schwaiger, B.; Puri, A.; Hou, S.; Wakhloo, A.; Moonis, M.; Henniger, N.; Goddeau, R.; Massari, F.; Minaeian, A.; Lozano, J. D.; Ramzan, M.; Stout, C.; Patel, A.; Tunguturi, A.; Onteddu, S.; Carandang, R.; Howk, M.; Ribó, M.; Sanjuan, E.; Rubiera, M.; Pagola, J.; Flores, A.; Muchada, M.; Meler, P.; Huerga, E.; Gelabert, S.; Coscojuela, P.; Tomasello, A.; Rodriguez, D.; Santamarina, E.; Maisterra, O.; Boned, S.; Seró, L.; Rovira, A.; Molina, C. A.; Millán, M.; Muñoz, L.; Pérez de la Ossa, N.; Gomis, M.; Dorado, L.; López-Cancio, E.; Palomeras, E.; Munuera, J.; García Bermejo, P.; Remollo, S.; Castaño, C.; García-Sort, R.; Cuadras, P.; Puyalto, P.; Hernández-Pérez, M.; Jiménez, M.; Martínez-Piñeiro, A.; Lucente, G.; Dávalos, A.; Chamorro, A.; Urra, X.; Obach, V.; Cervera, A.; Amaro, S.; Llull, L.; Codas, J.; Balasa, M.; Navarro, J.; Ariño, H.; Aceituno, A.; Rudilosso, S.; Renu, A.; Macho, J. M.; San Roman, L.; Blasco, J.; López, A.; Macías, N.; Cardona, P.; Quesada, H.; Rubio, F.; Cano, L.; Lara, B.; de Miquel, M. A.; Aja, L.; Serena, J.; Cobo, E.; Lees, Kennedy R.; Arenillas, J.; Roberts, R.; Al-Ajlan, F.; Zimmel, L.; Patel, S.; Martí-Fàbregas, J.; Salvat-Plana, M.; Bracard, S.; Anxionnat, René; Baillot, Pierre-Alexandre; Barbier, Charlotte; Derelle, Anne-Laure; Lacour, Jean-Christophe; Richard, Sébastien; Samson, Yves; Sourour, Nader; Baronnet-Chauvet, Flore; Clarencon, Frédéric; Crozier, Sophie; Deltour, Sandrine; Di Maria, Federico; Le Bouc, Raphael; Leger, Anne; Mutlu, Gurkan; Rosso, Charlotte; Szatmary, Zoltan; Yger, Marion; Zavanone, Chiara; Bakchine, Serge; Pierot, Laurent; Caucheteux, Nathalie; Estrade, Laurent; Kadziolka, Krzysztof; Leautaud, Alexandre; Renkes, Céline; Serre, Isabelle; Desal, Hubert; Guillon, Benoît; Boutoleau-Bretonniere, Claire; Daumas-Duport, Benjamin; de Gaalon, Solène; Derkinderen, Pascal; Evain, Sarah; Herisson, Fanny; Laplaud, David-Axel; Lebouvier, Thibaud; Lintia-Gaultier, Alina; Pouclet-Courtemanche, Hélène; Rouaud, Tiphaine; Rouaud Jaffrenou, Violaine; Schunck, Aurélia; Sevin-Allouet, Mathieu; Toulgoat, Frederique; Wiertlewski, Sandrine; Gauvrit, Jean-Yves; Ronziere, Thomas; Cahagne, Vincent; Ferre, Jean-Christophe; Pinel, Jean-François; Raoult, Hélène; Mas, Jean-Louis; Meder, Jean-François; Al Najjar-Carpentier, Amen-Adam; Birchenall, Julia; Bodiguel, Eric; Calvet, David; Domigo, Valérie; Godon-Hardy, Sylvie; Guiraud, Vincent; Lamy, Catherine; Majhadi, Loubna; Morin, Ludovic; Trystram, Denis; Turc, Guillaume; Berge, Jérôme; Sibon, Igor; Menegon, Patrice; Barreau, Xavier; Rouanet, François; Debruxelles, Sabrina; Kazadi, Annabelle; Renou, Pauline; Fleury, Olivier; Pasco-Papon, Anne; Dubas, Frédéric; Caroff, Jildaz; Godard Ducceschi, Sophie; Hamon, Marie-Aurélie; Lecluse, Alderic; Marc, Guillaume; Giroud, Maurice; Ricolfi, Frédéric; Bejot, Yannick; Chavent, Adrien; Gentil, Arnaud; Kazemi, Apolline; Osseby, Guy-Victor; Voguet, Charlotte; Mahagne, Marie-Hélène; Sedat, Jacques; Chau, Yves; Suissa, Laurent; Lachaud, Sylvain; Houdart, Emmanuel; Stapf, Christian; Buffon Porcher, Frédérique; Chabriat, Hugues; Guedin, Pierre; Herve, Dominique; Jouvent, Eric; Mawet, Jérôme; Saint-Maurice, Jean-Pierre; Schneble, Hans-Martin; Nighoghossian, Norbert; Berhoune, Nadia-Nawel; Bouhour, Françoise; Cho, Tae-Hee; Derex, Laurent; Felix, Sandra; Gervais-Bernard, Hélène; Gory, Benjamin; Manera, Luis; Mechtouff, Laura; Ritzenthaler, Thomas; Riva, Roberto; Salaris Silvio, Fabrizio; Tilikete, Caroline; Blanc, Raphael; Obadia, Michaël; Bartolini, Mario Bruno; Gueguen, Antoine; Piotin, Michel; Pistocchi, Silvia; Redjem, Hocine; Drouineau, Jacques; Neau, Jean-Philippe; Godeneche, Gaelle; Lamy, Matthias; Marsac, Emilia; Velasco, Stephane; Clavelou, Pierre; Chabert, Emmanuel; Bourgois, Nathalie; Cornut-Chauvinc, Catherine; Ferrier, Anna; Gabrillargues, Jean; Jean, Betty; Marques, Anna-Raquel; Vitello, Nicolas; Detante, Olivier; Barbieux, Marianne; Boubagra, Kamel; Favre Wiki, Isabelle; Garambois, Katia; Tahon, Florence; Ashok, Vasdev; Coskun, Oguzhan; Rodesch, Georges; Lapergue, Bertrand; Bourdain, Frédéric; Evrard, Serge; Graveleau, Philippe; Decroix, Jean Pierre; Wang, Adrien; Sellal, François; Ahle, Guido; Carelli, Gabriela; Dugay, Marie-Hélène; Gaultier, Claude; Lebedinsky, Arie