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Sample records for stroke patients admitted

  1. Hemispheric distribution of middle cerebral artery ischemic strokes in patients admitted to military hospital rawalpindi

    International Nuclear Information System (INIS)

    Tariq, M.; Ishtiaq, S.; Zulfiqar, S.O.

    2016-01-01

    Objective: To determine the difference in the frequency of middle cerebral artery (MCA) ischemic strokes between left and right cerebral hemispheres in the adult patients admitted to the Military Hospital (MH) Rawalpindi. Study Design: A descriptive study. Place and Duration of Study: MH Rawalpindi from 01 Dec 2013 to 30 Mar 2014. Patients and Methods: Seventy eight adult patients admitted to MH Rawalpindi with neurologic deficits consistent with MCA strokes and having no evidence of intracerebral haemorrhage on Computed Tomographic (CT) scan of brain. Descriptive Statistics were calculated using SPSS version 17. Results: A total of 78 patients met the inclusion criteria of the study; 35 (45 percent) patients had right MCA stroke while 43 (55 percent) had left MCA stroke. Conclusion: Left MCA ischemic strokes are more common than right MCA ischemic strokes. (author)

  2. Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy.

    Science.gov (United States)

    Weber, Ralph; Reimann, Gernot; Weimar, Christian; Winkler, Angela; Berger, Klaus; Nordmeyer, Hannes; Hadisurya, Jeffrie; Brassel, Friedhelm; Kitzrow, Martin; Krogias, Christos; Weber, Werner; Busch, Elmar W; Eyding, Jens

    2016-03-01

    After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated. We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit. Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients. In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0-2, 44.0% versus 35.7%, p = 0.08). Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging.

  3. Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial.

    Science.gov (United States)

    Walker, M F; Gladman, J R; Lincoln, N B; Siemonsma, P; Whiteley, T

    1999-07-24

    Patients who have a stroke are not always admitted to hospital, and 22-60% remain in the community, frequently without coordinated rehabilitation. We aimed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital. In this single-blind randomised controlled trial, consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated randomly to up to 5 months of occupational therapy at home or to no intervention (control group) 1 month after their stroke. The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living. Patients were assessed on outcome measures at baseline (before randomisation) and at 6 months. The primary outcome measure was the score on the extended activities of daily living (EADL) scale at 6 months. Other outcome measures included the Barthel index, the general health questionnaire 28, the carer strain index, and the London handicap scale. All assessments were done by an independent assessor who was unaware of treatment allocation. The analysis included only data from completed questionnaires. 185 patients were included: 94 in the occupational therapy group and 91 in the control group. 22 patients were not assessed at 6 months. At follow-up, patients who had occupational therapy had significantly higher median scores than the controls on: the EADL scale (16 vs 12, pstroke who were not admitted to hospital.

  4. Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

    Science.gov (United States)

    Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

    2011-08-01

    Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

  5. Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals.

    Science.gov (United States)

    Asplund, Kjell; Sukhova, Maria; Wester, Per; Stegmayr, Birgitta

    2015-03-01

    In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance. Riksstroke collects clinical data during hospital stay (national coverage 94%). Follow-up data at 3 months were collected using administrative registers and a questionnaire completed by surviving patients (response rate 88%). Structural data were collected from a questionnaire completed by hospital staff (response rate 100%). Multivariate analyses with adjustment for clustering were used to test differences between types of hospitals. The proportion of patients admitted directly to a stroke unit was highest in community hospitals and lowest in university hospitals. Magnetic resonance, carotid imaging, and thrombectomy were more frequently performed in university hospitals, and the door-to-needle time for thrombolysis was shorter. Secondary prevention with antihypertensive drugs was used less often, and outpatient follow-up was less frequent in university hospitals. Fewer patients in community hospitals were dissatisfied with their rehabilitation. After adjusting for possible confounders, poor outcome (dead or activities of daily living dependency 3 months after stroke) was not significantly different between the 3 types of hospital. In a setting with national stroke guidelines, stroke units in all hospitals, and measurement of hospital performance and benchmarking, outcome (after case-mix adjustment) is similar in university, specialized nonuniversity, and community hospitals. There seems to be fewer barriers to organizing well-functioning stroke services in community hospitals compared with university hospitals. © 2015 American Heart Association, Inc.

  6. The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Rasmussen, Lars S.; Lohse, Nicolai

    2017-01-01

    Background: Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit. Methods: Prospective, observational study with 5...... patients. Primary outcome was long-term mortality after admission to the stroke unit. Results: Of the 1679 patients admitted to the stroke unit, 1068 were eligible for inclusion. Mortality rates were 9.04 per 100 person-years at risk (PYR) in GEMS patients and 9.71 per 100 PYR in HEMS patients (IRR = 1...... for neurological outcome is probably difficult to detect by considering mortality, but for the secondary analyses we had less statistical power as illustrated by the wide confidence intervals. Conclusion: Helicopter transport of stroke patients was not associated with reduced mortality or disability, nor improved...

  7. The impact of a neuro-intensivist on patients with stroke admitted to a neurosciences intensive care unit.

    Science.gov (United States)

    Varelas, Panayiotis N; Schultz, Lonni; Conti, Mary; Spanaki, Marianna; Genarrelli, Thomas; Hacein-Bey, Lotfi

    2008-01-01

    Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU). Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month periods, before and after the appointment of a NI. Outcomes and disposition of patients with ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were compared between the two periods, using univariate and multivariate analyses. One hundred and seventy-four patients with strokes were admitted in the period before and 259 in the period after the NI. Observed mortality did not differ between the two periods. More patients were discharged home in the after period (75% vs. 54% in the before period (P = 0.003). After adjusting for covariates, the NICU and hospital LOS were shorter for each type of stroke in the after period (Cox proportional hazard ratios, 95% CI were 2.37, 1.4-4.1 and 1.8, 1.04-3 for IS, 1.98, 1.3-3 and 1.2, 0.8-1.9 for ICH, and 1.6, 1.1-2.3 and 1.4, 1.01-2 for SAH, respectively) or for all strokes (1.92, 1.52-2.43 and 1.7, 1.28-2.25 for the first 12 days of hospital admission). The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU.

  8. The prevalence of HIV among patients admitted with stroke at the ...

    African Journals Online (AJOL)

    lmboera

    The respective proportions were 44% vs 24.7%; 26.7% vs 7.6%; 20.0% vs 2.9%; 13.3% vs 1.2%; ... Key words: HIV, stroke, prevalence, hospital, Tanzania ..... The clinical picture of patients with stroke and HIV infection is of importance. As.

  9. A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke.

    Science.gov (United States)

    Smith, Eric E; Shobha, Nandavar; Dai, David; Olson, DaiWai M; Reeves, Mathew J; Saver, Jeffrey L; Hernandez, Adrian F; Peterson, Eric D; Fonarow, Gregg C; Schwamm, Lee H

    2013-01-28

    We aimed to derive and validate a single risk score for predicting death from ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Data from 333 865 stroke patients (IS, 82.4%; ICH, 11.2%; SAH, 2.6%; uncertain type, 3.8%) in the Get With The Guidelines-Stroke database were used. In-hospital mortality varied greatly according to stroke type (IS, 5.5%; ICH, 27.2%; SAH, 25.1%; unknown type, 6.0%; Pmortality and to assign point scores for a prediction model in the overall population and in the subset with the National Institutes of Health Stroke Scale (NIHSS) recorded (37.1%). The c statistic, a measure of how well the models discriminate the risk of death, was 0.78 in the overall validation sample and 0.86 in the model including NIHSS. The model with NIHSS performed nearly as well in each stroke type as in the overall model including all types (c statistics for IS alone, 0.85; for ICH alone, 0.83; for SAH alone, 0.83; uncertain type alone, 0.86). The calibration of the model was excellent, as demonstrated by plots of observed versus predicted mortality. A single prediction score for all stroke types can be used to predict risk of in-hospital death following stroke admission. Incorporation of NIHSS information substantially improves this predictive accuracy.

  10. Hospital-acquired symptomatic urinary tract infection in patients admitted to an academic stroke center affects discharge disposition.

    Science.gov (United States)

    Ifejika-Jones, Nneka L; Peng, Hui; Noser, Elizabeth A; Francisco, Gerard E; Grotta, James C

    2013-01-01

    To test the role of hospital-acquired symptomatic urinary tract infection (SUTI) as an independent predictor of discharge disposition in the acute stroke patient. A retrospective study of data collected from a stroke registry service. The registry is maintained by the Specialized Programs of Translational Research in Acute Stroke Data Core. The Specialized Programs of Translational Research in Acute Stroke is a national network of 8 centers that perform early phase clinical projects, share data, and promote new approaches to therapy for acute stroke. A single university-based hospital. We performed a data query of the fields of interest from our university-based stroke registry, a collection of 200 variables collected prospectively for each patient admitted to the stroke service between July 2004 and October 2009, with discharge disposition of home, inpatient rehabilitation, skilled nursing facility, or long-term acute care. Baseline demographics, including age, gender, ethnicity, and National Institutes of Health Stroke Scale (NIHSS) score, were collected. Cerebrovascular disease risk factors were used for independent risk assessment. Interaction terms were created between SUTI and known covariates, such as age, NIHSS, serum creatinine level, history of stroke, and urinary incontinence. Because patients who share discharge disposition tend to have similar length of hospitalization, we analyzed the effect of SUTI on the median length of stay for a correlation. Days in the intensive care unit and death were used to evaluate morbidity and mortality. By using multivariate logistic regression, the data were analyzed for differences in poststroke disposition among patients with SUTI. Of 4971 patients admitted to the University of Texas at Houston Stroke Service, 2089 were discharged to home, 1029 to inpatient rehabilitation, 659 to a skilled nursing facility, and 226 to a long-term acute care facility. Patients with an SUTI were 57% less likely to be discharged home

  11. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  12. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    钱方媛

    2014-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke andpost-stroke depression(PSD)initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory(BDI,21-item)and DSM-Ⅳcriteria was used to diagnose post-stroke depression(PSD)at 2 weeks after stroke.

  13. 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.

  14. Auditing the frequency and the clinical and economic impact of testing for Fabry disease in patients under the age of 70 with a stroke admitted to Saint Vincent's University Hospital over a 6-month period.

    Science.gov (United States)

    Lambe, J; Noone, I; Lonergan, R; Tubridy, N

    2018-02-01

    Fabry disease is an X-linked recessive lysosomal storage disorder that provokes multi-organ morbidity, including early-onset stroke. Worldwide prevalence may be greater than previously estimated, with many experiencing first stroke prior to diagnosis of Fabry disease. The aim of this study is to screen a cohort of stroke patients under 70 years of age, evaluating the clinical and economic efficacy of such a broad screening programme for Fabry disease. All stroke patients under 70 years of age who were entered into the Saint Vincent's University Hospital stroke database over a 6-month period underwent enzyme analysis and/or genetic testing as appropriate for Fabry disease. Patients' past medical histories were analysed for clinical signs suggestive of Fabry disease. Cost-effectiveness analysis of testing was performed and compared to overall economic impact of young stroke in Ireland. Of 22 patients tested for Fabry disease, no new cases were detected. Few clinical indicators of Fabry disease were identified at the time of testing. Broad screening programmes for Fabry disease are highly unlikely to offset the cost of testing. The efficacy of future screening programmes will depend on careful selection of an appropriate patient cohort of young stroke patients with multi-organ morbidity and a positive family history.

  15. Prevalence of HIV infection among trauma patients admitted to ...

    African Journals Online (AJOL)

    Prevalence of HIV infection among trauma patients admitted to Bugando Medical Centre, ... This was a descriptive cross sectional study involving trauma patients aged 11 years and ... A total of 250 trauma patients were recruited and studied.

  16. The Importance of Educating Patients With Stroke About Vitamin D.

    Science.gov (United States)

    Schneider, Melissa A

    2017-12-01

    There is a growing body of evidence linking vitamin D to more than only bone health. Researchers are discovering connections between low vitamin D levels and increased stroke risk, higher mortality, and poorer outcomes after stroke. Nurses need to be aware of ongoing research regarding vitamin D and include information about this important vitamin with patient education, especially for older patients admitted with stroke symptoms or risks.

  17. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  18. Chronic obstructive pulmonary disease in patients admitted with heart failure

    DEFF Research Database (Denmark)

    Iversen, K K; Kjaergaard, J; Akkan, D

    2008-01-01

    OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in patients with heart failure (HF). The primary aims were to determine the prevalence of COPD and to test the accuracy of self-reported COPD in patients admitted with HF. Secondary aims were to study...... valve. CONCLUSION: Chronic obstructive pulmonary disease is frequent in patients admitted with HF and self-reported COPD only identifies a minority. The prevalence of COPD was high in both patients with systolic and nonsystolic HF....... a possible relationship between right and left ventricular function and pulmonary function. DESIGN: Prospective substudy. SETTING: Systematic screening at 11 centres. SUBJECTS: Consecutive patients (n = 532) admitted with HF requiring medical treatment with diuretics and an episode with symptoms...

  19. Patient knowledge on stroke risk factors, symptoms and treatment options.

    Science.gov (United States)

    Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente; Rønning, Ole Morten

    2018-01-01

    Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: "Do you believe that stroke is a serious disorder?" and "Do you believe that time is of importance for stroke treatment?". In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger ( p options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

  20. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, Peter Krogh; Husted, Steen; Damsgaard, Else Marie Skjøde

    2007-01-01

    focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery......INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have......, length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...

  1. Prognosis of patients with rheumatic diseases admitted to intensive care.

    Science.gov (United States)

    Beil, M; Sviri, S; de la Guardia, V; Stav, I; Ben-Chetrit, E; van Heerden, P V

    2017-01-01

    Variable mortality rates have been reported for patients with rheumatic diseases admitted to an intensive care unit (ICU). Due to the absence of appropriate control groups in previous studies, it is not known whether the presence of a rheumatic disease constitutes a risk factor. Moreover, the accuracy of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for predicting outcome in this group of patients has been questioned. The primary goal of this study was to compare outcome of patients with rheumatic diseases admitted to a medical ICU to those of controls. The records of all patients admitted between 1 April 2003 and 30 June 2014 (n=4020) were screened for the presence of a rheumatic disease during admission (n=138). The diagnosis of a rheumatic disease was by standard criteria for these conditions. An age- and gender-matched control group of patients without a rheumatic disease was extracted from the patient population in the database during the same period (n=831). Mortality in ICU, in hospital and after 180 days did not differ significantly between patients with and without rheumatic diseases. There was no difference in the performance of the APACHE II score for predicting outcome in patients with rheumatic diseases and controls. This score, as well as a requirement for the use of inotropes or vasopressors, accurately predicted hospital mortality in the group of patients with rheumatic diseases. In conclusion, patients with a rheumatic condition admitted to intensive care do not do significantly worse than patients without such a disease.

  2. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2018-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  3. Characterization of patients aged 45 or under admitted with hypertensive emergencies in the Hospital do Prenda.

    Science.gov (United States)

    García, Geovedy Martínez; Miúdo, Venâncio; Manuel Lopes, Conceição da Graça Alves; Vassuelela Gomes, Juliana

    2014-01-01

    The incidence and prevalence of hypertensive emergency have been little addressed in the literature. However, over the last decade increasing numbers of young patients with different forms of hypertensive crisis have been observed in emergency departments. We performed this study to ascertain the clinical and epidemiological characteristics of patients aged ≤ 45 years admitted with a diagnosis of hypertensive emergency. We conducted an observational, descriptive, cross-sectional prospective study of 123 patients hospitalized for hypertensive emergency in the Hospital do Prenda, Luanda, between May 2011 and June 2012. Mean age was 36.62 ± 5.49 years, and most were male (52.85%). The main risk factor was hypertension (65.9%), with 17.3% complying with therapy. The most frequent forms of presentation were hypertensive encephalopathy and hemorrhagic stroke (9.8% and 82.1%, respectively). The main drugs used were diuretics, angiotensin-converting enzyme inhibitors and calcium channel blockers. Mortality during hospitalization was 25.2% (31 patients), hemorrhagic stroke being the most common cause. There was a significant association between age and in-hospital mortality. Of patients admitted with hypertensive emergency, 30.1% were aged ≤ 45 years. Hemorrhagic stroke was the most common presentation. There was a significant relationship between mode of presentation, age and in-hospital mortality. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Prevalence of HIV infection among trauma patients admitted to ...

    African Journals Online (AJOL)

    Tanzania Journal of Health Research Volume 12, Number 4, October 2010 ... Thus, all trauma health care workers in this region need to practice universal barrier ... of HIV in trauma patients is vital for education and post-exposure prophylaxis. ... of HIV among trauma patients admitted at Bugando Medical Centre in Mwanza, ...

  5. 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore.

    Science.gov (United States)

    Sun, Yan; Lee, Sze Haur; Heng, Bee Hoon; Chin, Vivien S

    2013-10-03

    Stroke is the 4th leading cause of death and 1st leading cause of disability in Singapore. However the information on long-term post stroke outcomes for Singaporean patients was limited. This study aimed to investigate the post stroke outcomes of 5-year survival and rehospitalization due to stroke recurrence for hemorrhagic and ischemic stroke patients in Singapore. The outcomes were stratified by age, ethnic group, gender and stroke types. The causes of death and stroke recurrence were also explored in the study. A multi-site retrospective cohort study. Patients admitted for stroke at any of the three hospitals in the National Healthcare Group of Singapore were included in the study. All study patients were followed up to 5 years. Kaplan-Meier was applied to study the time to first event, death or rehospitalization due to stroke recurrence. Cox proportional hazard model was applied to study the time to death with adjustment for stroke type, age, sex, ethnic group, and admission year. Cumulative incidence model with competing risk was applied for comparing the risks of rehospitalization due to stroke recurrence with death as the competing risk. Totally 12,559 stroke patients were included in the study. Among them, 59.3% survived for 5 years; 18.4% were rehospitalized due to stroke recurrence in 5 years. The risk of stroke recurrence and mortality increased with age in all stroke types. Gender, ethnic group and admitting year were not significantly associated with the risk of mortality or stroke recurrence in hemorrhagic stroke. Male or Malay patient had higher risk of stroke recurrence and mortality in ischemic stroke. Hemorrhagic stroke had higher early mortality while ischemic stroke had higher recurrence and late mortality. The top cause of death among died stroke patients was cerebrovascular diseases, followed by pneumonia and ischemic heart diseases. The recurrent stroke was most likely to be the same type as the initial stroke among rehospitalized stroke

  6. admission patterns and outcomes of paediatric patients admitted at ...

    African Journals Online (AJOL)

    OBJECTIVE To determine patterns of admissions due to diarrhea and their outcomes of paediatric patients at Muhimbili National Hospital (MNH). METHODOLOGY A hospital-based prospective study including all children admitted to the Diarrhea Unit during the study period. Data was collected using content analysis ...

  7. Pre-stroke apathy symptoms are associated with an increased risk of delirium in stroke patients.

    Science.gov (United States)

    Klimiec, Elzbieta; Kowalska, Katarzyna; Pasinska, Paulina; Klimkowicz-Mrowiec, Aleksandra; Szyper, Aleksandra; Pera, Joanna; Slowik, Agnieszka; Dziedzic, Tomasz

    2017-08-09

    Neuropsychiatric symptoms can be interrelated to delirium. We aimed to investigate an association between pre-stroke neuropsychiatric symptoms and the risk of delirium in stroke patients. We included 606 patients (median age: 73, 53% female) with stroke or transient ischemic attack admitted within 48 hours from symptoms onset. We assessed delirium on a daily basis during the first 7 days of hospitalization. To make diagnosis of delirium we used DSM-5 criteria. We used Neuropsychiatric Inventory to assess neuropsychiatric symptoms occurring within 4 weeks prior to stroke. We diagnosed delirium in 28.2% of patients. On univariate analysis, higher score of pre-stroke depression (OR: 1.58, 95% CI: 1.04-2.40, P = 0.03), apathy (OR: 2.23, 95% CI: 1.44-3.45, P delirium. On multivariate analysis adjusted for age, atrial fibrillation, diabetes mellitus, stroke severity, right hemisphere lesion, pre-stroke cognitive decline, pre-stroke disability and infections, higher apathy score (OR: 2.03, 95% CI: 1.17-3.50, P = 0.01), but no other neuropsychiatric symptoms, remained independent predictor of delirium. We conclude that pre-stroke apathy symptoms are associated with increased risk of delirium in stroke patients.

  8. [Length of stay in patients admitted for acute heart failure].

    Science.gov (United States)

    Martín-Sánchez, Francisco Javier; Carbajosa, Virginia; Llorens, Pere; Herrero, Pablo; Jacob, Javier; Miró, Òscar; Fernández, Cristina; Bueno, Héctor; Calvo, Elpidio; Ribera Casado, José Manuel

    2016-01-01

    To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p<0.001). A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  9. Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China.

    Science.gov (United States)

    Fang, Jing; Yan, Weihong; Jiang, Guo-Xin; Li, Wei; Cheng, Qi

    2011-02-01

    To observe the time interval between stroke onset and hospital arrival (time-to-hospital) in acute ischemic stroke patients and analyze its putatively associated factors. During the period from November 1, 2006 to August 31, 2008, patients with acute ischemic stroke admitted consecutively to the Department of Neurology, Ninth Hospital, Shanghai, were enrolled in the study. Information of the patients was registered including the time-to-hospital, demographic data, history of stroke, season at attack, neurological symptom at onset, etc. Characteristics of the patients were analyzed and logistic regression analyses were conducted to identify factors associated with the time-to-hospital. There were 536 patients in the study, 290 (54.1%) males and 246 (45.9%) females. The median time-to-hospital was 8h (ranged from 0.1 to 300 h) for all patients. Within 3h after the onset of stroke, 162 patients (30.2%) arrived at our hospital; and within 6h, 278 patients (51.9%). Patients with a history of stroke, unconsciousness at onset, or a high NIHSS score at admission had significantly less time-to-hospital. The time interval between stroke onset and hospital arrival was importance of seeking immediate medical help after stroke onset of patients and their relatives could significantly influence their actions. Copyright © 2010 Elsevier B.V. All rights reserved.

  10. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  11. The Importance of Patient Involvement in Stroke Rehabilitation

    DEFF Research Database (Denmark)

    Kristensen, Hanne Kaae; Tistad, Malin; Koch, Lena von

    2016-01-01

    OBJECTIVE: To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD: Data...... was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess....... CONCLUSIONS: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs....

  12. Rehabilitative Games for Stroke Patients

    Directory of Open Access Journals (Sweden)

    A. Pyae

    2015-07-01

    Full Text Available Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement.

  13. Mortality and causes of death in first admitted schizophrenic patients

    DEFF Research Database (Denmark)

    Mortensen, P B; Juel, K

    1993-01-01

    Although many studies have shown an increased mortality in schizophrenic patients, the literature provides little information about mortality from specific causes in relation to age, gender, and duration of illness. This study examined mortality and causes of death in a total national sample...... of 9156 first admitted schizophrenic patients. Suicide accounted for 50% of deaths in men and 35% of deaths in women. Suicide risk was particularly increased during the first year of follow-up. Death from natural causes, with the exception of cancer and cerebrovascular diseases, was increased. Suicide...

  14. Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

    DEFF Research Database (Denmark)

    Brunner-Frandsen, Nicole; Dammann Andersen, Andreas; Ashournia, Hamoun

    2015-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study...... was set up to clarify whether this effort has resulted in a decreased proportion of patients with known AF experiencing an ischemic stroke. METHODS: Patients admitted to the Department of Neurology, Vejle Hospital, Denmark, with ischemic stroke from January 1997 to December 2012 were included in the study....... RESULTS: A total of 4134 patients were included in the study. Overall, the yearly proportion of patients with known AF varied between 9% and 18%. No significant change was observed (P = .511). The proportion of patients with known AF treated with anticoagulants at the time of the stroke and the proportion...

  15. Acute coronary syndrome patients admitted to a cardiology vs non-cardiology service: variations in treatment & outcome.

    Science.gov (United States)

    O'Neill, Deirdre E; Southern, Danielle A; Norris, Colleen M; O'Neill, Blair J; Curran, Helen J; Graham, Michelle M

    2017-05-16

    Specialized cardiology services have contributed to reduced mortality in acute coronary syndromes (ACS).  We sought to evaluate the outcomes of ACS patients admitted to non-cardiology services in Southern Alberta. Retrospective chart review performed on all troponin-positive patients in the Calgary Health Region identified those diagnosed with ACS by their attending team. Patients admitted to non-cardiology and cardiology services were compared, using linked data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry and the Strategic Clinical Network for Cardiovascular Health and Stroke. From January 1, 2007 to December 31, 2008, 2105 ACS patients were identified, with 1636 (77.7%) admitted to cardiology and 469 (22.3%) to non-cardiology services. Patients admitted to non-cardiology services were older, had more comorbidities, and rarely received cardiology consultation (5.1%). Cardiac catheterization was underutilized (5.1% vs 86.4% in cardiology patients (p cardiology vs. cardiology services (49.1% vs. 11.0% respectively at 4-years, p cardiology services. These patients had worse outcomes, despite adjustment for baseline risk factor differences. Although many patients were appropriately admitted to non-cardiology services, the low use of investigations and secondary prevention medications may contribute to poorer patient outcome. Further research is required to identify process of care strategies to improve outcomes and lessen the burden of illness for patients and the health care system.

  16. Characteristics of patients with measles admitted to allied hospital rawalpindi

    International Nuclear Information System (INIS)

    Sultana, A.; Sabir, S.A.; Awan, A.

    2015-01-01

    Measles, a virus borne droplet infection, is one of the leading causes of death among young children worldwide despite presence of a safe and cost-effective vaccine. Objective of our study was to identify the characteristics of measles patients admitted to Allied Hospitals, Rawalpindi. Methods: This cross-sectional study was conducted amongst patients admitted with measles in paediatric units of Rawalpindi Medical College Allied Hospitals, Rawalpindi. A standard proforma was used to collect data from the respondents. Results: A total of 55 patients (mean age-29.36 months) with measles were included in the study. 65.5% children were vaccinated while 34.5% were not vaccinated. Among those vaccinated 14 were male. Out of the vaccinated children 52.6% were residents of middle class areas, 31.6% lower middle class area, 10.5% upper middle class areas and 5.3% rural areas. In 55.0% of patients who were vaccinated with at least one dose of measles at nine month of age the estimated calendar months of vaccination was March to April while in 30% the overall climatic period of vaccination was of summer (May to September). Twenty one study subjects were exposed to a case of measles in the family and thirty five out of all developed at least one known complication of the disease. Pneumonia was the most common complication reported in patients (63.6%) followed by diarrhoea (27.3%). Conclusion: Majority of the patients suffering from measles were not vaccinated and the most common reason for failure to immunize children was lack of awareness. Educated and well off fathers were more likely to get their children immunized. The vaccinated children who developed measles majority were vaccinated during months of March, April and May. (author)

  17. Hospital-based stroke care in Ireland: results from one regional register.

    LENUS (Irish Health Repository)

    Fan, C W

    2000-01-01

    Most patients with acute stroke are admitted to hospital. If stroke services in this country are to be improved, we need accurate and reliable information about the types of stroke patients being admitted, their present management and outcome.

  18. Tuberculosis Patients Admitted with High Fever and Hilar Mass

    Directory of Open Access Journals (Sweden)

    Yusuf Aydemir

    2014-08-01

    Full Text Available Tuberculosis may occur with very different clinical and radiological features. Therefore, can be difficulties from time to time in the differential diagnosis. 22-year-old male patient with a history of drug use, presenting with high fever was admitted to the Infectious Diseases Clinic. Patient who fail to respond to empiric antibiotic therapy was transferred to our clinic due to the radiologically mass in the lung. Acid-fast bacilli were negative in sputum and bronchial lavage, tuberculosis was diagnosed with excision of the axillary lymphadenomegaly. Fever fell down with antituberculosis treatment and clinical improvement was observed. We present the case of tuberculosis which have with different clinical and radiological findings, in order to always keep in mind.

  19. Pattern of Leukaemia Patients Admitted in Ayub Teaching Hospital Abbottabad

    International Nuclear Information System (INIS)

    Khan, T. M.

    2016-01-01

    Background: Any tissue of the body can give rise to cancer. However, those tissues which multiply rapidly are at high risk of developing cancer and haematopoietic system is one of them. Neoplasms of this system are known as leukaemia and lymphoma, according to the types of white cells involved.Study of cancer patterns in different societies, however can contribute a substantial knowledge about the aetiology of cancer. The present Study was designed and aimed to estimate the frequency of different types of leukaemia in patients admitted in Ayub Teaching hospital Abbottabad. Methods: Data from the patients admitted at oncology Department of Ayub Teaching Hospital Abbottabad from 2010 to 2015 was collected and analysed to calculate cumulative and year-wise frequency of leukaemia and its major types. Frequency distribution with reference to gender and age was also calculated. Results: In our analysis about 16 percent patients had acute myelocytic leukaemia and 32 percent patients had acute lymphocytic leukaemia; while chronic myeloid leukaemia outnumbered chronic lymphocytic leukaemia (11 percent and 3 percent); Hodgkin lymphoma was seen in 18 percent cases while Non Hodgkin lymphoma (NHL) was present in 20 percent cases. Out of the total, 150 cases (75 percent) belonged to mountainous areas of Hazara, i.e., 40 cases belonged to Kohistan, another 40 cases were residents of Battagram, 45 cases belonged to hilly areas of Mansehra and 25 cases to Kaghan valley, while only 50 (25 percent) cases were from the plain areas of Abbottabad and Haripur districts, i.e., 20 and 30 cases respectively. Conclusion: Leukaemia is more common in hilly areas of Hazara, since majority of the cases belonged to well-known mountainous regions of Kohistan, Battagram, Kaghan or Mansehra and only few cases belonged to the plain areas of Abbottabad and Haripur districts. (author)

  20. Investigation and diagnostic formulation in patients admitted with transient loss of consciousness

    LENUS (Irish Health Repository)

    Briggs, R

    2017-05-01

    Several commonly completed tests have low diagnostic yield in the setting of transient loss of consciousness (T-LOC). We estimated the use and cost of inappropriate investigations in patients admitted with T-LOC and assessed if these patients were given a definitive diagnosis for their presentation. We identified 80 consecutive patients admitted with T-LOC to a university teaching hospital. Eighty-eight percent (70\\/80) had a computerized topography (CT) brain scan and 49% (34\\/70) of these scans were inappropriate based on standard guidelines. Almost half (17\\/80) of electroencephalograms (EEG) and 82% (9\\/11) of carotid doppler ultrasound performed were not based on clinical evidence of seizure or stroke respectively. Forty-four percent (35\\/80) of patients had no formal diagnosis documented for their presentation. Inappropriate investigation in T-LOC is very prevalent in the acute hospital, increasing cost of patient care. In addition, there is poor diagnostic formulation for T-LOC making recurrent events more likely in the absence of definitive diagnoses

  1. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    Directory of Open Access Journals (Sweden)

    Koopmanschap Marc A

    2003-02-01

    Full Text Available Abstract Background Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. Methods Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. Results 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. Conclusion This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

  2. Protein consumptions in stroke patients

    Directory of Open Access Journals (Sweden)

    Zahra Maghsoudi

    2013-01-01

    Full Text Available Background : Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women and 60 controls (30 men and 30 women was collected with a food frequency questionnaire (FFQ. The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women. Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex.

  3. Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients

    OpenAIRE

    Pandey, Aparna; Saxena, Kiran; Verma, Meena; Bharosay, Anuradha

    2011-01-01

    Background: A study to investigate the level of the neurobiochemical marker, Neuron-Specific Enolase (NSE), at the time of admission and its correlation with the blood sugar level in ischemic stroke patients. Patients and Methods: We investigated 90 patients with complete stroke who were admitted to the Stroke Unit of the Department of Neurology at Sri Aurobindo Institute of Medical Sciences. NSE was measured with commercially available quantitative ′sandwich′ enzyme-linked immunosorbent assa...

  4. Stroke occurring in patients with cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Solène Moulin

    Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

  5. Comparison of mortality in patients with acute myocardial infarction accidentally admitted to non-cardiology departments versus that in patients admitted to coronary care units

    DEFF Research Database (Denmark)

    D'Souza, Maria; Saaby, Lotte; Poulsen, Tina S

    2014-01-01

    The aim of this study was to prospectively investigate the clinical characteristics including symptoms and long-term mortality in patients with acute myocardial infarction (AMI) accidentally admitted to non-cardiology departments (NCDs). For comparison, similar observations in patients admitted...

  6. Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation.

    Science.gov (United States)

    Isono, Naofumi; Imamura, Yuki; Ohmura, Keiko; Ueda, Norihide; Kawabata, Shinji; Furuse, Motomasa; Kuroiwa, Toshihiko

    2017-06-01

    For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. A minimal transthyretin concentration (stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. 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

    . METHODS: The analysis was based on consecutive patients admitted within 6 hours after stroke onset and discharged with ischemic stroke, surviving at least 3 months after ictus. To prevent bias, the analysis was based on a registry from before implementation of tissue plasminogen activator treatment; all...... 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 ictus (P...

  8. Knowledge of Stroke Risk Factors and Warning Signs in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand

    Directory of Open Access Journals (Sweden)

    Jittima Saengsuwan

    2017-01-01

    Full Text Available Stroke is a global burden. It is not known whether patients who are most at risk of stroke (recurrent stroke or recurrent transient ischaemic attack have enough knowledge of stroke risk factors and warning signs. The aim of this study was to assess the knowledge of stroke risk factors and warning signs in this high-risk population. We performed a cross-sectional questionnaire-based study of patients with recurrent stroke or recurrent TIA admitted to Srinagarind Hospital and Khon Kaen Hospital, Thailand. A total of 140 patients were included in the study (age 65.6±11.3 years [mean ± SD], 62 females. Using an open-ended questionnaire, nearly one-third of patients (31.4% could not name any risk factors for stroke. The most commonly recognized risk factors were hypertension (35%, dyslipidemia (28.6%, and diabetes (22.9%. Regarding stroke warning signs, the most commonly recognized warning signs were sudden unilateral weakness (61.4%, sudden trouble with speaking (25.7%, and sudden trouble with walking, loss of balance, or dizziness (21.4%. Nineteen patients (13.6% could not identify any warning signs. The results showed that knowledge of stroke obtained from open-ended questionnaires is still unsatisfactory. The healthcare provider should provide structured interventions to increase knowledge and awareness of stroke in these patients.

  9. An audit of the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital.

    Science.gov (United States)

    Khalil, Viviane; Li, Matthew; Hua, Qiantong Amanda

    2015-02-01

    According to the Australian Bureau of Statistics, stroke is the second leading cause of death in Australia. The clinical Guidelines for stroke management published by the National Stroke Foundation provide a series of evidence based recommendations to assist clinicians in the management of stroke patients. Appropriate management of patients admitted to stroke units reduces death and disability by 20 %. Moreover, a multidisciplinary team approach also improves patient outcomes. To retrospectively review the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital, and to compare adherence with the guidelines for stroke management with the national stroke foundation data with and without pharmacist intervention. A retrospective audit of medical records was undertaken of all patients admitted to a large teaching hospital with the diagnosis of stroke or cerebral infarction from January 2013 to May 2013. A total of 124 patients were included in the study. Most patients were discharged on appropriate pharmacological intervention for the prevention of secondary stroke: antihypertensive agents (71 %), lipid lowering agents (67 %) and antithrombotic (85 %) medications. The majority of the cohort was discharged on the appropriate evidence based medications for the management of secondary stroke. Further improvement may be achieved by pharmacist intervening as part of a multidisciplinary team.

  10. Fatigue after Stroke: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Victoria Louise Barbour

    2012-01-01

    Full Text Available Background. Fatigue after stroke is common and distressing to patients. Aims. Our aims were to explore patients' perceptions of post-stroke fatigue, including the causes of fatigue and the factors that alleviate fatigue, in a mixed methods study. Results. We interviewed 15 patients who had had a stroke and were inpatients on stroke rehabilitation wards. A substantial proportion of patients reported that their fatigue started at the time of their stroke. Various different factors were reported to improve fatigue, including exercise, good sleep, rehabilitation and rest. Fatigue influences patients' sense of “control” after their stroke. Conclusion. Our results are consistent with the possibility that poststroke fatigue might be triggered by factors that occur at the time of the stroke (e.g., the stroke lesion itself, or admission to hospital and then exacerbated by poor sleep and boredom. These factors should be considered when developing complex interventions to improve post-stroke fatigue.

  11. Sexual Health of Adolescent Patients Admitted to a Psychiatric Unit.

    Science.gov (United States)

    Harrison, Megan E; van Zanten, Stephanie Veldhuijzen; Noel, Ariana; Gresham, Louise; Norris, Mark L; Robinson, Amy; Chan, Jason; Boafo, Addo

    2018-04-01

    To review sexual health screening practices during admission to an adolescent psychiatry unit. Retrospective chart review of randomly selected youth admitted over a one-year period (2013). Data extracted included demographics, reasons for admission, sexual health history, as well as any comorbid behaviours noted. The main outcome measure was whether sexual health details were documented at any time during admission; if so, this information was extracted for analysis. Statistical analysis was done using univariate associations and logistic association. Mean age of subjects (n=99, 79 females and 20 males) was 15.24 years (SD = 1.30). Most common reasons for admission were suicidal gestures/self harm (n=57, 58%) and mood disorders (n=53, 54%). Thirty-seven patients (37%) had sexual health information documented in their charts. No demographic variables were significantly associated with being asked sexual health questions. Patients who had mood disorder diagnoses had 6 times the odds (95%CI: 1.18 to 29.96, P=0.03) of sexual health questions being documented compared to those not diagnosed with mood disorders. Screening for sexual health concerns is not being documented in the majority of adolescent psychiatry inpatients. Omitting sexual health screening during hospitalizations represents a missed opportunity for investigation and management of sexual health issues in this high-risk group. As many adolescents, particular those struggling with mental illness, do not attend preventative health visits, screening for pregnancy risk and other reproductive health needs is recommended at every adolescent encounter and in all settings.

  12. The Importance of Patient Involvement in Stroke Rehabilitation

    Science.gov (United States)

    2016-01-01

    Objective To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. Method Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. Results The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. Conclusions The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health

  13. admission patterns and outcomes of paediatric patients admitted at ...

    African Journals Online (AJOL)

    National Hospital (MNH). The sample population included all children admitted to the Diarrhea Unit and sample size was made up of all admissions in Diarrhea Unit of MNH from 18th February to 8th March, 2008. Data was collected using a content analytic checklist which was designed to cover all necessary information.

  14. The prevalence and the clinical characteristics of metabolic syndrome patients admitted to the cardiac care unit

    Directory of Open Access Journals (Sweden)

    Ziyad Alakkas

    2016-07-01

    Conclusion: Of the patients admitted to the CCU, 47.8% had MetS, with those patients likely to be female and obese. Furthermore, MetS patients were more likely to be admitted with heart failure and suffer from moderate-to-severe LVH.

  15. Presentations and outcomes of patients with acute decompensated heart failure admitted in the winter season.

    Science.gov (United States)

    Kaneko, Hidehiro; Suzuki, Shinya; Goto, Masato; Arita, Takuto; Yuzawa, Yasufumi; Yagi, Naoharu; Murata, Nobuhiro; Yajima, Junji; Oikawa, Yuji; Sagara, Koichi; Otsuka, Takayuki; Matsuno, Shunsuke; Kano, Hiroto; Uejima, Tokuhisa; Nagashima, Kazuyuki; Kirigaya, Hajime; Sawada, Hitoshi; Aizawa, Tadanori; Yamashita, Takeshi

    2014-12-01

    Seasonal variations in cardiovascular disease is well recognized. However, little is known about the presentations and outcomes of Japanese heart failure (HF) patients in the winter season. We used a single hospital-based cohort from the Shinken Database 2004-2012, comprising all new patients (n=19,994) who visited the Cardiovascular Institute Hospital. A total of 375 patients who were admitted owing to acute decompensated HF were included in the analysis. Of these patients, 136 (36%) were admitted in winter. Winter was defined as the period between December and February. The HF patients admitted in winter were older, and had a higher prevalence of hypertension and diabetes mellitus than the patients admitted in other seasons. Patients with conditions categorized as clinical scenario 1 tended to be admitted more commonly in winter. HF with preserved left ventricular ejection fraction (LVEF) was more common in HF patients admitted in winter than in those admitted in other seasons. Beta-blocker use at hospital discharge was more common in the patients admitted in other seasons. Kaplan-Meier curves and log-rank test results indicated that the incidences of all-cause death, cardiovascular death, and HF admission were comparable between the patients admitted in winter and those admitted in other seasons. HF admission was frequently observed in the winter season and HF patients admitted in the winter season were older, and had higher prevalence of hypertension and diabetes mellitus, and preserved LVEF suggesting that we might need to pay more attention for elderly patients with hypertension, diabetes mellitus, and HF with preserved LVEF to decrease HF admissions in the winter season. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  16. Edaravone offers neuroprotection for acute diabetic stroke patients.

    Science.gov (United States)

    Zheng, J; Chen, X

    2016-11-01

    Edaravone, a novel free-radical scavenger, has been shown to alleviate cerebral ischemic injury and protect against vascular endothelial dysfunction. However, the effects of edaravone in acute diabetic stroke patients remain undetermined. A randomized, double-blind, placebo-controlled study was performed to prospectively evaluate the effects of edaravone on acute diabetic stroke patients admitted to our hospital within 24 h of stroke onset. The edaravone group received edaravone (30 mg twice per day) diluted with 100 ml of saline combined with antiplatelet drug aspirin and atorvastatin for 14 days. The non-edaravone group was treated only with 100 ml of saline twice per day combined with aspirin and atorvastatin. Upon admission, and on days 7, 14 post-stroke onset, neurological deficits and activities of daily living were assessed using the National Institutes of Health Stroke Scale (NIHSS) and the Barthel Index (BI), respectively. The occurrence of hemorrhage transformation, pulmonary infection, progressive stroke and epilepsy was also evaluated on day 14 post-treatment. A total of 65 consecutive acute diabetic stroke patients were enrolled, of whom 35 were allocated to the edaravone group and 30 to the non-edaravone group. There was no significant group difference in baseline clinical characteristics, but mean NIHSS scores were lower (60 %), and BI scores were 1.7-fold higher, in edaravone-treated patients vs. controls on day 14. Furthermore, the incidence of hemorrhage transformation, pulmonary infection, progressive stroke and epilepsy was markedly reduced in the edaravone vs. non-edaravone group. Edaravone represents a promising neuroprotectant against cerebral ischemic injury in diabetic patients.

  17. Patient feedback design for stroke rehabilitation technology

    NARCIS (Netherlands)

    Tetteroo, D.; Willems, L.; Markopoulos, P.; Fred, A.; Gamboa, H.; Elias, D.

    2015-01-01

    The use of technology in stroke rehabilitation is increasingly common. An important aspect in stroke rehabilitation is feedback towards the patient, but research on how such feedback should be designed in stroke rehabilitation technology is scarce. Therefore, in this paper we describe an exploratory

  18. Stroke in a Patient With HIV Infection

    Directory of Open Access Journals (Sweden)

    Buse Rahime Hasırcı

    2015-08-01

    Full Text Available Stroke which is a common complication in Human immumodeficiency virus type 1 positive patients is seen between 1% and 5% in clinical series. Vasculopathy and atherogenesis in HIV are the main pathologic mechanisms of stroke. We report a 63 year old man with sudden onset of a right hemiplegia and who was diagnosed as HIV-related stroke.

  19. The Frequency of Fabry Disease among Young Cryptogenic Stroke Patients in the City of Sakarya.

    Science.gov (United States)

    Gündoğdu, Aslı Aksoy; Kotan, Dilcan; Alemdar, Murat

    2017-06-01

    Fabry disease (FD) is known as a rare cause of stroke. Recent studies suggested that FD is an underdiagnosed entity among young stroke patients. We aimed to investigate the frequency of FD in young cryptogenic stroke patients who lived in the City of Sakarya and to define the clinical features that help in recognizing patients with FD. Acute ischemic stroke patients aged 18-55 years who were admitted to our hospital between October 2013 and September 2016 were evaluated for inclusion. Patients with other recognized causes of stroke were excluded. The screening was performed for alpha-galactosidase A (α-Gal A) activity on dried blood spot, and DNA was sequenced for GLA mutation in patients with low plasma α-Gal A activity. Among the 484 acute ischemic stroke patients, 54 (24 male, 44.4%) young cryptogenic stroke patients were enrolled. The α-Gal A activity was detected as low in 3 patients. c.[680G > A] p.[R227Q] missense mutation was identified in 2 male patients. The frequency of FD was calculated as 3.7%. Our research is the first FD screening study in Turkish stroke patients. Our results underlined the importance of considering FD during the etiologic evaluation of young cryptogenic stroke patients as it is a rare but potentially treatable entity. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Prevalence and Prognostic Significance of Runs of Premature Atrial Complexes in Ischemic Stroke Patients

    DEFF Research Database (Denmark)

    Høeg Vinther, Kristina; Tveskov, Claus; Möller, Sören

    2016-01-01

    BACKGROUND AND PURPOSE: Runs of premature atrial complexes (PACs) are common in stroke patients and perceived to be clinically insignificant, but their prognostic significance is unclear. This study investigated the association between runs of PACs in ischemic stroke patients and the risk...... of recurrent ischemic strokes/transient ischemic attacks (TIAs) or death. METHODS: The study included consecutive patients admitted with an ischemic stroke from August 2008 to April 2011. Patients with known and newly detected atrial fibrillation were excluded. Runs of PACs were defined as 3 or more PACs...... lasting less than 30 seconds during 48 hours of continuous inpatient cardiac telemetry. The patients were followed for 4 years or until death, whichever came first. They were stratified according to stroke severity. The combined primary endpoint was a recurrent ischemic stroke/TIA or death. RESULTS...

  1. Ipsilateral hemiparesis in ischemic stroke patients.

    Science.gov (United States)

    Inatomi, Y; Nakajima, M; Yonehara, T; Ando, Y

    2017-07-01

    To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients. Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI. Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine. Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. The impact of patient's weight on post-stroke rehabilitation.

    Science.gov (United States)

    Kalichman, Leonid; Alperovitch-Najenson, Deborah; Treger, Iuly

    2016-08-01

    Purpose To evaluate the influence of patient's weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission - FIM at discharge) were evaluated. The Kruskal-Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho = -0.20, p = 0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients' BMI. Implications for Rehabilitation In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients.

  3. Thrombolysis and clinical outcome in patients with stroke after implementation of the Tyrol Stroke Pathway: a retrospective observational study.

    Science.gov (United States)

    Willeit, Johann; Geley, Theresa; Schöch, Johannes; Rinner, Heinrich; Tür, Andreas; Kreuzer, Hans; Thiemann, Norbert; Knoflach, Michael; Toell, Thomas; Pechlaner, Raimund; Willeit, Karin; Klingler, Natalie; Praxmarer, Silvia; Baubin, Michael; Beck, Gertrud; Berek, Klaus; Dengg, Christian; Engelhardt, Klaus; Erlacher, Thomas; Fluckinger, Thomas; Grander, Wilhelm; Grossmann, Josef; Kathrein, Hermann; Kaiser, Norbert; Matosevic, Benjamin; Matzak, Heinrich; Mayr, Markus; Perfler, Robert; Poewe, Werner; Rauter, Alexandra; Schoenherr, Gudrun; Schoenherr, Hans-Robert; Schinnerl, Adolf; Spiss, Heinrich; Thurner, Theresa; Vergeiner, Gernot; Werner, Philipp; Wöll, Ewald; Willeit, Peter; Kiechl, Stefan

    2015-01-01

    Intravenous thrombolysis for ischaemic stroke remains underused worldwide. We aimed to assess whether our statewide comprehensive stroke management programme would improve thrombolysis use and clinical outcome in patients. In 2008-09, we designed the Tyrol Stroke Pathway, which provided information campaigns for the public and standardised the entire treatment pathway from stroke onset to outpatient rehabilitation. It was commenced in Tyrol, Austria, as a long-term routine-care programme and aimed to include all patients with stroke in the survey area. We focused on thrombolysis use and outcome in the first full 4 years of implementation (2010-13). We enrolled 4947 (99%) of 4992 patients with ischaemic stroke who were admitted to hospitals in Tyrol; 675 (14%) of the enrollees were treated with alteplase. Thrombolysis administration in Tyrol increased after programme implementation, from 160 of 1238 patients (12·9%, 95% CI 11·1-14·9) in 2010 to 213 of 1266 patients (16·8%, 14·8-19·0) in 2013 (ptrend 2010-13stroke programmes, thrombolysis administration remained stable or declined between 2010 and 2013 (mean reduction 14·4%, 95% CI 10·9-17·9). Although the 3-month mortality was not affected by our programme (137 [13%] of 1060 patients in 2010 vs 143 [13%] of 1069 patients in 2013), 3-month functional outcome significantly improved (modified Rankin Scale score 0-1 in 375 [40%] of 944 patients in 2010 vs 493 [53%] of 939 in 2013; score 0-2 in 531 [56%] patients in 2010 and 615 [65%] in 2013; ptrend 2010-13stroke management programme, thrombolysis administration increased and clinical outcome significantly improved, although mortality did not change. We hope that these results will guide health authorities and stroke physicians elsewhere when implementing similar programmes for patients with stroke. Reformpool of the Tyrolean Health Care Fund. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Time to inpatient rehabilitation hospital admission and functional outcomes of stroke patients.

    Science.gov (United States)

    Wang, Hua; Camicia, Michelle; Terdiman, Joe; Hung, Yun-Yi; Sandel, M Elizabeth

    2011-04-01

    To study the association of time to inpatient rehabilitation hospital (IRH) admission and functional outcomes of patients who have had a stroke. A retrospective cohort study. A regional IRH. Moderately (n = 614) and severely (n = 1294) impaired patients who had a stroke who were admitted to the facility between 2002 and 2006. Not applicable. Change in total, motor, and cognitive Functional Independence Measure (FIM) scores between IRH admission and discharge. After controlling for patient demographics and initial medical conditions and functional status, shorter periods from stroke onset to IRH admission were significantly associated with greater functional gains for these patients during IRH hospitalization. Moderately impaired patients achieved a greater total FIM gain when admitted to an IRH within 21 days of stroke. Severely impaired patients showed a gradient relationship between time to IRH admission and total FIM gain, with significantly different functional gain if admitted to an IRH within 30 and 60 days after stroke diagnosis. Results of multiple regression analysis also showed that age, race/ethnicity, side of stroke, history of a previous stroke, functional measures at IRH admission, IRH length of stay, and selected medications were associated with total, motor, and cognitive FIM score changes. In addition, certain factors such as older age, diagnosis of a hemorrhagic stroke or a previous history of stroke, and initial functional status were associated with longer periods between diagnosis and admission to an IRH after the stroke occurred. Our findings are consistent with the hypothesis that earlier transfer to an IRH may lead to better functional improvement after stroke. However, certain factors such as age, race/ethnicity, initial medical conditions and functional status, and length of stay at an IRH contributed to functional gain. Factors affecting the time to IRH admission also were addressed. Copyright © 2011 American Academy of Physical Medicine

  5. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

    Directory of Open Access Journals (Sweden)

    Josie Merchant

    2016-01-01

    Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

  6. Obese Japanese Patients with Stroke Have Higher Functional Recovery in Convalescent Rehabilitation Wards: A Retrospective Cohort Study.

    Science.gov (United States)

    Nishioka, Shinta; Wakabayashi, Hidetaka; Yoshida, Tomomi; Mori, Natsumi; Watanabe, Riko; Nishioka, Emi

    2016-01-01

    A protective effect of excessive body mass index (BMI) on mortality or functional outcome in patients with stroke is not well established in the Asian population. This study aimed to explore whether obese patients with stroke have advantages for functional improvement in Japanese rehabilitation wards. This retrospective cohort study included consecutive patients with stroke admitted and discharged from convalescent rehabilitation wards between 2011 and 2015. Demographic data, BMI, Functional Independence Measure (FIM) score, and nutritional status were analyzed. Participants were classified into 4 groups according to BMI (underweight stroke may have some advantages for functional recovery in rehabilitation wards. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Mediterranean Diet in patients with acute ischemic stroke: Relationships between Mediterranean Diet score, diagnostic subtype, and stroke severity index.

    Science.gov (United States)

    Tuttolomondo, Antonino; Casuccio, Alessandra; Buttà, Carmelo; Pecoraro, Rosaria; Di Raimondo, Domenico; Della Corte, Vittoriano; Arnao, Valentina; Clemente, Giuseppe; Maida, Carlo; Simonetta, Irene; Miceli, Giuseppe; Lucifora, Benedetto; Cirrincione, Anna; Di Bona, Danilo; Corpora, Francesca; Maugeri, Rosario; Iacopino, Domenico Gerardo; Pinto, Antonio

    2015-11-01

    Adherence to a Mediterranean Diet appears to reduce the risk of cardiovascular disease, cancer, Alzheimer's disease, and Parkinson's disease, as well as the risk of death due to cardiovascular disease. No study has addressed the association between diagnostic subtype of stroke and its severity and adherence to a Mediterranean Diet in subjects with acute ischemic stroke. To evaluate the association between Mediterranean Diet adherence, TOAST subtype, and stroke severity by means of a retrospective study. The type of acute ischemic stroke was classified according to the TOAST criteria. All patients admitted to our ward with acute ischemic stroke completed a 137-item validated food-frequency questionnaire adapted to the Sicilian population. A scale indicating the degree of adherence to the traditional Mediterranean Diet was used (Me-Di score: range 0-9). 198 subjects with acute ischemic stroke and 100 control subjects without stroke. Stroke subjects had a lower mean Mediterranean Diet score compared to 100 controls without stroke. We observed a significant positive correlation between Me-Di score and SSS score, whereas we observed a negative relationship between Me-Di score and NIHSS and Rankin scores. Subjects with atherosclerotic (LAAS) stroke subtype had a lower mean Me-Di score compared to subjects with other subtypes. Multinomial logistic regression analysis in a simple model showed a negative relationship between MeDi score and LAAS subtype vs. lacunar subtype (and LAAS vs. cardio-embolic subtype). Patients with lower adherence to a Mediterranean Diet are more likely to have an atherosclerotic (LAAS) stroke, a worse clinical presentation of ischemic stroke at admission and a higher Rankin score at discharge. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Polysomnographic indicators of mortality in stroke patients

    DEFF Research Database (Denmark)

    Ponsaing, Laura B; Iversen, Helle K; Jennum, Poul

    2017-01-01

    a 19-37-month follow-up period. RESULTS: Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher...... receive increased attention....

  9. Trends in in-hospital mortality among patients with stroke in China.

    Directory of Open Access Journals (Sweden)

    Qian He

    Full Text Available BACKGROUND: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. METHODS: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. RESULTS: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001. The percentage of severe patients increased while odds of mortality (2010 versus 2007 decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987, intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708, and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649. In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. CONCLUSIONS: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

  10. course and outcome of obstetric patients admitted to a university

    African Journals Online (AJOL)

    2011-10-10

    Oct 10, 2011 ... Healthcare planners and financiers should factor ... Acute lung injury .... at risk. Majority of the patients were young and represented a significant proportion of the productive ... of abscesses was necessary in 5% of patients.

  11. Rehabilitation of patients admitted to a respiratory intensive care unit.

    Science.gov (United States)

    Nava, S

    1998-07-01

    Pulmonary rehabilitation has been shown to be of benefit to clinically stable patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of pulmonary rehabilitation on some physiologic variables in COPD patients recovering from an episode of acute respiratory failure. A prospective, randomized study. A respiratory intensive care unit (RICU). Eighty COPD patients recovering from an episode of acute respiratory failure were randomized in a 3:1 fashion to receive stepwise pulmonary rehabilitation (group A, n=60 patients) or standard medical therapy (group B, n=20 patients). Improvements in exercise tolerance, sense of breathlessness, respiratory muscle function, and pulmonary function test values were measured, respectively, by exercise capacity (6-minute walking distance [6MWD]), dyspnea score (Visual Analog Scale [VAS]), maximal inspiratory pressure (MIP), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Group A received pulmonary rehabilitation that consisted of passive mobilization (step I), early deambulation (step II), respiratory and lower skeletal muscle training (step III), and if the patients were able, complete lower extremity training on a treadmill (step IV). Group B received standard medical therapy plus a basic deambulation program. Sixty-one of 80 patients were mechanically ventilated at admission to the unit and most of them were bedridden. Twelve of the 60 group A patients and 4 of the 20 group B patients died during their RICU stay, and 9 patients required invasive mechanical ventilation at home after their discharge. The total length of RICU stay was 38+/-14 days for patients in group A versus 33.2+/-11 days for those in group B. Most patients from both groups regained the ability to walk, either unaided or aided. At discharge, 6 MWD results were significantly improved (p respiratory failure and who, in most cases, required mechanical ventilation benefited from comprehensive early

  12. Clinical characteristics of patients with ischemic stroke following the 2016 Kumamoto earthquake.

    Science.gov (United States)

    Inatomi, Yuichiro; Nakajima, Makoto; Yonehara, Toshiro; Ando, Yukio

    2017-12-01

    To investigate the clinical characteristics of patients with ischemic stroke following the 2016 Kumamoto earthquake. We retrospectively studied patients with ischemic stroke admitted to our hospital for 12weeks following the earthquake. We compared the clinical backgrounds and characteristics of the patients: before (the same period from the previous 3years) and after the earthquake; and the early (first 2weeks) and late (subsequent 10weeks) phases. A total of 194 patients with ischemic stroke were admitted to our hospital after the earthquake; 496 (165.3/year) patients were admitted before the earthquake. No differences between the two groups were noted for the clinical backgrounds, characteristics, or biomarkers. Past history of sleeping in a shelter or small vehicle was found in 13% and 28% of patients, respectively. Sleeping in a shelter (27% vs. 10%, p=0.013) was found more frequently in patients during the early phase than during the late phase after the earthquake. Admission of patients with ischemic stroke increased after the earthquake; however no differences between before and after the earthquake were noted for their clinical characteristics. To prevent ischemic stroke following earthquakes, mental stress and physical status of evacuees must be assessed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. The prognostic importance of lung function in patients admitted with heart failure

    DEFF Research Database (Denmark)

    Iversen, Kasper Karmark; Kjaergaard, Jesper; Akkan, Dilek

    2010-01-01

    The purpose of the present study was to determine the prognostic importance for all-cause mortality of lung function variables obtained by spirometry in an unselected group of patients admitted with heart failure (HF).......The purpose of the present study was to determine the prognostic importance for all-cause mortality of lung function variables obtained by spirometry in an unselected group of patients admitted with heart failure (HF)....

  14. Mutations of the GLA gene in young patients with stroke: the PORTYSTROKE study--screening genetic conditions in Portuguese young stroke patients.

    Science.gov (United States)

    Baptista, Miguel Viana; Ferreira, Susana; Pinho-E-Melo, Teresa; Carvalho, Marta; Cruz, Vítor T; Carmona, Cátia; Silva, Fernando A; Tuna, Assunção; Rodrigues, Miguel; Ferreira, Carla; Pinto, Ana A N; Leitão, André; Gabriel, João Paulo; Calado, Sofia; Oliveira, João Paulo; Ferro, José M

    2010-03-01

    Fabry disease is an X-linked monogenic disorder caused by mutations in the GLA gene. Recent data suggest that stroke in young adults may be associated with Fabry disease. We aimed to ascertain the prevalence of this disorder among young adult patients with stroke in Portugal by GLA genotyping. During 1 year, all patients aged 18 to 55 years with first-ever stroke, who were admitted into any of 12 neurology hospital departments in Portugal, were prospectively enrolled (n=625). Ischemic stroke was classified according to Trial of Org 10172 in Acute Stroke Treatment criteria. Alpha-galactosidase activity was further assayed in all patients with GLA mutations. Four hundred ninety-three patients (mean age, 45.4 years; 61% male) underwent genetic analyses: 364 with ischemic stroke, 89 with intracerebral hemorrhage, 26 with subarachnoid hemorrhage, and 14 with cerebral venous thrombosis. Twelve patients had missense GLA mutations: 9 with ischemic stroke (p.R118C: n=4; p.D313Y: n=5), including 5 patients with an identified cause of stroke (cardiac embolism: n=2; small vessel disease: n=2; other cause: n=1), 2 with intracerebral hemorrhage (p.R118C: n=1; p.D313Y: n=1), and one with cerebral venous thrombosis (p.R118C: n=1). Leukocyte alpha-galactosidase activity was subnormal in the hemizygous males and subnormal or low-normal in the heterozygous females. Estimated prevalence of missense GLA mutations was 2.4% (95% CI, 1.3% to 4.1%). Despite a low diagnostic yield, screening for GLA mutations should probably be considered in different types of stroke. Restricting investigation to patients with cryptogenic stroke may underestimate the true prevalence of Fabry disease in young patients with stroke.

  15. Oropharyngeal Dysphagia in Acute Stroke Patients

    OpenAIRE

    Faezeh Asadollahpour; Kowsar Baghban; Mojgan Asadi; Ehsan Naderifar; Maryam Dehghani

    2015-01-01

    Background: The objective of this study was to investigate the prevalence of different kinds of swallowing disorder and it’s severity in patients after stroke. Patients and Methods: In this cross sectional study, 91 consecutive stroke patients were screened by the Northwestern Dysphagia Patient Check Sheet (NDPCS) and the Gugging Swallowing Screen (GUSS). Results: Forty seven percent of those assessed demonstrated signs of oropharyngeal dysphagia. Mild dysphagia was seen in (10.98%) pat...

  16. Risk factor and etiology analysis of ischemic stroke in young adult patients.

    Science.gov (United States)

    Renna, Rosaria; Pilato, Fabio; Profice, Paolo; Della Marca, Giacomo; Broccolini, Aldobrando; Morosetti, Roberta; Frisullo, Giovanni; Rossi, Elena; De Stefano, Valerio; Di Lazzaro, Vincenzo

    2014-03-01

    Approximately 10%-14% of ischemic strokes occur in young adults. To investigate risk factors and etiologies of strokes of young adults admitted to the "stroke unit" of Policlinico "Gemelli" of Rome from December 2005 to January 2013. In all, 150 consecutive patients younger than 50 years diagnosed with ischemic stroke were enrolled. Clinical evaluation consisted of a complete neurologic examination and the National Institutes of Health Stroke Scale. Diagnostic workup consisted of anamnesis, extensive laboratory, radiologic, and cardiologic examination. Stroke etiologies were classified according to the Trial of Org 10172 in Acute Stroke Treatment. Patients' mean age was 41 ± 8.0 years. The most common risk factors were dyslipidemia (52.7%), smoking (47.3%), hypertension (39.3%), and patent foramen ovale (PFO, 32.8%). Large-artery atherosclerosis was diagnosed as the cause of stroke in 17 patients (11.3%). Cardioembolism was presumed in 36 patients (24%), most of them presented a PFO at transesophageal echocardiography. Small-vessel occlusion was diagnosed in 12 patients (8%); all of them were hypertensive and most of them presented additional risk factors. Forty-one patients (27.3%) presented a stroke of other determined etiology and 44 (29.3%) presented a stroke of undetermined etiology. The 3-year survival was 96.8% and recurrent strokes occurred in only 3 cases. Traditional vascular risk factors are also very common in young adults with ischemic stroke, but such factors increase the susceptibility to stroke dependent to other causes as atherosclerosis and small-artery occlusion represent less than 20% of cases. Prognosis quoadvitam is good, being characterized by low mortality and recurrence rate. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aparna Pandey

    2011-01-01

    Full Text Available Background: A study to investigate the level of the neurobiochemical marker, Neuron-Specific Enolase (NSE, at the time of admission and its correlation with the blood sugar level in ischemic stroke patients. Patients and Methods: We investigated 90 patients with complete stroke who were admitted to the Stroke Unit of the Department of Neurology at Sri Aurobindo Institute of Medical Sciences. NSE was measured with commercially available quantitative ′sandwich′ enzyme-linked immunosorbent assay kits obtained from R and D Systems. Hyperglycemia was defined as blood glucose concentration ≥ 7 mmol / L, and measured using the glucose oxidase method immediately. Results: Significantly increased NSE and lipid profile levels were found in ischemic stroke patients as compared to the control. Hyperglycemic ischemic stroke patients had increased levels of NSE, lipid profile, and National Institute of Health stroke scale scores (NIHSS score compared to normoglycemic ischemic stroke patients. In addition the serum NSE level of hyperglycemic stroke patients was also positively correlated with the blood sugar level (r = 0.734 P < 0.001. Conclusions: Hyperglycemia predicts an increased risk of poor outcome after ischemic stroke and it is reflected by a significantly increased level of Neuron-Specific Enolase.

  18. 5. Factors associated with Outcome in Patients Admitted with ...

    African Journals Online (AJOL)

    RICHY

    in-hospital outcomes of Traumatic Brain Injury (TBI) ... percentage points lower than an earlier study done at ... Severity of injury; this is determined by use of ..... 10. Management Protocol in head injured patients at. UTH. Neurosurgical unit ...

  19. Profile of mortality of patients admitted to Weskoppies Psychiatric ...

    African Journals Online (AJOL)

    patients to community based care has also contributed to this decrease. ... 1Department of Psychiatry, University of Pretoria, Weskoppies Hospital, Pretoria, South Africa ... reports were checked against the Hospital Board Meeting notes.

  20. Pattern of admission and outcome of patients admitted into the ...

    African Journals Online (AJOL)

    2015-02-26

    Feb 26, 2015 ... Objective: The objective was to determine the pattern of admission and outcome of patients .... Referred to Europe (London) .... In: A Concise Textbook. ... Khush KK, Rapaport E, Waters D. The history of the coronary care unit.

  1. Incidence of pterygium in patients admitted to a university hospital

    Directory of Open Access Journals (Sweden)

    Fethiye Gülden Turgut

    2013-12-01

    Full Text Available Objectives: This study aimed to investigate the incidence of pterygium in a particular district of Istanbul, its association with age, and gender, and the severity of the disease. Methods: All patients aged ≥ 30 years referred to our outpatient clinics between January 2009 and December 2009 were included in this retrospective study. Age, gender, anterior segment photos, and findings of biomicroscopic eye examination were evaluated. Results: The incidence of pterygium for all age groups was 2.91% (male 1.75%, female 3.67% with an increasing incidence with age. A significant difference was detected in its incidence favoring female patients in 40-49, and 70-79, and male patients in ≥ 80 age groups, respectively. In addition, pterygium was seen in one (75.4% or both eyes (24.6% preferring right or left eye in 50.7%, and 49.3% of the patients, respectively. Pterygium was in nasal or temporal region in 98%, and 2% of the patients, respectively. The disease state in 59.9% of the patients was consistent with Stage 2 pterygium. The distance of pterygium from limbus was observed greatest in 60-69, and at a minimum in 40-49 age groups. No relationship was found between eye colour and development of pterygium. Conclusion: The incidence of pterygium increases with age. Incidence of pterygium differs between genders but without any significant difference. Its occurrence in one or both eyes and in right and left eyes was not influenced by gender of the patients. A statistically significant impact of eye colour of the patient on the development of pterygium was not disclosed. J Clin Exp Invest 2013; 4 (4: 436-442

  2. Etiologic Subtypes, Risk Factors, and Outcomes of Acute Ischemic Stroke in Young Patients

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    İnci Şule Özer

    2015-04-01

    Full Text Available Objective: Stroke in people aged less than 45 years is less frequent than in older patients, but has major impacts on both the individual and society. The aim of this study was to determine the etiologic subtypes of acute ischemic stroke in the young. Materials and Methods: We reviewed the hospital records of 619 patients who were admitted with acute ischemic stroke between January 2011 and November 2014. Acute ischemic stroke in the young was defined as patients aged 45 years and under. Demographic data, the National Institutes of Health Stroke Scale (NIHSS scores at admission and detailed investigations aimed at determining etiologic cause were recorded. Etiologic stroke subtypes were determined using the automated Causative Classification System. Modified Rankin Scale (mRS scores were recorded in the follow-up. Results: There were 32 (5.2% young patients with acute ischemic stroke. The rates of hypertension, diabetes mellitus, atrial fibrillation, and coronary artery disease were significantly lower in young patients compared with patients aged more than 45 years (p<0.05. The mean NIHSS score at admission and hospital mortality was significantly lower in patients aged 45 years and under compared with those older than 45 years (p=0.006, p=0.043. Cardioaortic embolism was the most common etiologic stroke subtype in both groups. Other causes were significantly more frequent in the young acute ischemic stroke group compared with the older patients. The median follow-up mRS was significantly lower in patients aged 45 years and under compared with those older than 45 years (p<0.001. Conclusion: Young patients with ischemic stroke have different risk factors, stroke etiology, stroke severity and prognosis compared with patients older than 45 years with the same condition

  3. Factors associated with delayed presentation in patients with TIA and minor stroke in China: analysis of data from the China National Stroke Registry (CNSR).

    Science.gov (United States)

    Wang, Linyu; Chao, Yangyun; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, David Z; Meng, Xia; Wang, Anxin; Wang, Yongjun; Xu, Yuming

    2013-06-01

    We aimed to evaluate the management of patients with transient ischemic attack (TIA) and minor stroke in China. Data from the China National Stroke Registry (CNSR) were used to identify patients who were admitted to 132 urban hospitals across China with TIA or minor stroke. Factors associated with delayed presentation to hospital were evaluated. Univariate and multivariate analyses were performed to analyze relationships between patient characteristics and time of presentation. Of the 7467 patients entered into the CNSR (1204 with TIA, 6263 with minor stroke), 780 patients (64·78%) with TIA and 3467 patients (55·36%) with minor stroke had delayed presentation to hospital (>24 hours). In both groups, factors associated with early presentation (≤24 hours) included transportation by ambulance and direct presentation to the emergency room. In patients with minor stroke, early presentation was associated with older age (65-80 years), motor and sensory symptoms, speech impairment, atrial fibrillation, previous TIA, and living in central or eastern China; and delayed presentation was associated with female sex, cognitive dysfunction, and diabetes. In patients with TIA, early presentation was associated with motor symptoms, and delayed presentation was associated with headache or vertigo. In China, many patients with TIA and minor stroke do not seek medical treatment immediately. Further education is needed to teach members of the public about the warning signs and symptoms of TIA and minor stroke, and encourage the use of ambulance transportation after TIA or stroke.

  4. Rehabilitation of a patient with stroke

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    Apurba Barman

    2013-01-01

    Full Text Available Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community and improve the self-esteem of patient. A comprehensive stroke rehabilitation service should provide early assessment of impairments and disabilities, management and prevention of complications and well-organized rehabilitation program in both in-patient and out-patient settings. A multidisciplinary or interdisciplinary team approach is necessary to reduce the post-stroke disabilities. It has many members, including physicians, physical therapists, occupational therapists, speech and language pathologists, orthotist, psychotherapists, social workers, vocational rehabilitation therapists, rehabilitation nurse, patients, families and other caregivers. Physicians caring for patients with stroke during rehabilitation must be aware of potential medical complications, as well as a number of special problems that may complicate recovery, including cognitive deficits, aphasia, dysphagia, urinary incontinence, shoulder pain, spasticity, falls and depression. Involvement of patient and caregivers in the rehabilitation process is essential. This article outlines the salient features of the early comprehensive rehabilitation after stroke.

  5. Emergency department boarding times for patients admitted to intensive care unit: Patient and organizational influences.

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    Montgomery, Phyllis; Godfrey, Michelle; Mossey, Sharolyn; Conlon, Michael; Bailey, Patricia

    2014-04-01

    Critically ill patients can be subject to prolonged stays in the emergency department following receipt of an order to admit to an intensive care unit. The purpose of this study was to explore patient and organizational influences on the duration of boarding times for intensive care bound patients. This exploratory descriptive study was situated in a Canadian hospital in northern Ontario. Through a six-month retrospective review of three data sources, information was collected pertaining to 16 patient and organizational variables detailing the emergency department boarding time of adults awaiting transfer to the intensive care unit. Data analysis involved descriptive and non-parametric methods. The majority of the 122 critically ill patients boarded in the ED were male, 55 years of age or older, arriving by ground ambulance on a weekday, and had an admitting diagnosis of trauma. The median boarding time was 34 min, with a range of 0-1549 min. Patients designated as most acute, intubated, and undergoing multiple diagnostic procedures had statistically significantly shorter boarding times. The study results provide a profile that may assist clinicians in understanding the complex and site-specific interplay of variables contributing to boarding of critically ill patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital

    DEFF Research Database (Denmark)

    Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

    2016-01-01

    university hospital during a 3-month period (September 2013–November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions...... with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP....

  7. Topographic Evaluation of Aphasia in 100 Stroke Patients

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    S Ghandehari

    2005-07-01

    Full Text Available Introduction: Aphasia is a common manifestation of stroke and evaluation of relationships of aphasia and brain topography could lead to better understanding of cognitive neurophysiology. Methods: 100 stroke patients with aphasia admitted in Valie-Asr hospital, Khorasan since April 2003 were enrolled in this prospective cross-sectional study. Diagnosis of stroke and aphasia was made by a neurologist and topography of involved cerebrovascular territories confirmed by topographic maps of brain in CT scan. Results: Global, Broca and Wernicke subtypes of aphasia constituted 52%, 40% and 6% of the cases, respectively. Based on the usual nourishment of Broca and Wernicke areas by anterior and posterior cortical branches of the middle cerebral artery, 79% of Global, 47% of Broca and 50% of Wernicke aphasias had compatible infarct topography. The infarct topography in other cases was not congruent with the involved linguistic areas of their brain. Conclusion: Specific cerebrovascular topography for subtypes of aphasia in stroke patients was not found. The effects of cerebrovascular lesions on linguistic functions are not predictable by their topography in CT scan.

  8. Default Mode Network Connectivity in Stroke Patients.

    Science.gov (United States)

    Tuladhar, Anil Man; Snaphaan, Liselore; Shumskaya, Elena; Rijpkema, Mark; Fernandez, Guillén; Norris, David G; de Leeuw, Frank-Erik

    2013-01-01

    The pathophysiology of episodic memory dysfunction after infarction is not completely understood. It has been suggested that infarctions located anywhere in the brain can induce widespread effects causing disruption of functional networks of the cortical regions. The default mode network, which includes the medial temporal lobe, is a functional network that is associated with episodic memory processing. We investigated whether the default mode network activity is reduced in stroke patients compared to healthy control subjects in the resting state condition. We assessed the whole brain network properties during resting state functional MRI in 21 control subjects and 20 'first-ever' stroke patients. Patients were scanned 9-12 weeks after stroke onset. Stroke lesions were located in various parts of the brain. Independent component analyses were conducted to identify the default mode network and to compare the group differences of the default mode network. Furthermore, region-of-interest based analysis was performed to explore the functional connectivity between the regions of the default mode network. Stroke patients performed significantly worse than control subjects on the delayed recall score on California verbal learning test. We found decreased functional connectivity in the left medial temporal lobe, posterior cingulate and medial prefrontal cortical areas within the default mode network and reduced functional connectivity between these regions in stroke patients compared with controls. There were no significant volumetric differences between the groups. These results demonstrate that connectivity within the default mode network is reduced in 'first-ever' stroke patients compared to control subjects. This phenomenon might explain the occurrence of post-stroke cognitive dysfunction in stroke patients.

  9. Motor Imagery Impairment in Postacute Stroke Patients

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    Niclas Braun

    2017-01-01

    Full Text Available Not much is known about how well stroke patients are able to perform motor imagery (MI and which MI abilities are preserved after stroke. We therefore applied three different MI tasks (one mental chronometry task, one mental rotation task, and one EEG-based neurofeedback task to a sample of postacute stroke patients (n=20 and age-matched healthy controls (n=20 for addressing the following questions: First, which of the MI tasks indicate impairment in stroke patients and are impairments restricted to the paretic side? Second, is there a relationship between MI impairment and sensory loss or paresis severity? And third, do the results of the different MI tasks converge? Significant differences between the stroke and control groups were found in all three MI tasks. However, only the mental chronometry task and EEG analysis revealed paresis side-specific effects. Moreover, sensitivity loss contributed to a performance drop in the mental rotation task. The findings indicate that although MI abilities may be impaired after stroke, most patients retain their ability for MI EEG-based neurofeedback. Interestingly, performance in the different MI measures did not strongly correlate, neither in stroke patients nor in healthy controls. We conclude that one MI measure is not sufficient to fully assess an individual’s MI abilities.

  10. The influence of the day of the week of hospital admission on the prognosis of stroke patients.

    Science.gov (United States)

    Barros, Juliana B; Goulart, Alessandra Carvalho; Alencar, Airlane P; Lotufo, Paulo A; Bensenor, Isabela M

    2013-04-01

    This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients.

  11. CHARACTERISTICS OF PATIENTS WITH CEREBRAL STROKE OR TRANSIENT ISCHEMIC ATTACK, INCLUDED INTO THE LIS-2 REGISTER (LYUBERTSY STUDY OF MORTALITY IN PATIENTS AFTER STROKE

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    S. Yu. Martsevich

    2015-01-01

    Full Text Available Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. All patients (n=960 admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%, atrial fibrillation in 252 (26.8% patients, 199 (20.7% patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years. Low frequency of the antihypertensive therapy (34.5%, lipid-lowering therapy (0.7%, antiplatelet agents (5.7%, anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

  12. Outcome of patients with pulmonary embolism admitted to the intensive care unit

    International Nuclear Information System (INIS)

    AlOtair, Hadeel; Chaudhry, Mohammed; Shaikh, Shaffi; BaHammam, Ahmed

    2009-01-01

    Pulmonary embolism (PE) is an important cause of in-hospital mortality. Many patients are admitted to the intensive care unit (ICU) either due to hemodynamic instability or severe hypoxemia. Few reports have addressed the outcome of patients with PE; however, none were from ICUs in the Middle East. To describe the demographics, clinical presentation, risk factors and outcome of patients with PE admitted to the medical ICU and to identify possible factors associated with poor prognosis. Data were collected retrospectively by reviewing the records of patients admitted to the medical ICU with primary diagnosis of PE between January 2001 and June 2007. Demographic, clinical, radiological and therapeutic data were collected on admission to ICU. Fifty-six patients (43% females) with PE were admitted to the ICU during the study period. Their mean age was 40.6 + - 10.6 years. Seven patients (12.5%) had massive PE with hemodynamic instability and 15 (26.8%) had submassive PE. The remaining patients were admitted due to severe hypoxemia. Recent surgery followed by obesity were the most common risk factors (55.4 and 28.6%, respectively). Four patients with massive PE received thrombolysis because the remaining three had absolute contraindications. Fatal gastrointestinal bleeding occurred in one patient post thrombolysis. Additionally, two patients with massive PE and five with submassive PE died within 72 h of admission to the ICU, resulting in an overall mortality rate of 14%. Nonsurvivors were older and had a higher prevalence of immobility and cerebrovascular diseases compared with survivors. The mortality rate of patients with PE admitted to the ICU in our center was comparable to other published studies. Older age, immobility as well as coexistent cerebrovascular diseases were associated with a worse outcome. (author)

  13. Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India

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    Latha KS

    2011-04-01

    Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.

  14. Hypercholesterolemia in patients of ischemic stroke

    International Nuclear Information System (INIS)

    Saeed, E.; Ali, R.; Din, M.J.U.; Saeed, A.; Jadoon, R.J.

    2015-01-01

    Background: Stroke is a common neurological disease that results in significant mortality and morbidity globally. Several risk factors have been identified for stroke among which hyperlipidaemia is one of the modifiable risk factors. Recent clinical trials have shown a reduction in ischemic stroke for patients taking lipid lowering medications. Therefore, the aim of this study was to find out the frequency of hypercholesterolemia in patients of ischemic stroke in Hazara region. Method: This cross sectional study was carried out in the Medical Department of Ayub Teaching Hospital, Abbottabad. Ninety patients of stroke confirmed as ischemic by CT scan brain were enrolled in the study after informed consent. The frequency of hypercholesterolemia in patients was recorded. Results: There were 55 (61.1 percentage) males. The mean age of patients was 64.4±11.5 years. The mean serum cholesterol in all patients was 4.16±1.1 mmol/l. The mean serum cholesterol of male patients was 4.3±1.2 mmol/l and 4.0±10.9 mmol/l in the case of females. Conclusions: Hypercholesterolemia could not be established as a major risk factor for stroke in our setup through this study that allude to the fact that other risk factors might be contributing more to the incidence of cerebrovascular accident in our population. (author)

  15. What happens to stroke patients after hospital discharge?

    LENUS (Irish Health Repository)

    Noone, I

    2001-05-01

    Of 231 stroke patients discharged from hospital, 34 patients (14.7%) had died when reviewed 6 months later. Of 195 survivors, 115 (58%) were independent and living in the community. The remaining 80 (42%) patients were dependent. The majority of dependent patients were in institutional care but 29 (36%) were residing in the community of whom a substantial number were not receiving physiotherapy, occupational therapy or day care. Patients who were dependent in nursing homes were less likely to have received physiotherapy (48% versus 70%) or occupational therapy (28% versus 60%) compared to disabled patients in hospital based extended nursing care. 45 patients (24%) had been re-admitted to hospital although only 48% of patients had been reviewed in hospital outpatients since discharge. 64% of patients were on anti-thrombotic treatment. This survey suggests that 6 months after hospital discharge, most stroke patients are still alive and living in the community. Many of the dependent survivors have ongoing unmet medical and rehabilitation needs.

  16. Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards*

    Science.gov (United States)

    Almeida, Luiz Maurício Costa; Diniz, Michelle dos Santos; Diniz, Lorena dos Santos; Machado-Pinto, Jackson; Silva, Francisco Chagas Lima

    2013-01-01

    BACKGROUND Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. PMID:24173179

  17. Can stroke patients use visual analogue scales?

    Science.gov (United States)

    Price, C I; Curless, R H; Rodgers, H

    1999-07-01

    Visual analogue scales (VAS) have been used for the subjective measurement of mood, pain, and health status after stroke. In this study we investigated how stroke-related impairments could alter the ability of subjects to answer accurately. Consent was obtained from 96 subjects with a clinical stroke (mean age, 72.5 years; 50 men) and 48 control subjects without cerebrovascular disease (mean age, 71.5 years; 29 men). Patients with reduced conscious level or severe dysphasia were excluded. Subjects were asked to rate the tightness that they could feel on the (unaffected) upper arm after 3 low-pressure inflations with a standard sphygmomanometer cuff, which followed a predetermined sequence (20 mm Hg, 40 mm Hg, 0 mm Hg). Immediately after each change, they rated the perceived tightness on 5 scales presented in a random order: 4-point rating scale (none, mild, moderate, severe), 0 to 10 numerical rating scale, mechanical VAS, horizontal VAS, and vertical VAS. Standard tests recorded deficits in language, cognition, and visuospatial awareness. Inability to complete scales with the correct pattern was associated with any stroke (P<0.001). There was a significant association between success using scales and milder clinical stroke subtype (P<0.01). Within the stroke group, logistic regression analysis identified significant associations (P<0.05) between impairments (cognitive and visuospatial) and inability to complete individual scales correctly. Many patients after a stroke are unable to successfully complete self-report measurement scales, including VAS.

  18. Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

    Science.gov (United States)

    Langhorne, Peter; Taylor, Gillian; Murray, Gordon; Dennis, Martin; Anderson, Craig; Bautz-Holter, Erik; Dey, Paola; Indredavik, Bent; Mayo, Nancy; Power, Michael; Rodgers, Helen; Ronning, Ole Morten; Rudd, Anthony; Suwanwela, Nijasri; Widen-Holmqvist, Lotta; Wolfe, Charles

    Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (pstroke patients with mild to moderate disability. Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

  19. MEMORY SONGS DECREASE DEPRESSION FOR STROKE PATIENTS

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    Harmayetty Harmayetty

    2017-07-01

    Full Text Available Introduction: Biological, physical and phsycosocial changes in stroke patient could be a stressor that induced a depression state. There would be an emotional disturbance in stroke patient and stroke attack would be recurrent, if it was not treated. One of the alternative techniques to reduce depression is musical therapy especially memory songs. Method: This study was used a quasy experimental pre-post test purposive sampling design. The population was stroke patients who treated in Neurological Ward A and Stroke Unit Dr Soetomo Hospital Surabaya. There were 12 respondents divided into 6 respondents for treatment group and 6 respondents for control group. The independent variable was music (memory song and dependent variable was depression. Data were collected by using questionnaire which adapted from Hamilton Depression Rating Scale and Geriatric Depression Rating Scale, then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that there was a difference between pre test and post test in depression (p=0.0196 and there was a difference in the depression between treatment group and control group (p=0.002. Discussion: It can be concluded that music (memory songs has an effect to the depression of stroke patient. Further studies are needed to concerning other factors that may affect the relaxation technique especially in listening music.

  20. Malnutrition in Patients with Acute Stroke

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    Stella D. Bouziana

    2011-01-01

    Full Text Available Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding.

  1. The value of serum mean platelet volume in ischaemic stroke patient

    International Nuclear Information System (INIS)

    Tamer, F.; Fevzi, Y.; Deniz, A.E.; Cemil, K.; Cihat, Y.; Muhittin, Y.; Serkan, Y.M.; Ali, C.M.; Faith, B.

    2013-01-01

    Objective: To investigate the value of serum Mean Platelet Volume in acute ischaemic stroke patients. Method: The retrospective case-control study was conducted at Ankara Numune Training and Research Hospital in Turkey and comprised record of patients of acute ischaemic stroke admitted to the Emergency Department between June 2010 and January 2012. The two groups were statistically compared using SPSS 18.0. Result: Overall, there were 482 stroke patients (Group 1) and 315 subjects as controls (Group 2). The median value in Group 1 was 9.0 (2.1) (fL), while in Group 2 it was 8.80 (2.4) (fL). The difference was statistically significant (Z=-2.80; p<0.05). Conclusion: Mean Platelet Volume increased in the stroke patients. (author)

  2. The prognostic importance of lung function in patients admitted with heart failure.

    Science.gov (United States)

    Iversen, Kasper Karmark; Kjaergaard, Jesper; Akkan, Dilek; Kober, Lars; Torp-Pedersen, Christian; Hassager, Christian; Vestbo, Jorgen; Kjoller, Erik

    2010-07-01

    The purpose of the present study was to determine the prognostic importance for all-cause mortality of lung function variables obtained by spirometry in an unselected group of patients admitted with heart failure (HF). This was a prospective prognostic study performed as part of the EchoCardiography and Heart Outcome Study (ECHOS). This analysis included 532 patients admitted with a clinical diagnosis of HF. All patients underwent spirometry and echocardiography and the diagnosis of HF was made according to established criteria. Mean forced expiratory volume in 1 s (FEV(1)) was 65% of the predicted value [95% confidence interval (CI) 63-67%], mean forced vital capacity (FVC) was 71% of predicted (95% CI 69-72%), and FEV(1)/FVC was 0.72 (95% CI 0.71-0.73). FEV(1), FVC, and FEV(1)/FVC were all significant prognostic factors for all-cause mortality in univariate analyses. In a multivariate analysis, FEV(1) had independent prognostic value (hazard ratio 0.86 per 10% change, P information for all-cause mortality in patients admitted with HF. Spirometry therefore seems to be worth considering for all patients admitted with HF in order to identify patients at high risk.

  3. Bacteriology in acute exacerbation of chronic obstructive pulmonary disease in patients admitted to hospital

    DEFF Research Database (Denmark)

    Larsen, Mette V; Janner, Julie H; Nielsen, Susanne D

    2009-01-01

    patients admitted to Hvidovre hospital with the diagnosis AECOPD during 2004. A total of 118 patients were included. Microscopy, culture and sensitivity testing investigated their sputums. Clinical and paraclinical features were collected from the patients' files. Among the 118 patients, 59 (50%) had....... pneumonia, mostly H. influenzae and Moraxella catarrhalis. Patients with low FEV(1)sensitivity patterns of the bacteria showed that the majority were resistant to penicillin. If antibiotics are initiated empirically......We investigated the bacterial flora and antimicrobial sensitivity in sputum from patients admitted to hospital with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in order to recommend the best empirical treatment for these patients. The survey was a retrospective study of all...

  4. Use of APACHE II and SAPS II to predict mortality for hemorrhagic and ischemic stroke patients.

    Science.gov (United States)

    Moon, Byeong Hoo; Park, Sang Kyu; Jang, Dong Kyu; Jang, Kyoung Sool; Kim, Jong Tae; Han, Yong Min

    2015-01-01

    We studied the applicability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in patients admitted to the intensive care unit (ICU) with acute stroke and compared the results with the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). We also conducted a comparative study of accuracy for predicting hemorrhagic and ischemic stroke mortality. Between January 2011 and December 2012, ischemic or hemorrhagic stroke patients admitted to the ICU were included in the study. APACHE II and SAPS II-predicted mortalities were compared using a calibration curve, the Hosmer-Lemeshow goodness-of-fit test, and the receiver operating characteristic (ROC) curve, and the results were compared with the GCS and NIHSS. Overall 498 patients were included in this study. The observed mortality was 26.3%, whereas APACHE II and SAPS II-predicted mortalities were 35.12% and 35.34%, respectively. The mean GCS and NIHSS scores were 9.43 and 21.63, respectively. The calibration curve was close to the line of perfect prediction. The ROC curve showed a slightly better prediction of mortality for APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients. The GCS and NIHSS were inferior in predicting mortality in both patient groups. Although both the APACHE II and SAPS II systems can be used to measure performance in the neurosurgical ICU setting, the accuracy of APACHE II in hemorrhagic stroke patients and SAPS II in ischemic stroke patients was superior. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Acupuncture therapy for stroke patients.

    Science.gov (United States)

    Li, Xin; Wang, Qiang

    2013-01-01

    Acupuncture is one of the most important parts of Traditional Chinese Medicine, has been used for more than 3000 years as prevention and treatment for various diseases in China as well as in adjacent regions, and is widely accepted in western countries in recent years. More and more clinical trials revealed that acupuncture shows positive effect in stroke, not only as a complementary and alternative medicine for poststroke rehabilitation but also as a preventive strategy which could induce cerebral ischemic tolerance, especially when combined with modern electrotherapy. Acupuncture has some unique characteristics, which include acupoint specificity and parameter-dependent effect. It also involves complicated mechanism to exert the beneficial effect on stroke. Series of clinical trials have shown that acupuncture primarily regulates the release of neurochemicals, hemorheology, cerebral microcirculation, metabolism, neuronal activity, and the function of specific brain region. Animal studies showed that the effects of acupuncture therapy on stroke were possibly via inhibition of postischemic inflammatory reaction, stimulation of neurogenesis and angiogenesis, and influence on neural plasticity. Mechanisms for its preconditioning effect include activity enhancement of antioxidant, regulation of the endocannabinoid system, and inhibition of apoptosis. Although being controversial, acupuncture is a promising preventive and treatment strategy for stroke, but further high-quality clinical trials would be needed to provide more confirmative evidence. © 2013 Elsevier Inc. All rights reserved.

  6. Prognosis and risk factors for deterioration in patients admitted to a medical emergency department

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Brabrand, Mikkel; Lassen, Annmarie Touborg

    2014-01-01

    vital signs at arrival to a medical emergency department (MED). DESIGN AND SETTING: Single-centre, retrospective cohort study of all patients admitted to the MED from September 2010-August 2011. SUBJECTS: Patients were included when their vital signs (systolic blood pressure, pulse rate, respiratory.......2-3.0%) among the non-deteriorating, hazard ratio 4.11 (95% CI: 2.38-7.10). CONCLUSIONS: Among acutely admitted medical patients who arrive with normal vital signs, 31.0% showed signs of deterioration within 24 hours. Risk factors included old age, Do-not-attempt-to-resuscitate order, admission from the open...... general ED. Thirty-day mortality among patients with deterioration was four times higher than among non-deteriorating patients. Further research is needed to determine whether intensified monitoring of vital signs can help to prevent deterioration or mortality among medical emergency patients....

  7. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian

    2003-01-01

    -four per cent of the patients admitted with cardiac arrest expressed no prior symptoms. Two-thirds of patients with typical symptoms interpreted it as cardiac-still only half took action within 20 min. Fifty per cent of patients who called a physician were delayed by wrong advice or misinterpretation. One...... for medical assistance. Perceiving jeopardy had positive influence on the behaviour. Awareness of therapeutic options influences the decision-making process....

  8. ACE Gene in Egyptian Ischemic Stroke Patients.

    Science.gov (United States)

    Mostafa, Magdy A; El-Nabiel, Lobna M; Fahmy, Nagia Aly; Aref, Hany; Shreef, Edrees; Abd El-Tawab, Fathy; Abdulghany, Osama M

    2016-09-01

    Angiotensin-1-converting enzyme (ACE) is a crucial player in vascular homeostasis and in the pathogenesis of atherosclerosis and hypertension. The present study was conducted to determine whether there is an association between the ACE insertion/deletion (I/D) polymorphism and ischemic stroke in Egyptian population. Also, we analyzed the ACE gene I/D polymorphism as a risk factor for small-vessel (SV) versus large-vessel (LV) disease. Sixty patients with ischemic stroke were included: 30 with SV disease and 30 with LV disease. In addition, a control group of 30 apparent healthy subjects were studied. Clinical assessment, computed tomography, magnetic resonance imaging brain, and genetic study using the polymerase chain reaction of ACE gene were done for all subjects. We found that the distribution of ACE gene polymorphism frequency was significantly different between the 3 groups. The DD genotype was far more common in stroke patients compared to controls. It was also significantly more common in each of the patient groups compared to controls but rather similar in the 2 patient groups with SV and LV diseases. We found that the ACE gene deletion/deletion genotype is common in Egyptian patients with non-cardioembolic ischemic stroke but does not appear to be specific neither to SV nor to LV disease. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Meta-analysis of recent studies on patients admitted to hospital due to adverse drug effects

    NARCIS (Netherlands)

    Atiqi, R.; Cleophas, T. J.; van Bommel, E.; Zwinderman, A. H.

    2009-01-01

    The use of drugs has expanded during the previous decade. However, earlier studies oil patients admitted for adverse drugs effects (ADEs) have been heterogeneous. The objectives of this Study were to assess the number of recent admissions to hospital Clue to ADEs and to assess the degree of

  10. Comparison Between Emergency Department and Inpatient Nurses’ Perceptions of Boarding of Admitted Patients

    Science.gov (United States)

    Pulliam, Bryce C.; Liao, Mark Y.; Geissler, Theodore M.; Richards, John R.

    2013-01-01

    Introduction: The boarding of admitted patients in the emergency department (ED) is a major cause of crowding and access block. One solution is boarding admitted patients in inpatient ward (W) hallways. This study queried and compared ED and W nurses’ opinions toward ED and W boarding. It also assessed their preferred boarding location if they were patients. Methods: A survey administered to a convenience sample of ED and W nurses was performed in a 631-bed academic medical center (30,000 admissions/year) with a 68-bed ED (70,000 visits/ year). We identified nurses as ED or W, and if W, whether they had previously worked in the ED. The nurses were asked if there were any circumstances where admitted patients should be boarded in ED or W hallways. They were also asked their preferred location if they were admitted as a patient. Six clinical scenarios were then presented, and the nurses’ opinions on boarding based on each scenario were queried. Results: Ninety nurses completed the survey, with a response rate of 60%; 35 (39%) were current ED nurses (cED), 40 (44%) had previously worked in the ED (pED). For all nurses surveyed 46 (52%) believed admitted patients should board in the ED. Overall, 52 (58%) were opposed to W boarding, with 20% of cED versus 83% of current W (cW) nurses (P boarding, with 82% of cED versus 33% of cW nurses (P boarding were lack of monitoring and patient privacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existed in all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen, and an intubated, unstable sepsis patient. Conclusion: Inpatient nurses and those who have never worked in the ED are more opposed to inpatient boarding than ED nurses and nurses who have worked previously in the ED. Primary nursing concerns about boarding are lack of monitoring and privacy in hallway beds. Nurses admitted as patients seemed to prefer not being boarded where they work

  11. Comparison between emergency department and inpatient nurses' perceptions of boarding of admitted patients.

    Science.gov (United States)

    Pulliam, Bryce C; Liao, Mark Y; Geissler, Theodore M; Richards, John R

    2013-03-01

    The boarding of admitted patients in the emergency department (ED) is a major cause of crowding and access block. One solution is boarding admitted patients in inpatient ward (W) hallways. This study queried and compared ED and W nurses' opinions toward ED and W boarding. It also assessed their preferred boarding location if they were patients. A survey administered to a convenience sample of ED and W nurses was performed in a 631-bed academic medical center (30,000 admissions/year) with a 68-bed ED (70,000 visits/ year). We identified nurses as ED or W, and if W, whether they had previously worked in the ED. The nurses were asked if there were any circumstances where admitted patients should be boarded in ED or W hallways. They were also asked their preferred location if they were admitted as a patient. Six clinical scenarios were then presented, and the nurses' opinions on boarding based on each scenario were queried. Ninety nurses completed the survey, with a response rate of 60%; 35 (39%) were current ED nurses (cED), 40 (44%) had previously worked in the ED (pED). For all nurses surveyed 46 (52%) believed admitted patients should board in the ED. Overall, 52 (58%) were opposed to W boarding, with 20% of cED versus 83% of current W (cW) nurses (P boarding, with 82% of cED versus 33% of cW nurses (P boarding were lack of monitoring and patient privacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existed in all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen, and an intubated, unstable sepsis patient. Inpatient nurses and those who have never worked in the ED are more opposed to inpatient boarding than ED nurses and nurses who have worked previously in the ED. Primary nursing concerns about boarding are lack of monitoring and privacy in hallway beds. Nurses admitted as patients seemed to prefer not being boarded where they work. ED and inpatient nurses seemed to agree that

  12. Trends in boarding of admitted patients in US Emergency Departments 2003-2005.

    Science.gov (United States)

    Carr, Brendan G; Hollander, Judd E; Baxt, William G; Datner, Elizabeth M; Pines, Jesse M

    2010-10-01

    Boarding of admitted patients in the Emergency Department (ED) is common and is associated with poor patient outcomes. We sought to estimate the magnitude of and trends for ED boarding in the US. We used the 2003-2005 National Hospital Ambulatory Medical Care Survey to estimate the time patients spent boarding in EDs in the US. We used fixed and imputed times required to evaluate, treat, and decide to admit each patient using the number of medications and diagnostic tests received. We calculated the absolute and relative patient-care hours spent boarding in US EDs over the 3-year period. Total patient-hours spent in US EDs increased from 209 million to 217 million between 2003 and 2005. Overall admission rates decreased between 2003 and 2005 (13.9% in 2003, 12.3% in 2005), whereas intensive care unit admission rates increased (1.3% in 2003, 2.0% in 2005). Mean ED length of stay decreased (5.4 h in 2003, 4.6 h in 2005). The proportion of patient-hours accounted for by ED boarding decreased over the study period (11.3-17.1% in 2003, 5.9-15.3% in 2004, and 2.8-12.0% 2005). Boarding of admitted patients in the ED accounts for a substantial portion of ED patient-care hours. Overall boarding time decreased over the 3 years. Copyright © 2010 Elsevier Inc. All rights reserved.

  13. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke.

    Science.gov (United States)

    Zhao, Lu; Wang, Ruihao; Song, Bo; Tan, Song; Gao, Yuan; Fang, Hui; Lu, Jie; Xu, Yuming

    2015-07-01

    The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24-6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85-3·37). Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship. © 2015 World Stroke Organization.

  14. Nitrogen balance in patients with hemiparetic stroke during the subacute rehabilitation phase.

    Science.gov (United States)

    Wada, A; Kawakami, M; Otsuka, T; Aoki, H; Anzai, A; Yamada, Y; Liu, F; Otaka, E; Akaboshi, K; Liu, M

    2017-06-01

    In highly invasive diseases, metabolism commonly changes. Hypercatabolism is frequent in acute stroke, and nitrogen balance tends to be negative. However, there has been no study describing nitrogen balance in subacute and chronic stroke patients. The present study aimed to examine nitrogen balance in the subacute and chronic phases and to identify the factors related to it. Nitrogen balance was calculated from the collected urine of 56 patients with subacute stroke [mean (SD) 53.8 (18.4) days post-stroke] who were admitted for rehabilitation for their first-ever ischaemic or nonsurgical haemorrhagic stroke. In the first experiment, their nitrogen balance was measured during the rehabilitation phase, and factors (type, severity of hemiparesis, activities of daily living, dysphagia and malnutrition status) related to it were evaluated. The second experiment was performed to describe the time course of nitrogen balance in 31 consecutive patients, with assessments made at admission and at discharge. Nitrogen balance was positive in all patients in the subacute phase. A significant difference was seen in nitrogen balance between high and low fat-free mass in male patients. In the chronic phase, nitrogen balance was positive in 96% of the patients. There was no significant difference in nitrogen balance between discharge and admission. In the subacute and chronic phases of stroke, it was confirmed that hypercatabolism had resolved and that intensive rehabilitation is possible in the convalescent period of stroke. © 2017 The British Dietetic Association Ltd.

  15. Characteristics of Inpatient Care and Rehabilitation for Acute First-Ever Stroke Patients

    Science.gov (United States)

    Chang, Won Hyuk; Shin, Yong-Il; Lee, Sam-Gyu; Oh, Gyung-Jae; Lim, Young Shil

    2015-01-01

    Purpose The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients. Materials and Methods This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records. Both ischemic and hemorrhagic strokes were included. Survey items included demographic data, risk factors, stroke type, state of rehabilitation treatment, discharge destination, and functional status at discharge. Results A total of 2159 patients were reviewed. The mean age was 61.5±14.4 years and the ratio of males to females was 1.23:1. Proportion of ischemic stroke comprised 54.9% and hemorrhagic stroke 45.1%. Early hospital mortality rate was 8.1%. Among these patients, 27.9% received rehabilitation consultation and 22.9% underwent inpatient rehabilitation treatment. The mean period from admission to rehabilitation consultation was 14.5 days. Only 12.9% of patients were transferred to a rehabilitation department and the mean period from onset to transfer was 23.4 days. Improvements in functional status were observed in the patients who had received inpatient rehabilitation treatment after acute stroke management. Conclusion Our analysis revealed that a relatively small portion of patients who suffered from an acute first-ever stroke received rehabilitation consultation and inpatient rehabilitation treatment. Thus, applying standardized clinical practice guidelines for post-acute rehabilitation care is needed to provide more effective and efficient rehabilitation services to patients with stroke. PMID:25510773

  16. Communication activity in stroke patients with aphasia.

    Science.gov (United States)

    Mazaux, Jean-Michel; Lagadec, Tiphaine; de Sèze, Mathieu Panchoa; Zongo, Drissa; Asselineau, Julien; Douce, Emmanuelle; Trias, Joel; Delair, Marie-France; Darrigrand, Bénédicte

    2013-04-01

    To study communication disability in stroke patients with aphasia. Prospective, multicentric cohort study of patients with aphasia, consecutively included after a first stroke, and examined 1 year later at home. Assessment included a stroke severity scale, the Barthel Index, the boston diagnostic aphasia examination, a communication questionnaire, and the aphasia depression rating scale. A total of 164 patients were included. Among the 100 survivors assessed at follow-up, 24% had severe aphasia, 12% moderate aphasia and 64% mild aphasia according to the Boston diagnostic aphasia examination severity score. Patients mainly reported difficulties in conversation with strangers and/or on abstract topics, using a phone, reading and writing administrative documents, dealing with money and outdoor communication activities. Communication was strongly related to aphasia severity. Age, gender, education level, residence status and type of stroke had no influence on communication activity. On multivariate analysis, severity of stroke and severity of aphasia on inclusion were found to account for 58% of variance and were independent predictors of the communication questionnaire score at follow-up. Documenting the most impaired communication skills may help to set priority goals for speech and language therapy in aphasia.

  17. Improving stroke patients' care: a patient held record is not enough

    Directory of Open Access Journals (Sweden)

    Lampe Fiona

    2001-03-01

    Full Text Available Abstract Background Stroke patients' care in hospital tends to be poorly organised, with poor communication and a lack of information being frequent sources of complaint. The purpose of this study was to evaluate whether a patient-held record (PHR would result in greater patient satisfaction and better care planning for stroke patients. Methods A time series control (6 months - intervention (8 months - control (6 months was used among London teaching hospital general medical and geriatric medicine inpatient wards. All stroke patients admitted to the wards during the intervention phase received a PHR and were instructed in its use. Demographic, stroke severity, social factors and outcomes were collected from all stroke patients during all phases of the study. Results Of 252 stroke patients aged 46 to 98 years entered into the study, by six months after admission 118 (46.8% had died. PHR and control group patients were well matched in terms of socio-demographic characteristics and pre-stroke ability. At six months after admission, 119 (97% patients responded to the questionnaire. Just over half (56%, 13 of intervention group patients recalled receiving a PHR. Of those patients, 59% reported reading the PHR, 27% had lost their PHR, and two-thirds said they had difficulties encouraging staff to write in the PHR. Half felt that possession of the PHR was more trouble than it was worth. PHR group patients were more satisfied with the recovery they had made (79% vs. 59%, p=0.04, but felt less able to talk to staff about their problems (61% vs. 82%, p=0.02. PHR group patients reported receiving fewer explanations about their condition (18% vs. 33%, p=0.12 and treatment (26% vs. 45%, p=0.07, and were more afraid of asking doctors questions (21% vs. 4%, p=0.01 than controls. PHR group patients were no better prepared for hospital discharge than control group patients, and both groups were ill-informed about services and benefits that might have helped

  18. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian

    2003-01-01

    OBJECTIVE: To study prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest. DESIGN: Structured interview of 250 consecutive patients with acute coronary syndrome and relatives of 48 patients with witnessed cardiac arrest. The following courses of action...... hundred and thirteen patients (45%) knew of thrombolytic therapy. Twenty-seven of 75 patients with knowledge of the benefit of prompt treatment with thrombolysis, acted in accordance with this awareness. CONCLUSION: Patients misinterpret symptoms of acute coronary syndrome and are misguided when calling...

  19. Randomized controlled trial of a comprehensive stroke education program for patients and caregivers.

    Science.gov (United States)

    Rodgers, H; Atkinson, C; Bond, S; Suddes, M; Dobson, R; Curless, R

    1999-12-01

    We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient- and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. Only 51 of 108 (47%) surviving patients randomized to the SEP completed the program, as did 20 of 93 (22%) informal carers of surviving patients. Perceived health status (Short Form 36 [SF-36] health survey) scores were similar for SEP patients and controls. Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group (P=0.04). Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls (patients, P=0.02; carers, P=0. 01). Patients in the SEP group were more satisfied with the information that they had received about stroke (P=0.004). There were no differences in emotional or functional outcomes between groups. Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services, this was not associated with an improvement in their perceived health status. Indeed, the social functioning of informal carers randomized to the SEP was less than in the control group.

  20. Quality of life and symptoms in patients with malignant diseases admitted to a comprehensive cancer centre

    DEFF Research Database (Denmark)

    Strömgren, Lene Annette Sand; Niemann, Carsten Utoft; Tange, Ulla Brix

    2014-01-01

    PURPOSE: Quality of life and symptomatology in patients with malignancies admitted to comprehensive cancer centres are rarely investigated. Thus, this study aimed to investigate symptomatology and health-related quality of life of inpatients with cancer. METHODS: A prospective, cross......-sample test, rank tests and Fisher's exact test. RESULTS: One hundred twenty-four patients were analysed, mean age = 59 years (SD = 13.7), 42 % admitted to haematological department; lung cancer was the most frequent diagnosis (15 %). Low health-related quality of life and severe symptom burden, especially...... in oncology patients (P = 0.0194 and 0.0064, respectively). CONCLUSIONS: Patients in the wards of haematology and oncology had pronounced symptomatology and low quality of life. A more systematic focus on the amelioration of problems with functioning and symptoms among inpatients with malignant diseases...

  1. Prevalence of serum anti-neuronal autoantibodies in patients admitted to acute psychiatric care

    DEFF Research Database (Denmark)

    Schou, M; Sæther, S G; Borowski, K

    2016-01-01

    BACKGROUND: Autoimmune encephalitis associated with anti-neuronal antibodies may be challenging to distinguish from primary psychiatric disorders. The significance of anti-neuronal antibodies in psychiatric patients without clear evidence of autoimmune encephalitis is unknown. We investigated...... the serum prevalence of six anti-neuronal autoantibodies in a cohort of unselected patients admitted to acute psychiatric care. METHOD: Serum was drawn from 925 patients admitted to acute psychiatric in-patient care. Psychiatric diagnoses were set according to International Classification of Diseases (ICD......)-10 criteria. Antibody analysis was performed with an indirect immunofluorescence test for N-methyl d-aspartate receptor (NMDAR) antibodies and five other anti-neuronal autoantibodies of the immunoglobulin (Ig) classes IgA, IgG and IgM isotype. RESULTS: Anti-neuronal autoantibodies were found in 11...

  2. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014.

    Science.gov (United States)

    Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie

    2017-11-01

    Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

  3. Reporting time of ischemic stroke patients within the time window for thrombolysis in a tertiary care hospital at rawalpindi

    International Nuclear Information System (INIS)

    Tariq, M.; Ishtiaq, S.; Anwar, S.O.

    2014-01-01

    To determine the reporting time of ischemic stroke patients within the time window for thrombolysis at Military Hospital (MH) Rawalpindi. Design: A descriptive study. Place and duration of Study: Military Hospital Rawalpindi over a period of four months from Dec 2013 to Mar 2014. Patients and Methods: Patients admitted to MH Rawalpindi with symptoms suggestive of stroke and having objective focal neurologic deficits consistent with stroke were included in the study. A CT scan of brain was carried out immediately to rule out intracranial bleed. The CT scan of brain was either normal or revealed radiological findings suggestive of an infarct. Results: A total of 86 patients met the inclusion criteria of the study. Only 19 (22%) patients with ischemic stroke presented to the hospital within 4.5 hours after onset of their symptoms. Conclusion: Only a small number of ischemic stroke patients report to the hospital within the therapeutic window for thrombolytic therapy. (author)

  4. Clues to occult cancer in patients with ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Suk Jae Kim

    Full Text Available BACKGROUND: We hypothesized that hidden malignancy could be detected in patients with cryptogenic stroke without active cancer when they showed the distinctive characteristics of cancer-related stroke. METHODS AND FINDINGS: Among 2,562 consecutive patients with acute ischemic stroke, patients with cryptogenic stroke were analyzed and categorized into two groups according to the presence of active cancer: cryptogenic stroke with active cancer (cancer-related stroke, CA-stroke group and without active cancer (CR-stroke group. Patients with active lung cancer without stroke were also recruited for comparison purposes (CA-control. Clinical factors, lesion patterns on diffusion-weighted MRI (DWI, and laboratory findings were analyzed among groups. A total of 348 patients with cryptogenic stroke were enrolled in this study. Among them, 71 (20.4% patients had active cancer at the time of stroke. The D-dimer levels were significantly higher in patients with CA-stroke than those with CR-stroke or CA-control (both p<0.001. Regarding lesion patterns, patients with CA-stroke mostly had multiple lesions in multiple vascular territories, while more than 80% of patients with CR-stroke had single/multiple lesions in a single vascular territory (P<0.001. D-dimer levels (OR 1.11 per 1 µg/mL increase; 95% CI 1.06-1.15; P<0.001 and DWI lesion patterns (OR 7.13; 95% CI 3.42-14.87; P<0.001 were independently associated with CA-stroke. Workup for hidden malignancy was performed during hospitalization in 10 patients who showed elevated D-dimer levels and multiple infarcts involving multiple vascular territories but had no known cancer, and it revealed hidden malignancies in all the patients. CONCLUSION: Patients with CA-stroke have distinctive D-dimer levels and lesion patterns. These characteristics can serve as clues to occult cancer in patients with cryptogenic stroke.

  5. [Assessment of patients with pressure sores admitted in a tertiary care center].

    Science.gov (United States)

    Moro, Adriana; Maurici, Alice; do Valle, Juliana Barros; Zaclikevis, Viviane Renata; Kleinubing, Harry

    2007-01-01

    To determine the prevalence and analyze the profile of patients with pressure sores, focusing on risk factors, the patients' clinical characteristics at a tertiary care center, as well as stage and location of the lesions on the body. This was a cross sectional not controlled observational study, all patients admitted from April to June of 2005 were observed daily to identify all cases of pressure sores. The affected patients were evaluated by a standard questionnaire and the Scale of Braden was applied to define the risk of developing ulcers. Of the 690 patients admitted during the referred period, a prevalence of 5.9% of patients with lesions was observed, equivalent to 41 patients 63.9% of which were elderly and the average length of stay was 18 days. In the sample studied 41.5% of patients were found in the internal medicine section and the intensive care unit, ICU. The most common location for sores was the sacral area, corresponding to 73.1% of the patients, and stage II was the most frequent, observed in 58.5% of those patients. According to the Braden scale, most patients, 80.4%, had a high risk of developing pressure ulcers, compared to 9.7% of patients with moderate risk and 7.4% with low risk. The affected patients were at high risk of developing pressure sores. Prevalence of these lesions and the clinical and demographic profile of the affected patients are in accordance with the data in literature.

  6. Acute management of stroke patients taking non-vitamin K antagonist oral anticoagulants Addressing Real-world Anticoagulant Management Issues in Stroke (ARAMIS) Registry: Design and rationale.

    Science.gov (United States)

    Xian, Ying; Hernandez, Adrian F; Harding, Tina; Fonarow, Gregg C; Bhatt, Deepak L; Suter, Robert E; Khan, Yosef; Schwamm, Lee H; Peterson, Eric D

    2016-12-01

    Non-vitamin K antagonist oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) have been increasingly used as alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation. Yet there is substantial lack of information on how patients on NOACs are currently treated when they have an acute ischemic stroke and the best strategies for treating intracerebral hemorrhage for those on chronic anticoagulation with warfarin or a NOAC. These are critical unmet needs for real world clinical decision making in these emergent patients. The ARAMIS Registry is a multicenter cohort study of acute stroke patients who were taking chronic anticoagulation therapy prior to admission and are admitted with either an acute ischemic stroke or intracerebral hemorrhage. Built upon the existing infrastructure of American Heart Association/American Stroke Association Get With the Guidelines Stroke, the ARAMIS Registry will enroll a total of approximately 10,000 patients (5000 with acute ischemic stroke who are taking a NOAC and 5000 with anticoagulation-related intracerebral hemorrhage who are on warfarin or a NOAC). The primary goals of the ARAMIS Registry are to provide a comprehensive picture of current treatment patterns and outcomes of acute ischemic stroke patients on NOACs, as well as anticoagulation-related intracerebral hemorrhage in patients on either warfarin or NOACs. Beyond characterizing the index hospitalization, up to 2500 patients (1250 ischemic stroke and 1250 intracerebral hemorrhage) who survive to discharge will be enrolled in an optional follow-up sub-study and interviewed at 3 and 6 months after discharge to assess longitudinal medication use, downstream care, functional status, and patient-reported outcomes. The ARAMIS Registry will document the current state of management of NOAC treated patients with acute ischemic stroke as well as contemporary care and outcome of anticoagulation-related intracerebral hemorrhage. These

  7. Visual interaction in recently admitted and chronic long-stay schizophrenic patients.

    Science.gov (United States)

    Rutter, D R

    1976-09-01

    Several reports have suggested that schizophrenic patients engage in very little Looking and eye-contact. However, previous work, much of it methodologically unsatisfactory, has been based almost always on the clinical psychiatric interview, with the result that several important questions remain unanswered. In particular, we do not know how schizophrenic patients behave in free conversation, how their behaviour with another patient may differ from their behaviour with a psychiatrically normal partner, nor even whether they show individual consistency across encounters. The first study was designed to examine these questions, by observing recently admitted schizophrenic patients in two free dyadic conversations, one with a schizophrenic partner and one with a psychiatrically normal partner, and comparing them with three control groups: depressive patients; patients suffering from neurotic or personality disorders; and psychiatrically normal chest patients. The second study went on to test whether the early descriptions of gross abnormality may be more appropriate to chronic long-stay patients than to recently admitted patients, and the design consisted of a comparison between the two groups. The first study revealed a quite unexpected pattern of results. Consistently across their two encounters, schizophrenic subjects behaved similarly for the most part to all three control groups, normal and abnormal alike. Moreover, the few differences which did emerge conflicted sharply with previous findings, including the writer's, and were no more marked in patient-patient than patient-normal encounters. The second study revealed no differences between chronic long-stay and recently admitted schizophrenic patients. It is suggested that the differences in findings between the present two studies and previous reports are most likely to be attributable to differences in verbal content: schizophrenic patients show abnormalities of visual interaction when talking about personal

  8. Comparison Between Emergency Department and Inpatient Nurses’ Perceptions of Boarding of Admitted Patients

    Directory of Open Access Journals (Sweden)

    Bryce C. Pulliam

    2013-03-01

    Full Text Available Introduction: The boarding of admitted patients in the emergency department (ED is a major causeof crowding and access block. One solution is boarding admitted patients in inpatient ward (Whallways. This study queried and compared ED and W nurses’ opinions toward ED and W boarding.It also assessed their preferred boarding location if they were patients.Methods: A survey administered to a convenience sample of ED and W nurses was performedin a 631-bed academic medical center (30,000 admissions/year with a 68-bed ED (70,000 visits/year. We identified nurses as ED or W, and if W, whether they had previously worked in the ED. Thenurses were asked if there were any circumstances where admitted patients should be boarded inED or W hallways. They were also asked their preferred location if they were admitted as a patient.Six clinical scenarios were then presented, and the nurses’ opinions on boarding based on eachscenario were queried.Results: Ninety nurses completed the survey, with a response rate of 60%; 35 (39% were currentED nurses (cED, 40 (44% had previously worked in the ED (pED. For all nurses surveyed 46(52% believed admitted patients should board in the ED. Overall, 52 (58% were opposed to Wboarding, with 20% of cED versus 83% of current W (cW nurses (P < 0.0001, and 28% of pEDversus 85% of nurses never having worked in the ED (nED were opposed (P < 0.001. If admittedas patients themselves, 43 (54% of all nurses preferred W boarding, with 82% of cED versus33% of cW nurses (P < 0.0001 and 74% of pED versus 34% nED nurses (P = 0.0007. The mostcommonly cited reasons for opposition to hallway boarding were lack of monitoring and patientprivacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existedin all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen,and an intubated, unstable sepsis patient.Conclusion: Inpatient nurses and those who have never worked in

  9. Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

    DEFF Research Database (Denmark)

    Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne

    2015-01-01

    OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliabi......OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter......-rater reliability of four simple measures of physical performance in acutely admitted older medical patients. DESIGN: During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4......, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%. CONCLUSION: In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different...

  10. Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward.

    Directory of Open Access Journals (Sweden)

    Roar Fosse

    Full Text Available No prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide.From 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014.Compared to a matched control group (n = 120, after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor.Suicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk.

  11. Impact of hyperglycemia on ischemic stroke mortality in diabetic and non-diabetic patients

    International Nuclear Information System (INIS)

    Kes, V.B.; Solter, V.V.; Supanc, V.; Demarin, V.

    2007-01-01

    Previous studies suggest that infarct expansion may be responsible for increased mortality after stroke onset in patients with prolonged stress hyperglycemia on stroke mortality in patients with and without diabetes. For 630 stroke patients admitted to the neurological intensive care department within 24 hours of stroke onset, we correlated mean blood glucose levels (MBGL) at admission and 72 hours after admission in diabetic and non-diabetic patients with final outcome. Blood glucose levels higher then 6.1 mmol/L (121mg/dL) was treated as hyperglycemia. Of 630 patients (mean age 71+-6), 410 were non-diabetic (mortality, 25%) and 220 patients were diabetic (mortality, 20%). All patients who died within 28 days of hospitalization had prolonged hyperglycemia at admission and after 72 hours, despite insulin therapy). The unadjusted relative risk of in-hospital mortality within 28 days of all stroke patients was 0.68 (95% CI, 0.14-1.9) for non-diabetic patients and 0.39 (95% CI, 0.27-1.56) for diabetic patients. The unadjusted relative risk of in-hospital mortality within 28 days in ischemic stroke in patients with MBGL> 6.1-8.0 mmol/L (121-144 mg/dL) at admission after 72 hours was 1.83 (95% CI, 0.41-5.5) for non-diabetic patients and 1.13 (95% CI, 0.78-4.5) for diabetic patients and 1.13 (95%, 0.78-4.5) for diabetic patients. Non-diabetic patients with hyperglycemia had a 1.7 times higher relative risk of in-hospital 28-day mortality than patients with diabetes. Prolonged stress hyperglycemia in ischemic stroke patients increases the risk of in-hospital 28-day mortality, especially in non-diabetic patients. (author)

  12. Communication in conversation in stroke patients.

    Science.gov (United States)

    Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

    2010-07-01

    In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe

  13. Screening for Fabry's disease in young patients with ischemic stroke in a Chinese population.

    Science.gov (United States)

    Song, Xiaowei; Xue, Sufang; Zhao, Jingyan; Wu, Jian

    2017-04-01

    Fabry disease is an X-linked lysosomal storage disorder frequently associated with cerebrovascular disease. Data regarding Fabry disease and ischemic stroke has been lacking in China. In this study, we investigated the prevalence of Fabry disease and the distribution of the alpha-galactosidase A (α-GalA) gene - GLA mutations in young stroke patients in the Chinese population and its association with stroke subtypes. A total of 357 ischemic stroke patients admitted to Xuanwu Hospital of Capital Medical University, aged 18-55 years old, including 293 patients with cerebral infarction and 64 patients with transient ischemic attack, were enrolled in this study. Mutations in the GLA gene were screened by Sanger sequencing. Enzyme levels were measured to further confirm the disease in patients with the gene mutation. The mutation frequency was compared among different stroke subtypes and further compared with the control group individually. No pathogenic mutations in the coding regions of the GLA gene were identified in this group of patients and thus no Fabry disease was found in our study. However, the frequency of an intronic polymorphism c.-10C>T was significantly different among different Trial of Org 10172 in Acute Stroke Treatment subtypes (p T polymorphism in patients with stroke due to other causes and undetermined causes was much higher than that in the control group (OR = 3.18, 95% CI: 1.29-7.83, p stroke patients. In addition, our results suggested that the c.-10C>T polymorphism may be a risk factor for ischemic stroke of other and undetermined causes. Further study is required to confirm our findings.

  14. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  15. Treatment of hyperglycaemia in patients with acute stroke.

    Science.gov (United States)

    Castilla-Guerra, L; Fernández-Moreno, M C; Hewitt, J

    2016-03-01

    The proportion of diabetic patients who are hospitalised for stroke has been increasing in recent years, currently reaching almost a third of all cases of stroke. In addition, about half of patients with acute stroke present hyperglycaemia in the first hours of the stroke. Although hyperglycaemia in the acute phase of stroke is associated with a poor prognosis, its treatment is currently a topic of debate. There is no evidence that the adminstration of intravenous insulin to these patients offers benefits in terms of the evolution of the stroke. New studies in development, such as the SHINE study (Stroke Hyperglycemia Insulin Network Effort), may contribute to clarifying the role of intensive control of glycaemia during the acute phase of the stroke. Ultimately, patients who have presented with stroke should be screened for diabetes. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  16. Thrombolysis with Intravenous Tissue Plasminogen Activator (rt-PA) Predicts Favorable Discharge Disposition in Patients with Acute Ischemic Stroke

    Science.gov (United States)

    Ifejika-Jones, Nneka L.; Harun, Nusrat; Mohammed-Rajput, Nareesa A.; Noser, Elizabeth A.; Grotta, James C.

    2011-01-01

    Background and Purpose Acute ischemic stroke patients receiving IV tissue plasminogen activator (rt-PA) within 3 hours of symptom onset are 30% more likely to have minimal disability at three months. During hospitalization, short-term disability is subjectively measured by discharge disposition, whether to home, Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Subacute Care (Sub). There are no studies assessing the role of rt-PA use as a predictor of post-stroke disposition. Methods Retrospective analysis of all ischemic stroke patients admitted to the University of Texas Houston Medical School (UTHMS) Stroke Service between Jan 2004 and Oct 2009. Baseline demographics and National Institute of Health Stroke Scale (NIHSS) score were collected. Cerebrovascular disease risk factors were used for risk stratification. Results Home vs. IR, SNF, Sub Of 2225 acute ischemic stroke patients, 1019 were discharged home, 1206 to another level of care. Patients who received rt-PA therapy were 1.9 times more likely to be discharged home (P = stroke patients, 719 patients were discharged to acute IR, 371 were discharged to SNF, 116 to Sub. There were no differences in disposition between patients who received rt-PA therapy. Conclusions Stroke patients who receive IV rt-PA for acute ischemic stroke are more 1.9 times more likely to be discharged directly home after hospitalization. This study is limited by its retrospective nature and the undetermined role of psychosocial factors related to discharge. PMID:21293014

  17. Risk factors for falls of hospitalized stroke patients

    NARCIS (Netherlands)

    Tutuarima, J. A.; van der Meulen, J. H.; de Haan, R. J.; van Straten, A.; Limburg, M.

    1997-01-01

    Patients with stroke are at a high risk for falling. We assessed the fall incidence and risk factors for patients hospitalized as the result of an acute stroke. We studied a cohort of 720 stroke patients from 23 hospitals in The Netherlands. The data were abstracted from the medical and nursing

  18. Focused cardiac ultrasound in the emergency department for patients admitted with respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, C. B.

    2015-01-01

    In patients admitted with respiratory failure, a large proportion is diagnosed incorrectly in the emergency department and an even larger proportion seems to receive inappropriate treatment. Inappropriate initial treatment of these patients in the emergency department is associated with increased...... triage, patients with cardiac arrest, patients with undifferentiated shock, patients with cardiopulmonary instability, patients with respiratory symptoms, trauma patients with suspected cardiac injuries, and assessment of the fluid status before fluid loading. When using focused cardiac ultrasound (US......) in patients with respiratory symptoms, the typical objectives would be to identify pericardial effusion and enlargement of cardiac cavities, to estimate global systolic left-ventricular function, and to assess the volume status. The routine use of focused cardiac US in patients with respiratory symptoms may...

  19. Current approaches to antithrombotic therapy in patients with cardioembolic stroke

    Directory of Open Access Journals (Sweden)

    Oleg Ivanovich Vinogradov

    2013-01-01

    Full Text Available The rate of cardiogenic embolism among all ischemic strokes is as high as 38%. Cardioembolic strokes are characterized by the higher magnitude of neurological deficit, the high risk of recurrent acute stroke, and a lethal outcome. This review deals with the etiopathogenesis of thrombus formation in the heart chambers, with current criteria for the verification of cardioembolic strokes, with the results of trials of new oral anticoagulants, and latest guidelines for antithrombotic therapy to prevent stroke. Special focus is given to secondary stroke prevention in patients with nonvalvular atrial fibrillation since it is atrial fibrillation that is the most common cause of cardioembolic stroke.

  20. A Retrospective Analysis of Pediatric Patients Admitted to the Pediatric Emergency Service for Carbon Monoxide Intoxication

    OpenAIRE

    Metin Uysalol; Ezgi Paslı Uysalol; Gamze Varol Saraçoğlu; Semra Kayaoğlu

    2011-01-01

    Objective: The aim of the study is to analyze the general aspects of cases with carbon monoxide intoxication in order to improve the approach to future patients. Material and Methods: The hospital records of 84 children (mean age 4.71±2.64 years; 48 male, 36 female) who had been admitted to Paediatric Emergency Department for carbon monoxide intoxication between October 2007 and February 2009, were retrospectively evaluated in a descriptive analysis.Results: The source of carbon monoxide into...

  1. Retrospective Evaluation of Patients Admitted to the Pediatric Emergency Department with Intoxication

    Directory of Open Access Journals (Sweden)

    Alaaddin Yorulmaz

    2017-12-01

    Full Text Available Introduction: In this study, we aimed to retrospectively analyze the demographic and epidemiologic features, clinical course, laboratory results and prognoses of the patients admitted to the department of pediatric emergency due to poisoning. Methods: This trial enrolled a total of 430 patients aged 1 month to 18 years. The medical data of the patients were reviewed retrospectively according to patient's medical record. Demographic data such as age, sex, time of occurrence, time of patient presentation to the emergency department, time to first medical intervention after taking the drug, cause of poisoning, received active substances, ways of taking, number of active substances received, and symptoms at admission to the hospital were analyzed. Results: The study population consisted of 0.74% of all patients who were admitted to the department of pediatric emergency. 243 (56.5% patients were female and 187 (43.5% were male. The age of the patients ranged from 4 months to 220 months (72.89±66.38. One hundred-thirteen (26.3% of our patients were referred to our hospital in the summer, 111 (25.8% in the spring, 110 (25.6% in the autumn and 96 (22.3% in the winter. Eighteen patients were admitted to our emergency department with poisoning in 2014, 193 in 2015, 178 in 2016 and 41 in 2017. 12.3% of our patients were referred to our emergency department between hours 00:00 and 08:00, 35.1% between 08:00 and 16:00 and 52.6% between 16:00 and 24:00. Ninety-six of the patients were admitted to our emergency department due to suicidal poisoning and 334 due to accidental poisoning. Nausea was present at the time of presentation in 142 (33.02% of our patients, vomiting in 122 (28.37% and dizziness in 102 (23.72%. Conclusion: We believe that determination of the epidemiological features of the poisonings in our country by large scale studies and public consciousness will contribute significantly to the prevention of childhood poisoning.

  2. Stressors in the relatives of patients admitted to an intensive care unit.

    Science.gov (United States)

    Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner

    2016-09-01

    To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.

  3. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  4. Pediatric Stroke

    Science.gov (United States)

    ... and Patient Resources Home » Patients & Families » About Stroke » Pediatric Stroke » Introduction Introduction What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Introduction Types of Stroke Diagnosis and Treatment ...

  5. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Jørgensen, H S; Reith, J

    2004-01-01

    BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age as an ind...... and rehabilitation after stroke.......BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age...... as an independent predictor of short- and long-term outcome. METHODS: In the community-based Copenhagen Stroke Study we recorded admission clinical characteristics in 1197 consecutive stroke patients. Patients were stratified according to age groups on admission. Follow-up was performed at a mean of 7 years after...

  7. 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...

  8. Severity scores in trauma patients admitted to ICU. Physiological and anatomic models.

    Science.gov (United States)

    Serviá, L; Badia, M; Montserrat, N; Trujillano, J

    2018-02-02

    The goals of this project were to compare both the anatomic and physiologic severity scores in trauma patients admitted to intensive care unit (ICU), and to elaborate mixed statistical models to improve the precision of the scores. A prospective study of cohorts. The combined medical/surgical ICU in a secondary university hospital. Seven hundred and eighty trauma patients admitted to ICU older than 16 years of age. Anatomic models (ISS and NISS) were compared and combined with physiological models (T-RTS, APACHE II [APII], and MPM II). The probability of death was calculated following the TRISS method. The discrimination was assessed using ROC curves (ABC [CI 95%]), and the calibration using the Hosmer-Lemeshoẃs H test. The mixed models were elaborated with the tree classification method type Chi Square Automatic Interaction Detection. A 14% global mortality was recorded. The physiological models presented the best discrimination values (APII of 0.87 [0.84-0.90]). All models were affected by bad calibration (P<.01). The best mixed model resulted from the combination of APII and ISS (0.88 [0.83-0.90]). This model was able to differentiate between a 7.5% mortality for elderly patients with pathological antecedents and a 25% mortality in patients presenting traumatic brain injury, from a pool of patients with APII values ranging from 10 to 17 and an ISS threshold of 22. The physiological models perform better than the anatomical models in traumatic patients admitted to the ICU. Patients with low scores in the physiological models require an anatomic analysis of the injuries to determine their severity. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  9. Predictors of pneumonia in acute stroke in patients in an emergency unit

    Directory of Open Access Journals (Sweden)

    Sara R. M. Almeida

    2015-05-01

    Full Text Available Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001, higher National Institute of Health Stroke Scale (NIHSS (p = 0.047 and, lower Glasgow Coma Score (GCS (p < 0.0001. Patients with pneumonia had longer hospitalization (p < 0.0001. Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002. Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  10. [Clinical analysis of patients with tuberculosis admitted on an emergency cases].

    Science.gov (United States)

    Okada, Toru; Shibuya, Yasuhiro; Saito, Hitoshi; Enomoto, Tatsuji; Nakamura, Seiichi

    2008-08-01

    A retrospective study was made of 75 patients with tuberculosis and tuberculous pleurisy who received medical care in our hospital from 2002 through 2006. Of the 75 patients, 9 were admitted as tertiary emergency cases, and 12 patients were admitted by ambulance as secondary emergency cases. We studied the reason for their emergency medical admission, and the process of diagnosing 21 patients as tuberculosis. In some cases, the reasons for emergency admission were cardiorespiratory arrest, loss of consciousness, and injury resulting from a traffic accident, not common symptoms of tuberculosis such as dyspnea, hemoptysis and bloody sputum. Chest radiographic findings of most patients showed tuberculosis, and other cases were likely to be diagnosed as tuberculosis from their medical history or back-ground such as being homeless, previous tuberculosis, and receiving for therapy of tuberculosis. It was not so difficult to diagnose our cases as tuberculosis, nevertheless we may have an unconscious patient with normal chest radiograph. These data suggest that any patients visiting the emergency room may possibly have tuberculosis even if they are without respiratory symptoms.

  11. The pattern of neurological disorders in patients admitted to El shaab teaching hospital

    Energy Technology Data Exchange (ETDEWEB)

    Mohamed, Taj Eldin Hag Osman [Faculty of Medicine, University of Khartoum, Khartoum (Sudan)

    1999-07-01

    This thesis was designed to study the pattern of neurological disorders of admitted patients to the neurology centre at El shaab teaching hospital in the period from january 1997 to december 1998. 402 cases were admitted. (35%) were in the age group 21-40, 30% in 41-60, 20% in 61-80, 14% in 0-20 and 1% in >81 males constituted 72% and females 28%. Cerebrovascular diseases top the list with 18.9%, followed by paraplegia's with 17.4%, peripheral neuropathies 11.7, (guillain barre was the most common). Brain space occupying lesions 10.4% (tumors and tuberculomas was the most common),movement disorders with 10% (Parkinson's disease was the most encountered), muscle disorders 6.2% (myasthenia gravis was the commonest). Ataxias 5.5%, headache and migraine was the least group of disorders.

  12. The pattern of neurological disorders in patients admitted to El shaab teaching hospital

    International Nuclear Information System (INIS)

    Mohamed, Taj Eldin Hag Osman

    1999-01-01

    This thesis was designed to study the pattern of neurological disorders of admitted patients to the neurology centre at El shaab teaching hospital in the period from january 1997 to december 1998. 402 cases were admitted. (35%) were in the age group 21-40, 30% in 41-60, 20% in 61-80, 14% in 0-20 and 1% in >81 males constituted 72% and females 28%. Cerebrovascular diseases top the list with 18.9%, followed by paraplegia's with 17.4%, peripheral neuropathies 11.7, (guillain barre was the most common). Brain space occupying lesions 10.4% (tumors and tuberculomas was the most common),movement disorders with 10% (Parkinson's disease was the most encountered), muscle disorders 6.2% (myasthenia gravis was the commonest). Ataxias 5.5%, headache and migraine was the least group of disorders

  13. Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

    Directory of Open Access Journals (Sweden)

    Abdulkadir Akturk

    2013-08-01

    Full Text Available Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the patients such as, age, gender, date of application and as well as the causes of trauma, physical examination findings and outcome situation in the emergency department were evaluated. The study was performed prospectively. SPSS V.20 was used for statistical analysis of the data obtained. Results: Total 175 patients were included to the study, 74 were male (42.28% and 101 were female (57.72%. The mean age of male patients were 75.01 ± 6.557 while the mean age of female patients were 76.10 ± 7.353. The most common cause of trauma in both gender was falls. This rate was 91.1% in female and 8.9% in male patients. 40.6% of the female patients and 27% of the male patients were admitted to the hospital before because of any trauma. The most common form of trauma according to exposed body localization in both gender was extremity traumas. It was seen in 51.5% of the females and 56.8% of the males. 30 female patients (29.7% and 13 male patients (17.6% had fracture in limbs. 78.3% of all patients were discharged from the emergency department and 21.7% of the patients were hospitalised. None of the patients were died in emergency department and none of the patients were referred to another institution from the emergency department. Total 38 patients were hospitalised, 32 of them were discharged, 2 of them were referred to another institution, and 4 of them were died. 26 of 38 hospitalised patients had undergone surgery while 20 of them were orthopedic surgeries

  14. Recovery of Dysphagia in Lateral Medullary Stroke

    OpenAIRE

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia...

  15. Kinesthetic taping improves walking function in patients with stroke

    DEFF Research Database (Denmark)

    Boeskov, Birgitte; Carver, Line Tornehøj; von Essen-Leise, Anders

    2014-01-01

    BACKGROUND: Stroke is an important cause of severe disability and impaired motor function. Treatment modalities that improve motor function in patients with stroke are needed. The objective of this study was to investigate the effect of kinesthetic taping of the anterior thigh and knee on maximal...... be a valuable adjunct in physical therapy and rehabilitation of patients with stroke....

  16. Rehabilitation of stroke patients needs a family-centred approach

    NARCIS (Netherlands)

    Visser-Meily, Anne; Post, Marcel; Gorter, Jan Willem; Berlekom, Steven Berdenis V.; van den Bos, Trudi; Lindeman, Eline

    2006-01-01

    To highlight the importance of the spouse in stroke rehabilitation. Stroke not only affects the patients, but also their families, but rehabilitation practice is still primarily focused on the patient only. Analysis of the position of the spouse and possible consequences of stroke for the spouse,

  17. How inflammation underlies physical and organ function in acutely admitted older medical patients

    DEFF Research Database (Denmark)

    Klausen, Henrik Hedegaard; Bodilsen, Ann Christine; Petersen, Janne

    2017-01-01

    OBJECTIVES: To investigate whether systemic inflammation in acutely admitted older medical patients (age >65 years) is associated with physical performance and organ dysfunction. Organ dysfunction´s association with physical performance, and whether these associations are mediated by systemic...... inflammation was assessed by suPAR, TNFα, and IL-6. Associations were investigated by regression analyses adjusted for age, sex, cognitive impairment, CRP, and VitalPAC Modified Early Warning Score. RESULTS: A total of 369 patients were evaluated. In adjusted analyses, suPAR and TNFα was associated with both...

  18. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  19. [Application and evalauation of care plan for patients admitted to Intensive Care Units].

    Science.gov (United States)

    Cuzco Cabellos, C; Guasch Pomés, N

    2015-01-01

    Assess whether the use of the nursing care plans improves outcomes of nursing care to patients admitted to the intensive care unit (ICU). The study was conducted in a University Hospital of Barcelona in Spain, using a pre- and post-study design. A total of 61 patient records were analysed in the pre-intervention group. A care plan was applied to 55 patients in the post-intervention group. Specific quality indicators in a medical intensive care unit to assess the clinical practice of nursing were used. Fisher's exact test was used to compare the degree of association between quality indicators in the two groups. A total of 116 records of 121 patients were evaluated: 61 pre-intervention and 55 post-intervention. Fisher test: The filling of nursing records, p=.0003. Checking cardiorespiratory arrest equipment, p <.001. Central vascular catheter related bacteraemia (B-CVC) p=.622. Ventilator associated pneumonia (VAP) p=.1000. Elevation of the head of the bed more than 30° p=.049, and the pain management in non-sedated patients p=.082. The implementation of nursing care plans in patients admitted to the intensive care area may contribute to improvement in the outcomes of nursing care. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  20. The relationship of air pollution and asthma patients admitted to hospitals in Kermanshah (2008-2009

    Directory of Open Access Journals (Sweden)

    Razieh Khamutian

    2015-01-01

    Full Text Available Background: Industrialization and urbanization have had a devastating impact on public health. Asthma is considered as one of the major challenges of public health. The purpose of this study was to determine the association between air pollution and the number of asthma patients admitted to hospitals in Kermanshah, Iran. Methods: In this cross-sectional and ecological study, the data on the number of asthma patients, the concentration levels of air pollutants and weather conditions were collected from the city of Kermanshah. To determine the association between asthma patients admitted to hospitals and air pollutants, Poisson regression was used (P<0.05. Results: according to the statistical analysis, air pollutants had significant correlation with each other. Based on the results of multiple Poisson regression, among air pollutants CO and O3 were significantly correlated with the number of asthma patients referred to hospitals, with relative risk of 1.18 and 1.016, respectively, and based on the results of single Poisson regression, among air pollutants NOx, NO, NO2 and CO were significantly correlated with the number of asthma patients referred to hospitals with relative risk of 1.011, 1.012, 1.054 and 1.247, respectively. Conclusion: according to the results of the present study, there was a significant association between air pollutants (mainly carbon monoxide and ozone and the total number of asthma patients referred to the hospitals in Kermanshah.

  1. Stroke Risk Perception in Atrial Fibrillation Patients is not Associated with Clinical Stroke Risk.

    Science.gov (United States)

    Fournaise, Anders; Skov, Jane; Bladbjerg, Else-Marie; Leppin, Anja

    2015-11-01

    Clinical risk stratification models, such as the CHA2DS2-VASc, are used to assess stroke risk in atrial fibrillation (AF) patients. No study has yet investigated whether and to which extent these patients have a realistic perception of their personal stroke risk. The purpose of this study was to investigate and describe the association between AF patients' stroke risk perception and clinical stroke risk. In an observational cross-sectional study design, we surveyed 178 AF patients with a mean age of 70.6 years (SD 8.3) in stable anticoagulant treatment (65% treatment duration >12 months). Clinical stroke risk was scored through the CHA2DS2-VASc, and patients rated their perceived personal stroke risk on a 7-point Likert scale. There was no significant association between clinical stroke risk assessment and patients' stroke risk perception (rho = .025; P = .741). Approximately 60% of the high-risk patients had an unrealistic perception of their own stroke risk, and there was no significant increase in risk perception from those with a lower compared with a higher risk factor load (χ(2) = .010; P = .522). Considering possible negative implications in terms of lack of motivation for lifestyle behavior change and adequate adherence to the treatment and monitoring of vitamin K antagonist, the apparent underestimation of risk by large subgroups warrants attention and needs further investigation with regard to possible behavioral consequences. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Clinical evaluation of patients with migraine induced stroke in mashhad, iran.

    Science.gov (United States)

    Ghandehari, Kavian; Sharifi, Atena; Nikbin, Zeynab; Fadaei, Sahar; Meybodi, Meysam Aghaei; Moshfegh, Mehdi; Hosseini, Mohammad Reza; Sarabi, Mohammad Reza Gerami; Maarufi, Parham

    2010-01-01

    Migraine Induced Stroke (MIS) is an important cause of brain infarction in the young people. Consecutive patients with MIS admitted in Ghaem hospital, Mashhad during 2006-2010 enrolled a prospective clinical study. All of the patients suspected to MIS had brain MRI with a 0.5 Tesla generation, Philips NT Intra, Netherland. All of the MIS patients underwent a standard battery of diagnostic investigations for detecting etiology of stroke. Disability of MIS patients was detected based on the modified Rankin scale at 90 days post stroke. 32 MIS patients (18 females, 14 males) with mean age 37.2 ± 3.8 years ranged 15-58 years were evaluated. Hypodense area of infarction corresponding to clinical manifestations was detected in MRI in 32% of our MIS patients. The mean disability score in our MIS patients was 1.09 ± 0.32, which is significantly lower than other stroke patients (z = 2.55, P = 0.007) MIS is an important cause of stroke in Persian young adults which have good prognosis.

  3. Clinical Study of Obesity and associated morbidities in patients admitted to College of Medical Sciences Teaching-Hospital, Bharatpur

    Directory of Open Access Journals (Sweden)

    Manohar Pradhan

    2015-12-01

    Full Text Available Background and Objectives: The present study was conducted with objective to study the incidence of obesity and associated co-morbidities in patients admitted to CMS-TH, Bharatpur.Materials and Methods: One hundred and fifty consecutive overweight patients from the January 2009 to December 2012 with Basal metabolic index (BMI>25 and obese patients (BMI>30 were included in this hospital based prospective study. Detailed evaluation of risk factors and family history of other diseases were taken, other obesity related indicators like WPRO, 2000 for BMI, waist circumference (NCEP ATP III and NCEP for South Asian ethnicity NCEP– National Cholesterol Education Program and waist hip ratio (WHO criteria were measured and comparison done in order to detect best method for application. These cases were evaluated for associated co-morbid condition and metabolic syndrome which were diagnosed using NCEP ATP III criteria.Results: The mean age of patients was 52.7 years. Commonest co-existing risk factors were alcohol consumption, smoking, hypertension and type 2 diabetes mellitus. Evaluation based on WHO criteria revealed that 56.7% patients were overweight, 38.7 % were obese class II and 4.6 % were class II. While 45.1% male and 69.1% female patients had central obesity. The figure was 81.7 % for males and 94.1% for females with WHO criteria using waist hip ratio. Risk factors like alcohol consumption (52.7%, smoking (52.7% and fatty liver disease (22.66% were the commonest co-morbid conditions.Conclusion: In the present study, risk factors of alcohol, smoking and hypertension and co-morbid conditions diabetes mellitus, dyslipidemia, ischemic heart disease, stroke and fatty liver were noted. Waist hip ratio was the best indicator to detect central obesity and co-morbid conditions and recommended to be used for Nepali population.JCMS Nepal. 2015;11(3:16-19

  4. Chinese Medicine Patterns in Patients with Post-Stroke Dementia

    OpenAIRE

    Tang, Nou-Ying; Liu, Chung-Hsiang; Liu, Hsu-Jan; Li, Tsai-Chung; Liu, Jui-Chen; Chen, Ping-Kun; Hsieh, Ching-Liang

    2012-01-01

    A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP). Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychi...

  5. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, P K; Damsgaard, Else Marie; Husted, Steen

    2007-01-01

    INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...... focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery...... improvement for serum proteins, and 22 % of the patients were malnourished 6 months after stroke. Udgivelsesdato: null-null...

  6. Inter-rater reliability of the Sødring Motor Evaluation of Stroke patients (SMES).

    Science.gov (United States)

    Halsaa, K E; Sødring, K M; Bjelland, E; Finsrud, K; Bautz-Holter, E

    1999-12-01

    The Sødring Motor Evaluation of Stroke patients is an instrument for physiotherapists to evaluate motor function and activities in stroke patients. The rating reflects quality as well as quantity of the patient's unassisted performance within three domains: leg, arm and gross function. The inter-rater reliability of the method was studied in a sample of 30 patients admitted to a stroke rehabilitation unit. Three therapists were involved in the study; two therapists assessed the same patient on two consecutive days in a balanced design. Cohen's weighted kappa and McNemar's test of symmetry were used as measures of item reliability, and the intraclass correlation coefficient was used to express the reliability of the sumscores. For 24 out of 32 items the weighted kappa statistic was excellent (0.75-0.98), while 7 items had a kappa statistic within the range 0.53-0.74 (fair to good). The reliability of one item was poor (0.13). The intraclass correlation coefficient for the three sumscores was 0.97, 0.91 and 0.97. We conclude that the Sødring Motor Evaluation of Stroke patients is a reliable measure of motor function in stroke patients undergoing rehabilitation.

  7. Medication coaching program for patients with minor stroke or TIA: a pilot study.

    Science.gov (United States)

    Sides, Elizabeth G; Zimmer, Louise O; Wilson, Leslie; Pan, Wenqin; Olson, Daiwai M; Peterson, Eric D; Bushnell, Cheryl

    2012-07-25

    Patients who are hospitalized with a first or recurrent stroke often are discharged with new medications or adjustment to the doses of pre-admission medications, which can be confusing and pose safety issues if misunderstood. The purpose of this pilot study was to assess the feasibility of medication coaching via telephone after discharge in patients with stroke. Two-arm pilot study of a medication coaching program with 30 patients (20 intervention, 10 control). Consecutive patients admitted with stroke or TIA with at least 2 medications changed between admission and discharge were included. The medication coach contacted intervention arm patients post-discharge via phone call to discuss risk factors, review medications and triage patients' questions to a stroke nurse and/or pharmacist. Intervention and control participants were contacted at 3 months for outcomes. The main outcomes were feasibility (appropriateness of script, ability to reach participants, and provide requested information) and participant evaluation of medication coaching. The median lengths of the coaching and follow-up calls with requested answers to these questions were 27 minutes and 12 minutes, respectively, and participant evaluations of the coaching were positive. The intervention participants were more likely to have seen their primary care provider than were control participants by 3 months post discharge. This medication coaching study executed early after discharge demonstrated feasibility of coaching and educating stroke patients with a trained coach. Results from our small pilot showed a possible trend towards improved appointment-keeping with primary care providers in those who received coaching.

  8. Epidemiology of 62 patients admitted to the intensive care unit after returning from Madagascar.

    Science.gov (United States)

    Allyn, Jérôme; Angue, Marion; Corradi, Laure; Traversier, Nicolas; Belmonte, Olivier; Belghiti, Myriem; Allou, Nicolas

    2016-04-01

    To our knowledge, there is no data on the epidemiology of patients hospitalized in intensive care unit (ICU) after a stay in Madagascar or other low-income countries. It is possible that such data may improve transfer delays and care quality for these patients. In a retrospective study, we reviewed the charts of all patients admitted to ICU of the Reunion Island Felix Guyon University Hospital from January 2011 through July 2013. We identified all patients who had stayed in Madagascar during the 6 months prior to ICU admission. Of 1842 ICU patients, 62 (3.4%) had stayed in Madagascar during the 6 months prior to ICU admission. Patients were 76% male and the median age was 60.5 (48.25-64.75) years; patients were more frequently residents of Madagascar than travellers (56.5%). In most cases, patients were not hospitalized or given antibiotics in Madagascar. The most frequent causes of hospitalization were infections including malaria (21%) and lower respiratory infection (11%). Carriage and infection with multidrug resistant (MDR) bacteria on ICU admission were frequent (37% and 9.7%, respectively). The mortality rate in ICU was 21%, and severity acute physiological Score II was 53.5 (37-68). Patients admitted to ICU after a stay to Madagascar are mainly elderly patients with chronic illnesses, and often foreign residents. The admission causes are specific of the country like malaria, or specific to the population concerned such as cardiovascular accidents that could be prevented. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  9. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    Science.gov (United States)

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  10. Association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic

    Science.gov (United States)

    Hocagil, Hilal; Izci, Filiz; Hocagil, Abdullah Cüneyt; Findikli, Ebru; Korkmaz, Sevda; Koc, Merve Iris

    2016-01-01

    Background Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic. Methods This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients. Results Of the patients exposed to violence 63% (n=46) were female and 27% (n=27) were male. Of these patients, 68.5% (n=50) were married, 43.8% (n=25) were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41) were primary school, 21.9% (n=16) were high school, and 21.9% (n=16) were university graduates. Smoking and alcohol use rates were 54.8% (n=40) and 17.8% (n=13), respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57). In addition, anxiety scores were high in 42.5% (n=31) and moderate in 9.6% (n=7) of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13) of the patients and 19.2% (n=14) of the patients’ relatives. The correlation between sociodemographic characteristics and anxiety scores revealed that married patients had higher anxiety scores (Pviolence-exposed patients admitted to emergency room were females, 56.2% were primary school graduates, and 43.8% were factory workers; this result shows that low socioeconomical status and education level affect exposure to trauma especially in females. In addition, ~20% of the patients and patients’ relatives had a psychiatric disorder and 53.4% of perpetrators were parents, spouses, and children; this result shows that psychiatric history and family relations are one of the

  11. Prevalence of Burnout Syndrome in patients admitted with acute coronary syndrome.

    Science.gov (United States)

    Prosdócimo, Ana Cláudia Giaxa; Lucina, Luciane Boreki; Marcia, Olandoski; Jobs, Priscila Megda João; Schio, Nicolle Amboni; Baldanzi, Fernanda Fachin; Costantini, Costantino Ortiz; Benevides-Pereira, Ana Maria Teresa; Guarita-Souza, Luiz Cesar; Faria-Neto, José Rocha

    2015-03-01

    Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS). To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged Burnout Syndrome was evaluated with the Burnout Syndrome Inventory (BSI), which assesses workplace conditions and four dimensions that characterize the syndrome: emotional exhaustion (EE), emotional distancing (EmD), dehumanization (De) and professional fulfillment (PF). The Lipp's Stress Symptoms Inventory for Adults (LSSI) was applied to evaluate global stress. Of 830 patients evaluated with suspected ACS, 170 met the study criteria, 90% of which were men, overall average age was 52 years, and 40.5% had an average income above 11 minimum wages. The prevalence of the Burnout Syndrome was 4.1%. When we evaluated each dimension individually, we found high EE in 34.7%, high De in 52.4%, high EDi in 30.6%, and low PF in 5.9%. The overall prevalence of stress was 87.5%. We found a low prevalence of Burnout Syndrome in an economically active, non-elderly population among patients admitted for ACS in a tertiary and private hospital.

  12. [Prognostic factors of early 30-day mortality in elderly patients admitted to an emergency department].

    Science.gov (United States)

    Morales Erazo, Alexander; Cardona Arango, Doris

    The main aim of this study was to identify the variables related to early mortality in the elderly at the time of admission to the emergency department. Using probability sampling, the study included patients 60 years old or older of both genders who were admitted for observation to the emergency department of the University Hospital of Nariño, ¿Colombia? in 2015. Using a questionnaire designed for this study, some multidimensional features that affect the health of the elderly were collected (demographic, clinical, psychological, functional, and social variables). The patients were then followed-up for 30 days in order to determine the mortality rate during this time. Univariate and multivariate logistic regressions and survival analysis were performed. Data were collected from 246 patients, with a mean age of 75.27 years and the majority female. The 30-day mortality rate was 15%. The variables most associated with death were: being female, temperature problems, initial diagnosis of neoplasia, and unable to walk independently in the emergency department. It is possible to determine the multidimensional factors present in the older patient admitted to an emergency department that could affect their 30-day mortality prognosis. and which should be intervened. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Topography of acute stroke in a sample of 439 right brain damaged patients.

    Science.gov (United States)

    Sperber, Christoph; Karnath, Hans-Otto

    2016-01-01

    Knowledge of the typical lesion topography and volumetry is important for clinical stroke diagnosis as well as for anatomo-behavioral lesion mapping analyses. Here we used modern lesion analysis techniques to examine the naturally occurring lesion patterns caused by ischemic and by hemorrhagic infarcts in a large, representative acute stroke patient sample. Acute MR and CT imaging of 439 consecutively admitted right-hemispheric stroke patients from a well-defined catchment area suffering from ischemia (n = 367) or hemorrhage (n = 72) were normalized and mapped in reference to stereotaxic anatomical atlases. For ischemic infarcts, highest frequencies of stroke were observed in the insula, putamen, operculum and superior temporal cortex, as well as the inferior and superior occipito-frontal fascicles, superior longitudinal fascicle, uncinate fascicle, and the acoustic radiation. The maximum overlay of hemorrhages was located more posteriorly and more medially, involving posterior areas of the insula, Heschl's gyrus, and putamen. Lesion size was largest in frontal and anterior areas and lowest in subcortical and posterior areas. The large and unbiased sample of stroke patients used in the present study accumulated the different sub-patterns to identify the global topographic and volumetric pattern of right hemisphere stroke in humans.

  14. Incidence of Osteoporosis in Patients Admitted to our Physical Medicine and Rehabilitation Outpatient Clinics

    Directory of Open Access Journals (Sweden)

    Berat Meryem Alkan

    2011-04-01

    Full Text Available Aim: Osteoporosis is a skeletal disease characterized with decreased bone mass and microarchtitectural deterioration of bone tissue which increases bone fragility and fracture risk. Osteoporosis and osteoporotic fractures constitute an important health problem in general population. This study aimed to determine the incidence of osteoporosis, chronic diseases accompanying osteoporosis and incidence of falls in male and female patients admitted to our out patient clinics retrospectively. Material and Methods: Patient records of the 11624 patients admitted to Ankara Atatürk Education and Research Hospital Physical Medicine and Rehabilitation Outpatient clinics between January 2010 and July 2010 were retrospectively reviewed and 644 patients diagnosed as osteoporosis according to femoral neck and/or lumbar dual energy x ray absoptiometry measurements were included in the study. Ages of the patients, sexes, chronic ilnesses, musculoskeletal sytem complaints and fall histories were also recorded. Results: The incidence of osteoporosis was found to be 7.61% in female patients and it was determined that incidence was 5-fold increased in women than in men. Besides, chronic ilnesses and fall history were accompanying in higher ratios in osteoporotic patients. Conclusion: Heart diseases, hypertension, diabetes, neurological diseases leading to impairment in balance and musculoskelatal system complaints were quite frequent in patients with osteoporosis and these diseases should be taken seriously since they increase the risk of falling. It is important to avoid using drugs which lead to balance impairment, to use walk aids like canes or walkers, to perform exercises including balance and coordination training and endurance exercises in order to prevent falls. (Turkish Journal of Osteoporosis 2011;17:10-3

  15. [Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the intensive care units].

    Science.gov (United States)

    Álvarez Lerma, F; Olaechea Astigarraga, P; Palomar Martínez, M; Rodríguez Carvajal, M; Machado Casas, J F; Jiménez Quintana, M M; Esteve Urbano, F; Ballesteros Herráez, J C; Zavala Zegarra, E

    2015-04-01

    The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality. To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection. An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis. A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8±17.1 years), with a high severity level (APACHE II score 22.03±7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR=7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR=2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR=8.91, 95%CI: 4.24-18.76). Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to

  16. Atrial fibrillation is a predictor of in-hospital mortality in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Ong CT

    2016-06-01

    Full Text Available Cheung-Ter Ong,1,2 Yi-Sin Wong,3 Chi-Shun Wu,1 Yu-Hsiang Su1 1Department of Neurology, Chia-Yi Christian Hospital, 2Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chiayi, 3Department of Family Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan, Republic of China Background/purpose: In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigated the factors that contribute to the risk of in-hospital mortality in acute ischemic stroke patients.Materials and methods: Between January 1, 2007, and December 31, 2011, 2,556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed.Results: Of the 2,556 ischemic stroke patients, 157 received thrombolytic therapy. Eighty of the 2,556 patients (3.1% died during hospitalization. Of the 157 patients who received thrombolytic therapy, 14 (8.9% died during hospitalization. History of atrial fibrillation (AF, P<0.01 and stroke severity (P<0.01 were independent risk factors of in-hospital mortality. AF, stroke severity, cardioembolism stroke, and diabetes mellitus were independent risk factors of hemorrhagic transformation. Herniation and sepsis were the most common complications of stroke that were attributed to in-hospital mortality. Approximately 70% of in-hospital mortality was related to stroke severity (total middle cerebral artery occlusion with herniation, basilar artery occlusion, and hemorrhagic transformation. The other 30% of in-hospital mortality was related to sepsis, heart disease, and other complications.Conclusion: AF is associated with higher in-hospital mortality rate than in patients without AF. For improving outcome of stroke patients, we also need to focus to reduce serious neurological

  17. Comparison of the Risk Factor Profile, Stroke Subtypes, and Outcomes Between Stroke Patients Aged 65 Years or Younger and Elderly Stroke Patients: A Hospital-based Study

    Directory of Open Access Journals (Sweden)

    Yi-Min Chen

    2013-12-01

    Conclusion: We conclude that, apart from risk factors and stroke subtypes, the functional outcomes observed in the two groups differed. Early identification of these differences with good management may help to improve the clinical outcomes in younger stroke patients.

  18. Factors Associated With Intestinal Constipation in Chronic Patients With Stroke Sequelae Undergoing Rehabilitation.

    Science.gov (United States)

    Engler, Tânia Mara Nascimento de Miranda; Aguiar, Márcia Helena de Assis; Furtado, Íris Aline Brito; Ribeiro, Samile Pereira; de Oliveira, Pérola; Mello, Paulo Andrade; Padula, Marcele Pescuma Capeletti; Beraldo, Paulo Sérgio Siebra

    The objective of this study was to define which stroke-related factors constitute independent variables in the incidence of intestinal constipation (IC) of chronic patients admitted to a hospital rehabilitation program. All patients consecutively admitted for rehabilitation were recruited for the study. In the Poisson multiple regression analysis using a hierarchical model, sociodemographic variables, comorbidities, medication, previous history of constipation, life habits, and stroke-related variables were considered for defining factors associated with IC. A 31% prevalence (95% confidence interval [CI]: 25.3-37.1) of IC was detected. Among the factors associated, female gender (adjusted prevalence ratio [PRadjusted] = 1.79; 95% CI: 1.20-2.68), intestinal complaints prior to stroke (PRadjusted = 3.71; 95% CI: 2.60-5.31), intake of less than 800 ml of fluid per day (PRadjusted = 1.72; 95% CI: 1.20- 2.45), age greater than 65 years at brain injury (PRadjusted = 1.67; 95% CI: 1.01-2.75), and partially impaired anterior brain circulation (PRadjusted = 3.35; 95% CI: 1.02-10.97) were associated with IC. Female gender, elderly, prior history of IC, low fluid intake, and partial impairment of anterior brain circulation were factors independently associated with IC in stroke survivors undergoing rehabilitation. These findings require further validation and may serve toward improving bowel retraining programs for this patient group.

  19. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation are at in......Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation.......96), and the combined endpoint of stroke progression, recurrent stroke, and death (D-dimer: 991 ng/ml vs 970 ng/ml, P = 0.91). Multivariable analyses did not alter the results. Conclusion -  D-dimer and other markers of hemostatic activation were not associated with stroke progression, recurrent stroke, or death...

  20. Liver stiffness and 30-day mortality in a cohort of patients admitted to hospital

    DEFF Research Database (Denmark)

    Lindvig, Kristoffer; Mössner, Belinda K; Pedersen, Court

    2012-01-01

    Eur J Clin Invest 2011 ABSTRACT: Background  Transient elastography (TE) is a new noninvasive method to assess the degree of liver fibrosis by measuring liver stiffness. The objective of this study was to determine whether increased liver stiffness in patients admitted to medical wards...... measure was 30-day mortality. Results  Among 568 patients admitted during 24 days, 289 (50·8%) were included in the study, 212 (73·4%) with valid TE measurement. Increased liver stiffness (TE value > 8 kPa) was found in 22·6% (48/212). This was independently associated with cirrhosis of the liver (P  8 k......Pa was 20·8% (10/48, 95%CI 10·5-35·0%) compared to patients with TE value ≤ 8 kPa 3·7% (6/164, 95%CI 1·3-7·8%) (P  8 kPa was an independent predictor of death. Conclusions  Elevated TE value at admission is associated with increased mortality, cirrhosis of the liver and CHF. This information may potentially...

  1. The effect of hospital volume on mortality in patients admitted with severe sepsis.

    Directory of Open Access Journals (Sweden)

    Sajid Shahul

    Full Text Available IMPORTANCE: The association between hospital volume and inpatient mortality for severe sepsis is unclear. OBJECTIVE: To assess the effect of severe sepsis case volume and inpatient mortality. DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011. EXPOSURES: The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles. MAIN OUTCOMES AND MEASURES: Inpatient mortality. RESULTS: Compared with the highest tertile of severe sepsis volume (>60 cases per year, the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year was 1.188 (95% CI: 1.074-1.315, while the odds ratio was 1.090 (95% CI: 1.031-1.152 for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64-38.03 for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51-32.64 for hospitals with the highest volume. CONCLUSIONS AND RELEVANCE: We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients.

  2. Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis.

    Directory of Open Access Journals (Sweden)

    Cynthia Chen

    Full Text Available OBJECTIVES: To (1 identify social and rehabilitation predictors of nursing home placement, (2 investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. DESIGN: National data were retrospectively extracted from medical records of community hospital. DATA SOURCES: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3% patients were discharged home and 924 (9.7% patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37, other community hospital (n = 31, death in community hospital (n = 12, acute hospital (n = 1,182 and discharge against doctor's advice (n = 24 were excluded. OUTCOME MEASURE: Nursing home placement. RESULTS: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years, had lower mean Bathel Index scores (40 vs. 48, a longer median length of stay (40 vs. 33 days and a longer time to rehabilitation (19 vs. 15 days, had a higher proportion without a caregiver (28 vs. 7%, being single (21 vs. 7% and had dementia (23 vs. 10%. Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001 and 65% (p = 0.043 respectively compared to stroke patients. CONCLUSIONS: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such

  3. Admission Blood Pressure of Stroke Patients and Its Relationship to ...

    African Journals Online (AJOL)

    Background: High blood pressure is often said to be associated with poor outcome in stroke. However, there remains some uncertainly about the relationship of blood pressure to mortality in stroke. Objective: This study seeks to determine the influence of admission blood pressure on early mortality of stroke patients at the ...

  4. Evaluation of Motor Recovery in Adult Patients with Hemiplegic stroke

    African Journals Online (AJOL)

    Background: Assessment of treatment efficacy through outcomes evaluation is an established practice in stroke rehabilitation. The evaluation of motor recovery is a cornerstone of the assessment of patients with stroke; and an integral component of stroke rehabilitation. Objective: The purpose of this study was to evaluate ...

  5. Risk factors of short-term stroke recurrence in patients with minor ischemic cerebrovascular events

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2013-03-01

    Full Text Available BACKGROUND: Assessing the risk of recurrent ischemic events in patients with transient ischemic attack (TIA and minor ischemic stroke (MIS is of a great importance in clinical practice. METHODS: Consecutive patients with TIA or MIS who were visited in Ghaem Hospital, (Mashhad, Iran were enrolled in a prospective cohort study during 2010 to 2011. Diagnosis of TIA or MIS was accomplished by a stroke neurologist. Only those who presented within 24 hours from the onset of symptoms were recruited. MIS was considered as an ischemic stroke with National Institutes of Health Stroke Scale (NIHSS < 4. The endpoint of the study was a new ischemic cerebrovascular event or vascular death in 90 days and additionally in 3 days. The decision to admit and type of treatment in each case was left to the discretion of the stroke neurologist. The association between 20 potential factors with recurrent ischemic events in 3 and 90 days was investigated using univariate and multivariate analysis (MVA. RESULTS: 393 TIA patients (238 males and 155 females and 118 MIS patients (77 males and 41 females were enrolled in the study. Stroke occurred in 117 (23.2% patients, TIA in 99 (19.6%, and there was 11 (2.2% vascular deaths within 3 months in the total 511 patients with minor ischemic events. Crescendo TIAs and multiple TIAs were associated with greater risk of stroke in 3 days in a univariate analysis (OR = 5.12, P < 0.001 and (OR = 3.98, P = 0.003, respectively. Patients with index stroke had 11.5% lower risk of recurrent stroke in 3 days than patients with index TIA in multivariate analysis (OR = 0.115, P = 0.039. Diabetes was independently associated with 3 months stroke recurrence in the patients with minor ischemic events (OR = 2.65, P = 0.039. CONCLUSION: Multiple and crescendo TIAs are the main predictors of stroke recurrence, derived from the univariate analysis of the patients with minor ischemic events.   Keywords: Transient Ischemic Attacks, Infarction, Brain

  6. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Science.gov (United States)

    Svindseth, Marit F; Nøttestad, Jim Aage; Wallin, Juliska; Roaldset, John Olav; Dahl, Alv A

    2008-01-01

    Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM). Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination. PMID:18304339

  7. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Directory of Open Access Journals (Sweden)

    Wallin Juliska

    2008-02-01

    Full Text Available Abstract Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM. Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS and the Global Assessment of Functioning (GAF. The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21, The Hospital Anxiety and Depression Scale (HADS and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM. Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

  8. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: The Bergen Stroke Study

    Directory of Open Access Journals (Sweden)

    Naess H

    2012-06-01

    Full Text Available Halvor Naess,1 Lene Lunde,2 Jan Brogger11Department of Neurology, Haukeland University Hospital, 2Department of Economics, University of Bergen, Bergen, NorwayBackground: Many patients with cerebral infarction suffer from symptoms such as pain, fatigue, and depression. The aim of this study was to evaluate these symptoms in relation to health-related quality of life (HRQoL on long-term follow-up.Materials and methods: All surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, Norway between February 2006 and November 2008 were sent a questionnaire, including a visual analog pain scale, Fatigue Severity Scale, Depression Subscale of Hospital Anxiety and Depression Scale, Barthel Index, and three measures of HRQoL – 15D, EuroQol, and EuroQol Visual Analogue Scale – at least 6 months after stroke onset. Cox regression survival analysis, including EQ-5D, was performed by November 2009.Results: The questionnaire was returned by 328 patients. All three symptoms were reported by 10.1% of the patients, and 26% reported two symptoms. There was a significant association between worse HRQoL scores and an increasing number of cooccurring symptoms for all three HRQoL scores. Fatigue, depression, pain, functional state, and sleeping disorder on follow-up accounted for 58%–83% of the variability in HRQoL, depending on which HRQoL scale was used. Cox regression analysis showed that mortality was associated with a low EuroQol score (P = 0.016.Conclusion: Pain, fatigue, and depression were common symptoms among these stroke patients and, to a large extent, they determined the patients' HRQoL. Low HRQoL was associated with increased mortality.Keywords: cerebral infarction, symptoms, mortality

  9. Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation.

    Science.gov (United States)

    Wiskar, Katie J; Celi, Leo Anthony; McDermid, Robert C; Walley, Keith R; Russell, James A; Boyd, John H; Rush, Barret

    2018-04-01

    Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 ( P care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 ( P care ( P care. The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.

  10. Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital.

    Science.gov (United States)

    Fernández-Ruiz, Mario; Calvo, Beatriz; Vara, Rebeca; Villar, Rocío N; Aguado, José María

    2013-10-01

    The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. Further educational efforts should be focused on improving catheterization prescribing practices by physicians. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  11. Significance of clay art therapy for psychiatric patients admitted in a day hospital

    Directory of Open Access Journals (Sweden)

    Aquiléia Helena de Morais

    2014-04-01

    Full Text Available Objective. To understand the significance of clay art therapy for psychiatric patients admitted in a day hospital. Methodology. Qualitative, descriptive and exploratory research, undertaken with 16 patients in a day hospital in Londrina, in the state of Parana, Brazil, who participated in seven clay therapy sessions. Data collection took place from January to July 2012 through interviews guided by a semi structured questionnaire and the data were submitted to content analysis. Results. Three themes emerged: Becoming familiar with clay art therapy; Feeling clay therapy; and Realizing the effect of clay therapy. Conclusion. The use of clay as a therapeutic method by psychiatric patients promoted creativity, self-consciousness, and benefited those who sought anxiety relief.

  12. Increasing rate of atrial fibrillation from 2003 to 2011 in patients with ischaemic stroke

    DEFF Research Database (Denmark)

    Jespersen, S F; Christensen, L. M.; Christensen, A

    2015-01-01

    BACKGROUND AND PURPOSE: The general awareness of atrial fibrillation is increasing. The key to prevent atrial fibrillation related stroke is oral anticoagulation therapy; however, it has often been proposed that oral anticoagulation therapy is under-utilized despite indication. The aim of the stu...... increase in the use of oral anticoagulation therapy, most probably reflecting an increased awareness and questioning assumed current under-use of oral anticoagulation therapy in secondary stroke prevention.......BACKGROUND AND PURPOSE: The general awareness of atrial fibrillation is increasing. The key to prevent atrial fibrillation related stroke is oral anticoagulation therapy; however, it has often been proposed that oral anticoagulation therapy is under-utilized despite indication. The aim of the study...... was to examine the trends in atrial fibrillation rate in patients after acute ischaemic stroke and to determine whether the use of oral anticoagulation therapy increased from 2003 to 2011. METHODS: In the nationwide Danish Stroke Registry 55 551 patients (≥18 years) admitted with acute ischaemic stroke were...

  13. Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: a population study.

    LENUS (Irish Health Repository)

    Hannon, Niamh

    2011-09-01

    Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic).

  14. Medication errors versus time of admission in a subpopulation of stroke patients undergoing inpatient rehabilitation complications and considerations.

    Science.gov (United States)

    Pitts, Eric P

    2011-01-01

    This study looked at the medication ordering error frequency and the length of inpatient hospital stay in a subpopulation of stroke patients (n-60) as a function of time of patient admission to an inpatient rehabilitation hospital service. A total of 60 inpatient rehabilitation patients, 30 arriving before 4 pm, and 30 arriving after 4 pm, with as admitting diagnosis of stroke were randomly selected from a larger sample (N=426). There was a statistically significant increase in medication ordering errors and the number of inpatient rehabilitation hospital days in the group of patients who arrived after 4 pm.

  15. [Withholding and withdrawing treatment in patients admitted in an Internal Medicine ward].

    Science.gov (United States)

    García Caballero, R; Herreros, B; Real de Asúa, D; Alonso, R; Barrera, M M; Castilla, V

    2016-01-01

    Many of the patients admitted to a general medical ward have a compromised quality of life, or short life expectancy, so they are potential candidates for withhold/withdraw (WH/WD) treatment. The first objectif was to describe which measures were WH/WD among patients who died during their admission in a general medical ward from a tertiary hospital in Madrid. Secondly, to define the clinical characteristics of this population. A cross-sectional descriptive study during 6 months from 2011 and 2012 of all the patients dead while their admission in the Internal Medicine Department. 2007 patients were admitted, 211 died (10.5%). 121 (57%) were female, with 85±9 years of mean age. 103 (48.8%) came from a residential facility and 105 fulfilled terminality criteria (49.8%). One decision to WH/WD treatment was made in 182 patients (86.3%, CI 95%: 81.4-91.1), two in 99 cases (46.9%, CI 95%: 39.9-53.9) and 3 or more in 31 subjects (14.7%, CI 95%: 9.6-19.7). The most frequent decisions involved do-not-resuscitate orders (154, 73.0%), rejection of «aggressive treatment measures» (80, 38.0%), use of antibiotics (19, 9.0%), admission in ICU (18, 8.5%), and/or surgical treatment (11, 5.2%). WH/WD treatment is very frequent among patients who died in a general medical ward. The most frequent involved do-not-resuscitate orders and rejection of «aggressive treatment measures». WH/WD decisions are adopted in an elderly population, with extensive comorbidity and an elevated prevalence of advanced dementia and/or terminal disease. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  16. Predictors of 30-day mortality in patients admitted to ED for acute heart failure.

    Science.gov (United States)

    Marchetti, Matthieu; Benedetti, Antoine; Mimoz, Olivier; Lardeur, Jean-Yves; Guenezan, Jérémy; Marjanovic, Nicolas

    2017-03-01

    Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality. We conducted a single site, retrospective review of adult patients (≥18years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period. There were a total of 322 patients. Mean age was 83.9±9.1years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30days of admission to the ED. The following three characteristics were associated with increased mortality: age>85years (OR=1.5[95%CI:0.8-2.7], p=0.01), creatinine clearance 5000pg/mL (OR=2.2[95%CI:1.2-4], p<0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634-0.935], p<0.001). For 7-day mortality, it was 7900pg/mL (0.698 [0.578-0.819], p<0.001) and for 30-day mortality, 5000pg/mL (0.667 [0.576-0.758], p<0.001). Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Effect of casemix funding on outcomes in patients admitted to hospital with suspected unstable angina.

    Science.gov (United States)

    Kerr, G D; Dunt, D; Gordon, I R

    1998-01-19

    To determine the effect of the introduction of casemix funding on resource utilisation and clinical outcomes in patients admitted to hospital with suspected unstable angina. A prospective cohort study with a 6-month follow-up. A suburban community hospital in Melbourne, Victoria. 336 consecutive patients admitted to the coronary care unit with suspected unstable angina before (156) and after (180) the introduction of casemix funding. Introduction of casemix funding in July 1993. Indices of resource utilisation: length of stay in hospital, length of stay in the coronary care unit, and total cost of investigations (pathology and radiology). Rates of serious cardiac events during hospital stay and after discharge. Readmissions within 28 days and 6 months of discharge. After the introduction of casemix funding there was a 1% increase in duration of hospital stay and a 5% increase in time spent in the coronary care unit, but neither of these increases was statistically significant. However, there was a significant reduction in total cost of investigations (39% decrease; 95% confidence interval, 14%-70%; P Casemix funding had no effect on short term clinical outcomes but resulted in significantly reduced investigation costs.

  18. Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo

    Directory of Open Access Journals (Sweden)

    Ishimoto Kayo

    2010-12-01

    Full Text Available Abstract Background Patients admitted to a psychiatric hospital with suicidal behavior (SB are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan. Method 155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined. Results The common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD. SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range of the total number of SBs in the lifetime history was 7 (1-141. Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified. Conclusions Features of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission

  19. Evaluation of Total Daily Dose and Glycemic Control for Patients on U-500 Insulin Admitted to the Hospital

    Science.gov (United States)

    2016-05-20

    regular insulin has significantly increased in recent years. These patients are severely insulin resistant requiring high doses of insulin to achieve...on U-500 Insulin Admitted to the Hospital presented at SURF Conference, San Antonio, TX 20 May 201 6 with MDWI 41-108, and has been assigned local...59th CSPG/SGVU) C.201 4 . I 52d PROTOCOL TITLE Evaluation of Total Dai ly Dose and Glycemic Control for Patients on U-500 Insulin Admitted to the

  20. Relationship Between Depression and Perception of Pain Severity in Patients Admitted to General Surgery Ward

    Directory of Open Access Journals (Sweden)

    Mehdi Samadzadeh

    2016-11-01

    Full Text Available Background Depression is considered as the most common psychological problem in individuals. Patients with persistent pain usually suffer from depression, disturbance in interpersonal relations, fatigue, and reduced physical and psychological performance. Objectives The aim of this study was to survey the relationship between depression and perception of pain severity in patients admitted to general surgery ward. Methods This research was a cross-sectional descriptive study. The study population included patients admitted to general surgery ward at hospitals of Ardabil city during 2010 - 2011. The study sample consisted of 168 individuals (male and female who were selected by nonrandomized convenience sampling method. The data were collected using a questionnaire on demographic information, the Beck depression inventory (BDI, and Toren questionnaire on pain beliefs and perceptions. The SPSS software was used for statistical analysis. Results The highest frequency of participants had moderate depression (44.1% while the lowest frequency belonged to healthy individuals (4.2%. The score of depression was higher in men (23.21 ± 7.56 than women (19.19 ± 6.84 as the same as the score of pain perception (8.91 ± 2.34 vs. 7.95 ± 1.87, respectively. The results indicated that there was a positive significant relationship between depression and perception of pain severity (P ≤ 0.01. This means that patients who have a history of depression feel much more pain during hospitalization and after the surgery. Conclusions Depressed or anguished patients report more pain compared to healthy ones.

  1. Evaluation of Different Methods for Removing Oral Biofilm in Patients Admitted to the Intensive Care Unit

    Science.gov (United States)

    Oliveira, Maria Sonia; Borges, Alvaro Henrique; Mattos, Fernanda Zanol; Semenoff, Tereza Aparecida Della Vedove; Segundo, Alex Semenoff; Tonetto, Mateus Rodrigues; Bandeca, Matheus Coêlho; Porto, Alessandra Nogueira

    2014-01-01

    Background: The present study aimed to evaluate the different methods for removing oral biofilm in combination with 0.12% chlorhexidine, in patients admitted to the intensive care unit (ICU) of the General University Hospital. Materials and Methods: Initially, the patients were included in the study and underwent periodontal evaluation by means of the visible plaque index (VPI) and gingival bleeding index (GBI). The removal of visible biofilm, by a professional, was carried out using a toothbrush and dental floss, followed by the application of a 0.12% chlorhexidine solution. The patients were included in this randomized and controlled study into four groups (total n = 48), as follows: Chlorhexidine and gauze 12/12 h; chlorhexidine and gauze 24/24 h; chlorhexidine and brushing 12/12 h; chlorhexidine and brushing 24/24 h. The patients underwent the biofilm removal protocol for 7 days and then were subjected to a new clinical evaluation as to VPI and GBI. Data analysis was performed through stratification and arrangement of the records, in order to carry out the associations with health indicators used in the study, and the statistical tests used were Kappa and t-test for independent and paired samples. Results: A decrease in the VPI and GBI values when comparing baseline to the final evaluation for all groups was observed. Conclusion: Based on the methodology, it was possible to concluded that chlorhexidine associated with the mechanical action of the toothbrush or gauze in the times 12 h and 24 h in the ICU environment presented the same results as regards amount of visible biofilm. How to cite the article: Oliveira MS, Borges AH, Mattos FZ, Semenoff TA, Segundo AS, Tonetto MR, Bandeca MC, Porto AN. Evaluation of different methods for removing oral biofilm in patients admitted to the intensive care unit. J Int Oral Health 2014;6(3):61-4. PMID:25083034

  2. Is a project needed to prevent urinary tract infection in patients admitted to spanish ICUs?

    Science.gov (United States)

    Álvarez Lerma, F; Olaechea Astigarraga, P; Nuvials, X; Gimeno, R; Catalán, M; Gracia Arnillas, M P; Seijas Betolaza, I; Palomar Martínez, M

    2018-02-06

    To analyze epidemiological data of catheter-associated urinary tract infection (CAUTI) in critically ill patients admitted to Spanish ICUs in order to assess the need of implementing a nationwide intervention program to reduce these infections. Non-intervention retrospective annual period prevalence analysis. Participating ICUs in the ENVIN-UCI multicenter registry between the years 2007-2016. Critically ill patients admitted to the ICU with catheter-associated urinary tract infection (CAUTI). Incidence rates per 1,000 catheter-days; urinary catheter utilization ratio; proportion of CAUTIs in relation to total health care-associated infections (HAIs). A total of 187,100 patients, 137,654 (73.6%) of whom had a urinary catheter in place during 1,215,673 days (84% of days of ICU stay) were included. In 4,539 (3.3%) patients with urinary catheter, 4,977 CAUTIs were diagnosed (3.6 episodes per 100 patients with urinary catheter). The CAUTI incidence rate showed a 19% decrease between 2007 and 2016 (4.69 to 3.8 episodes per 1,000 catheter-days), although a sustained urinary catheter utilization ratio was observed (0.84 [0.82-0.86]). The proportion of CAUTI increased from 23.3% to 31.9% of all HAIs controlled in the ICU. Although CAUTI rates have declined in recent years, these infections have become proportionally the first HAIs in the ICU. The urinary catheter utilization ratio remains high in Spanish ICUs. There is room for improvement, so that a CAUTI-ZERO project in our country could be useful. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department.

    Science.gov (United States)

    Jarrin, Irène; Sellier, Pierre; Lopes, Amanda; Morgand, Marjolaine; Makovec, Tamara; Delcey, Veronique; Champion, Karine; Simoneau, Guy; Green, Andrew; Mouly, Stéphane; Bergmann, Jean-François; Lloret-Linares, Célia

    2016-01-01

    Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine.The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department.A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management.The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine.The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to viral agents or

  4. Association of Osteopontin, Neopterin, and Myeloperoxidase With Stroke Risk in Patients With Prior Stroke or Transient Ischemic Attacks

    DEFF Research Database (Denmark)

    Ganz, Peter; Amarenco, Pierre; Goldstein, Larry B

    2017-01-01

    BACKGROUND AND PURPOSE: Established risk factors do not fully identify patients at risk for recurrent stroke. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or transient ischemic...

  5. 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...

  6. Platelets Proteomic Profiles of Acute Ischemic Stroke Patients.

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    Ozge Cevik

    Full Text Available Platelets play a crucial role in the pathogenesis of stroke and antiplatelet agents exist for its treatment and prevention. Through the use of LC-MS based protein expression profiling, platelets from stroke patients were analyzed and then correlated with the proteomic analyses results in the context of this disease. This study was based on patients who post ischemic stroke were admitted to hospital and had venous blood drawn within 24 hrs of the incidence. Label-free protein expression analyses of the platelets' tryptic digest was performed in triplicate on a UPLC-ESI-qTOF-MS/MS system and ProteinLynx Global Server (v2.5, Waters was used for tandem mass data extraction. The peptide sequences were searched against the reviewed homo sapiens database (www.uniprot.org and the quantitation of protein variation was achieved through Progenesis LC-MS software (V4.0, Nonlinear Dynamics. These Label-free differential proteomics analysis of platelets ensured that 500 proteins were identified and 83 of these proteins were found to be statistically significant. The differentially expressed proteins are involved in various processes such as inflammatory response, cellular movement, immune cell trafficking, cell-to-cell signaling and interaction, hematological system development and function and nucleic acid metabolism. The expressions of myeloperoxidase, arachidonate 12-Lipoxygenase and histidine-rich glycoprotein are involved in cellular metabolic processes, crk-like protein and ras homolog gene family member A involved in cell signaling with vitronectin, thrombospondin 1, Integrin alpha 2b, and integrin beta 3 involved in cell adhesion. Apolipoprotein H, immunoglobulin heavy constant gamma 1 and immunoglobulin heavy constant gamma 3 are involved in structural, apolipoprotein A-I, and alpha-1-microglobulin/bikunin precursor is involved in transport, complement component 3 and clusterin is involved in immunity proteins as has been discussed. Our data provides

  7. Patent Foramen Ovale and Cryptogenic Strokes in the Stroke in Young Fabry Patients Study.

    Science.gov (United States)

    Huber, Roman; Grittner, Ulrike; Weidemann, Frank; Thijs, Vincent; Tanislav, Christian; Enzinger, Christian; Fazekas, Franz; Wolf, Markus; Hennerici, Michael G; McCabe, Dominick J H; Putaala, Jukaa; Tatlisumak, Turgut; Kessler, Christoph; von Sarnowski, Bettina; Martus, Peter; Kolodny, Edwin; Norrving, Bo; Rolfs, Arndt

    2017-01-01

    A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; Pstrokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (Pstroke patients demonstrate a heterogeneous PFO prevalence. Even in case of less conclusive diseases like nonstenotic arteriosclerosis, patients should preferentially be considered to have a non-PFO-mediated stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2016 American Heart Association, Inc.

  8. METABOLIC THERAPY IN PATIENTS WITH ISCHEMIC STROKE

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    L. B. Zavaliy

    2018-01-01

    cognitive function in patients who had experienced a stroke,. The drug does not significantly improve the neurological status of patients after a stroke, but it reduces the risk of the stroke development in the next 10 years. Thus, we analyzed mechanisms of medical substances action and data of experimental and clinical studies, including ones after thrombolytic therapy and with inclusion of drugs for primary and secondary prevention of ischemic stroke. The reasonability and effectiveness of prescribing a combination of drugs of different pharmacological groups affecting brain metabolism remains controversial, since the excessive drug treatment may have complications. The safety of metabolic therapy is in doubt, and some of authors views presented confirm the need for additional large independent studies.

  9. Stroke Risk and Mortality in Patients With Ventricular Assist Devices.

    Science.gov (United States)

    Parikh, Neal S; Cool, Joséphine; Karas, Maria G; Boehme, Amelia K; Kamel, Hooman

    2016-11-01

    Ventricular assist devices (VADs) have advanced the management of end-stage heart failure. However, these devices are associated with hemorrhagic and thrombotic complications, including stroke. We assessed the incidence, risk factors, and outcomes of ischemic and hemorrhagic stroke after VAD placement. Using administrative claims data from acute care hospitals in California, Florida, and New York from 2005 to 2013, we identified patients who underwent VAD placement, defined by the International Classification of Diseases, Ninth Revision, Clinical Modification code 37.66. Ischemic and hemorrhagic strokes were identified by previously validated coding algorithms. We used survival statistics to determine the incidence rates and Cox proportional hazard analyses to examine the associations. Among 1813 patients, we identified 201 ischemic strokes and 116 hemorrhagic strokes during 3.4 (±2.0) years of follow-up after implantation of a VAD. The incidence of stroke was 8.7% per year (95% confidence interval [CI], 7.7-9.7). The annual incidence of ischemic stroke (5.5%; 95% CI, 4.8-6.4) was nearly double that of hemorrhagic stroke (3.1%; 95% CI, 2.6-3.8). Women faced a higher hazard of stroke than men (hazard ratio, 1.6; 95% CI, 1.2-2.1), particularly hemorrhagic stroke (hazard ratio, 2.2; 95% CI, 1.4-3.4). Stroke was strongly associated with subsequent in-hospital mortality (hazard ratio, 6.1; 95% CI, 4.6-7.9). The incidence of stroke after VAD implantation was 8.7% per year, and incident stroke was strongly associated with subsequent in-hospital mortality. Notably, ischemic stroke occurred at nearly twice the rate of hemorrhagic stroke. Women seemed to face a higher risk for hemorrhagic stroke than men. © 2016 American Heart Association, Inc.

  10. Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

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    Ana Cláudia Giaxa Prosdócimo

    2015-03-01

    Full Text Available Background: Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS. Objective: To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Methods: Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged <65 years, hospitalized with diagnosis of ACS. The Burnout Syndrome was evaluated with the Burnout Syndrome Inventory (BSI, which assesses workplace conditions and four dimensions that characterize the syndrome: emotional exhaustion (EE, emotional distancing (EmD, dehumanization (De and professional fulfillment (PF. The Lipp’s Stress Symptoms Inventory for Adults (LSSI was applied to evaluate global stress. Results: Of 830 patients evaluated with suspected ACS, 170 met the study criteria, 90% of which were men, overall average age was 52 years, and 40.5% had an average income above 11 minimum wages. The prevalence of the Burnout Syndrome was 4.1%. When we evaluated each dimension individually, we found high EE in 34.7%, high De in 52.4%, high EDi in 30.6%, and low PF in 5.9%. The overall prevalence of stress was 87.5%. Conclusion: We found a low prevalence of Burnout Syndrome in an economically active, non-elderly population among patients admitted for ACS in a tertiary and private hospital.

  11. Socio-economic correlates of relapsed patients admitted in a Nigerian mental health institution.

    Science.gov (United States)

    Gbiri, Caleb A; Badru, Fatai A; Ladapo, Harry T O; Gbiri, Adefolakemi A

    2011-03-01

    Relapse in psychiatric disorders is highly distressing, costly and engenders burn-out syndrome among mental-health workers. To study the socio-economic factors associated with relapse in individual admitted with psychiatric disorders and the pattern of socio-economic impact of relapse in those groups. A cross-sectional survey of all relapsed patients without cognitive deficit admitted into the federal Neuro-Psychiatric Hospital, Lagos, Nigeria between June and October 2007 was conducted using a self-validated Structured Interview Schedule (Relapse Socio-economic Impact Interview Schedule) and Key Informant Interview Guide. Secondary data were elicited from the patient folders, case notes, ward admission registers and nominal rolls. Data were summarised using mean, standard deviation, frequency and percentiles. Pearson's moment correlation coefficient was used to test the association among variables. The Mann-Whitney U-test was used to compare the pre-morbid and the post-morbid states. This study involved 102 respondents. Their mean age was 36.5 ± 9.8 years, mainly of male gender (72.5%) suffering from schizophrenic disorder (37.8%). Relapse and re-admission ranged between 2 and 12. Unemployment rate, marital separation and divorce increased more than 5-fold from pre-morbid to morbid states. Few (4.9%) could still settle their hospital/drug bills on their own, while most (95.1%) depended on family, philanthropist and government/waivers to pay for their bills. Their social relationships were negatively influenced with most of them expressing social isolation and low quality of life. There were significant relationships (Peconomic status, employment status and marital status of the respondents between the pre-morbid and post-morbid periods. The illness significantly affected the emotional status of the participants. Relapse and readmission in psychiatric patients have a negative impact on socio-economic well-being of patients, family and the society. Efforts should

  12. Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study.

    Science.gov (United States)

    Schmidt, Matthieu; Sonneville, Romain; Schnell, David; Bigé, Naike; Hamidfar, Rebecca; Mongardon, Nicolas; Castelain, Vincent; Razazi, Keyvan; Marty, Antoine; Vincent, François; Dres, Martin; Gaudry, Stephane; Luyt, Charles Edouard; Das, Vincent; Micol, Jean-Baptiste; Demoule, Alexandre; Mayaux, Julien

    2013-12-01

    Characteristics and outcomes of adult patients with disseminated toxoplasmosis admitted to the intensive care unit (ICU) have rarely been described. We performed a retrospective study on consecutive adult patients with disseminated toxoplasmosis who were admitted from January 2002 through December 2012 to the ICUs of 14 university-affiliated hospitals in France. Disseminated toxoplasmosis was defined as microbiological or histological evidence of disease affecting >1 organ in immunosuppressed patients. Isolated cases of cerebral toxoplasmosis were excluded. Clinical data on admission and risk factors for 60-day mortality were collected. Thirty-eight patients were identified during the study period. Twenty-two (58%) had received an allogeneic hematopoietic stem cell transplant (median, 61 [interquartile range {IQR}, 43-175] days before ICU admission), 4 (10%) were solid organ transplant recipients, and 10 (27%) were infected with human immunodeficiency virus (median CD4 cell count, 14 [IQR, 6-33] cells/µL). The main indications for ICU admission were acute respiratory failure (89%) and shock (53%). The 60-day mortality rate was 82%. Allogeneic hematopoietic stem cell transplant (hazard ratio [HR] = 2.28; 95% confidence interval [CI], 1.05-5.35; P = .04) and systolic cardiac dysfunction (HR = 3.54; 95% CI, 1.60-8.10; P toxoplasmosis leading to ICU admission has a poor prognosis. Recipients of allogeneic hematopoietic stem cell transplant appear to have the highest risk of mortality. We identified systolic cardiac dysfunction as a major determinant of outcome. Strategies aimed at preventing this fatal opportunistic infection may improve outcomes.

  13. What scares patients to get admitted in a psychiatry ward? An exploratory study

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    Sushmita Bhattacharya

    2018-01-01

    Full Text Available Background: There has been very little focus on understanding the experiences of people suffering from mental illness during their treatment in the outpatient and inpatient treatment facilities. Majority of the decisions regarding their treatment are taken by the mental health professionals in consultation with the caregivers, and the patient remains a passive recipient of the services. It is commonly seen that patients refuse admission in the psychiatry ward even when clinical needs warrant admission. Aim: The aim of the current study was to explore the perception of patients regarding admission in the psychiatry ward and the fears associated with indoor treatment facility. Methodology: A semistructured interview schedule was administered to 110 patients undergoing treatment from outpatient services to study their attitude toward treatment in psychiatry ward. Results: A large number of patients perceived psychiatry ward as a hostile place with unfriendly atmosphere and dark and unsupportive environment. However, the patients who had been admitted in the past found it less scary and appreciated good and friendly behavior of the staff in the ward. Conclusion: Negative perception of inpatient treatment and psychiatry wards is still highly prevalent among the patients. With growing focus on reducing stigma about psychiatric illnesses, dispelling the myths related to treatment in wards is the need of the hour.

  14. Risk factors associated with methicillin-resistant Staphylococcus aureus infection in patients admitted to the ED.

    Science.gov (United States)

    Viallon, Alain; Marjollet, Olivier; Berthelot, Philippe; Carricajo, Anne; Guyomarc'h, Stéphane; Robert, Florianne; Zeni, Fabrice; Bertrand, Jean Claude

    2007-10-01

    The objective of our study was to define the characteristics of patients admitted to the emergency department (ED) presenting with a methicillin-resistant Staphylococcus aureus (MRSA) infection. The study included all patients admitted to the ED between January 2003 and December 2004 in whom a staphylococcal infection was documented. The risk factors associated with carriage of MRSA, the diagnosis made in the ED, and the treatment administered were established from the patients' medical files. The sites from which the bacteria were isolated, the spectrum of resistance of the staphylococci to different antibiotics, and the presence or absence of the gene coding for Panton-Valentin leukocidin for certain S aureus isolates were determined from the reports issued by the bacteriologic department. Two groups of patients were compared: those with an infection caused by MRSA and those with an infection due to methicillin-susceptible S aureus (MSSA). A total of 238 patients were included, 93 presenting with an infection caused by MRSA and 145 an infection due to MSSA. The patients harboring MRSA had a higher median age than those carrying MSSA (74 vs 61 years, P = .0001), experienced a greater loss of autonomy (according to the Knauss index), and had more comorbidity factors. Nine patients, younger than 40 years, presented with an infection due to MRSA in the absence of any comorbidity factor or any factor associated with carriage of these bacteria. Seven patients in the MRSA group were tested for Panton-Valentine leukocidin genes, and a positive result was obtained in 2 of them. Regardless of whether the infection was caused by MRSA or by MSSA, the bacteria were most frequently isolated from a cutaneous site, in 40% and 65% of the patients, respectively. Irrespective of the group, 28% of the patients presented with bacteremia. The spectrum of resistance of these MRSA strains suggested a hospital rather than community origin. The initial antibiotic therapy was rarely

  15. Prediabetes is associated with post-stroke cognitive impairment in ischaemic stroke patients.

    Science.gov (United States)

    Wang, Qiongzhang; Zhao, Kai; Cai, Yan; Tu, Xinjie; Liu, Yuntao; He, Jincai

    2018-05-15

    Diabetes mellitus is associated with post-stroke cognitive impairment. To the best of our knowledge, no study has explored the relationship between prediabetes and post-stroke cognitive impairment. The purpose of this study is to explore the association between prediabetes and cognitive impairment in ischaemic stroke patients at 1 month. Two hundred one acute ischaemic stroke patients were consecutively recruited within the first 24 h after admission and were followed up for 1 month. Patients were divided into a diabetes mellitus group, prediabetes group and non-diabetes mellitus group by fasting glucose levels, 2-h postprandial blood glucose levels and glycosylated haemoglobin levels at admission. Cognitive function was evaluated by the Mini-Mental State Examination at 1 month after stroke. The prediabetes group had a higher risk of post-stroke cognitive impairment than the non-diabetes group (35.7% vs. 18.1%, χ 2  = 4.252, P = .039). In logistical analyses, prediabetes was associated with post-stroke cognitive impairment after adjusting for potential confounding factors (odds ratio 3.062, 95% confidence interval 1.130-8.299, P = .028). Our findings show that prediabetes is associated with post-stroke cognitive impairment and may predict its development at 1 month post-stroke. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic

    Directory of Open Access Journals (Sweden)

    Hocagil H

    2016-02-01

    Full Text Available Hilal Hocagil,1 Filiz Izci,2 Abdullah Cüneyt Hocagil,1 Ebru Findikli,3 Sevda Korkmaz,4 Merve Iris Koc5 1Department of Emergency, School of Medicine, Bulent Ecevit University, Zonguldak, 2Department of Psychiatry, School of Medicine, Istanbul Bilim University, Istanbul, 3Department of Psychiatry, School of Medicine, Sutcu Imam University, Kahramanmaras, 4Department of Psychiatry, School of Medicine, Firat University, Elazig, 5Department of Psychiatry, Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul, Turkey Background: Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic.Methods: This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients.Results: Of the patients exposed to violence 63% (n=46 were female and 27% (n=27 were male. Of these patients, 68.5% (n=50 were married, 43.8% (n=25 were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41 were primary school, 21.9% (n=16 were high school, and 21.9% (n=16 were university graduates. Smoking and alcohol use rates were 54.8% (n=40 and 17.8% (n=13, respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57. In addition, anxiety scores were high in 42.5% (n=31 and moderate in 9.6% (n=7 of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13 of the patients and 19.2% (n=14 of the patients’ relatives. The correlation between sociodemographic

  17. Prospective multicentre cohort study of heparin-induced thrombocytopenia in acute ischaemic stroke patients

    Science.gov (United States)

    Kawano, Hiroyuki; Yamamoto, Haruko; Miyata, Shigeki; Izumi, Manabu; Hirano, Teruyuki; Toratani, Naomi; Kakutani, Isami; Sheppard, Jo-Ann I; Warkentin, Theodore E; Kada, Akiko; Sato, Shoichiro; Okamoto, Sadahisa; Nagatsuka, Kazuyuki; Naritomi, Hiroaki; Toyoda, Kazunori; Uchino, Makoto; Minematsu, Kazuo

    2011-01-01

    Acute ischaemic stroke patients sometimes receive heparin for treatment and/or prophylaxis of thromboembolic complications. This study was designed to elucidate the incidence and clinical features of heparin-induced thrombocytopenia (HIT) in acute stroke patients treated with heparin. We conducted a prospective multicentre cohort study of 267 patients who were admitted to three stroke centres within 7 d after stroke onset. We examined clinical data until discharge and collected blood samples on days 1 and 14 of hospitalization to test anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs) using an enzyme-linked immunosorbent assay (ELISA); platelet-activating antibodies were identified by serotonin-release assay (SRA). Patients with a 4Ts score ≥4 points, positive-ELISA, and positive-SRA were diagnosed as definite HIT. Heparin was administered to 172 patients (64·4%: heparin group). Anti-PF4/H Abs were detected by ELISA in 22 cases (12·8%) in the heparin group. Seven patients had 4Ts ≥ 4 points. Among them, three patients (1·7% overall) were also positive by both ELISA and SRA. National Institutes of Health Stroke Scale score on admission was high (range, 16–23) and in-hospital mortality was very high (66·7%) in definite HIT patients. In this study, the incidence of definite HIT in acute ischaemic stroke patients treated with heparin was 1·7% (95% confidence interval: 0·4–5·0). The clinical severity and outcome of definite HIT were unfavourable. PMID:21671895

  18. SSRIs increase risk of blood transfusion in patients admitted for hip surgery.

    Directory of Open Access Journals (Sweden)

    Hermien Janneke Schutte

    Full Text Available BACKGROUND: Recent studies have shown that an increased bleeding tendency can be caused by Selective Serotonin Reuptake Inhibitors (SSRI use. We aimed to investigate the occurrence and risk of blood transfusion in SSRI users compared to non-SSRI users in a cohort of patients admitted for hip-surgery. METHODS: We conducted a retrospective cohort study of patients who underwent planned or emergency hip surgery from 1996 to 2011 in the Academic Medical Center in Amsterdam. Primary outcome measure was risk of blood transfusion. Secondary outcome measures were pre- and postoperative hemoglobin level. Multivariate logistic regression was used to adjust for potential confounders. RESULTS: One-hundred and fourteen SSRI users were compared to 1773 non-SSRI users. Risk of blood transfusion during admission was increased for SSRI users in multivariate analyses (OR 1.7 [95% CI 1.1-2.5]. Also, pre-operative hemoglobin levels were lower in SSRI users (7.8 ± 1.0 mmol/L compared to non-SSRI users (8.0 ± 1.0 mmol/L (p  =  0.042, as were postoperative hemoglobin levels (6.2 ± 1.0 mmol/L vs. 6.4 ± 1.0 mmol/L respectively (p  =  0.017. CONCLUSIONS: SSRI users undergoing hip surgery have an increased risk for blood transfusion during admission, potentially explained by a lower hemoglobin level before surgery. SSRI use should be considered as a potential risk indicator for increased blood loss in patients admitted for hip surgery. These results need to be confirmed in a prospective study.

  19. Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis.

    Science.gov (United States)

    Ellis, Graham; Mant, Jonathan; Langhorne, Peter; Dennis, Martin; Winner, Simon

    2010-05-12

    Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing. To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'. We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators. Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care. We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain. We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P

  20. Evaluation of neurogenic dysphagia in Iraqi patients with acute stroke.

    Science.gov (United States)

    Hasan, Zeki N; Al-Shimmery, Ehsan K; Taha, Mufeed A

    2010-04-01

    To clinically assess neurogenic dysphagia, and to correlate its presence with demographic features, different stroke risk factors, anatomical arterial territorial stroke types, and pathological stroke types. Seventy-two stroke inpatients were studied between July 2007 and February 2008, at the Departments of Medicine and Neurology at Al-Yarmouk Teaching Hospital, Baghdad, and Rizgary Teaching Hospital, Erbil, Iraq. All patients were assessed using the Mann Assessment of Swallowing Ability score (MASA), Modified Rankin Scale, and the Stroke Risk Scorecard. All patients were reassessed after one month. There were 40 males and 32 females. Sixty-eight patients had ischemic stroke, and 4 had primary intracerebral hemorrhage (ICH). According to the MASA score, 55% of anterior circulation stroke (ACS) cases were associated with dysphasia, and 91% of lateral medullary syndrome cases were associated with dysphagia. Fifty-six percent of ACS dysphagic cases improved within the first month. Forty percent of dysphagic patients died in the one month follow up period, and in most, death was caused by aspiration pneumonia. We observed no significant differences regarding demographic features of dysphagia. Dysphagia can be an indicator of the severity of stroke causing higher mortality and morbidity in affected patients. It was not related to the stroke risk factors and the type of stroke. It is essential from a prognostic point of view to assess swallowing, and to treat its complications early.

  1. Constipation--prevalence and incidence among medical patients acutely admitted to hospital with a medical condition.

    Science.gov (United States)

    Noiesen, Eline; Trosborg, Ingelise; Bager, Louise; Herning, Margrethe; Lyngby, Christel; Konradsen, Hanne

    2014-08-01

    To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients. Constipation is a common medical problem with severe consequences, and most people suffer from constipation at some point in their lives. In the general population, constipation is one of the most common complaints and is a significant personal and public health burden. Alteration in patients' patterns of elimination while in hospital has long been identified as either a potential or an actual problem that requires attention. Knowledge of the prevalence and incidence of constipation during hospitalisation is only sporadic. The study was descriptive and a prospective cohort design was chosen. The Constipation Assessment Scale was translated into Danish and was used for the assessment of patient-reported bowel function. Five nurses made the assessments at admission to the acute medical ward and three days after admission. Three hundred and seventy-three patients participated in this study. Thirty-nine percent of the patients showed symptoms of constipation at admission. Of the patients who did not have the symptoms at admission, 43% developed the symptoms during the first three days of their stay in hospital. Significantly more of the older patients developed symptoms of moderate constipation. The incidence rate was 143 new cases per 1000 patient days. In this study, symptoms of constipation were common among patients acutely admitted to hospital due to different medical conditions. Symptoms of constipation were also developed during the first three days of the stay in hospital. The study highlights the need to develop both clinical guidelines towards treating constipation, and preventive measures to ensure that patients do not become constipated while staying in hospital. © 2013 John Wiley & Sons Ltd.

  2. Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease.

    Directory of Open Access Journals (Sweden)

    Shigeki Bamba

    Full Text Available The relationship between skeletal muscle volume and the prognosis of patients with inflammatory bowel disease (IBD remains undetermined. We conducted a retrospective study of 72 IBD patients who were admitted to the hospital due to disease exacerbation. We enrolled IBD patients who had undergone abdominal computed tomography and assessed the nutritional indices, such as the Onodera's prognostic nutritional index (O-PNI and the controlling nutritional status (CONUT index. The L3 skeletal muscle index (SMI, which is the ratio of the cross-sectional area of skeletal muscles at the level of the third lumbar (L3 vertebra to the height squared, was used to identify sarcopenia. Sarcopenia, defined as a low SMI, was observed in 42% of all IBD patients (37% with Crohn's disease (CD and 48% with ulcerative colitis (UC. In UC patients, the O-PNI and CONUT values, height, and albumin levels were significantly lower than in CD patients. The SMI strongly correlated with sex, body weight, albumin level, and O-PNI in IBD patients. Multivariate analysis using the Cox regression model demonstrated that the presence of sarcopenia (P = 0.015 and disease type (CD or UC (P = 0.007 were significant factors predicting intestinal resection. The cumulative operation-free survival rate was significantly lower for sarcopenic patients than in all IBD patients (P = 0.003 and a stratified analysis of CD patients (P = 0.001 using the Kaplan-Meier method and log-rank test. The L3 skeletal muscle area is a prognostic factor for intestinal resection in patients with CD.

  3. Nutritional status of cancer patients admitted for chemotherapy at the National Kidney and Transplant Institute.

    Science.gov (United States)

    Montoya, J E; Domingo, F; Luna, C A; Berroya, R M; Catli, C A; Ginete, J K; Sanchez, O S; Juat, N J; Tiangco, B J; Jamias, J D

    2010-11-01

    Malnutrition is common among cancer patients. This study aimed to determine the overall prevalence of malnutrition among patients undergoing chemotherapy and to determine the predictors of malnutrition among cancer patients. A cross-sectional study was conducted on 88 cancer patients admitted for chemotherapy at the National Kidney and Transplant Institute, Philippines, from October to November 2009. Subjective Global Assessment (SGA), anthropometric data and demographic variables were obtained. Descriptive statistics, ANOVA and logistic regression analysis were performed between the outcome and variables. A total of 88 cancer patients were included in the study. The mean age of the patients was 55.7 +/- 14.8 years. The mean duration of illness was 9.7 +/- 8.7 months and the mean body mass index (BMI) was 22.9 kg/m2. The mean Karnofsky performance status was 79.3. 29.55 percent of the patients had breast cancer as the aetiology of their illness. 38 patients (43.2 percent) had SGA B and four (4.5 percent) had SGA C, giving a total malnutrition prevalence of 47.7 percent. The patients were statistically different with regard to their cancer stage (p is less than 0.001), weight (p is 0.01), BMI (p is 0.004), haemoglobin level (p is 0.001) and performance status by Karnofsky score (p is less than 0.001), as evaluated by ANOVA. Logistic regression analysis showed that cancer stage and Karnofsky performance score were predictors of malnutrition. About 47.7 percent of cancer patients suffer from malnutrition, as classified by SGA. Only cancer stage and Karnofsky performance status scoring were predictive of malnutrition in this select group of patients.

  4. [in-hospital mortality in patient with acute ischemic and hemorrhagic stroke].

    Science.gov (United States)

    Sadamasa, Nobutake; Yoshida, Kazumichi; Narumi, Osamu; Chin, Masaki; Yamagata, Sen

    2011-09-01

    There is a lack of evidence to compare in-hospital mortality with different types of stroke. The purpose of this study was to elucidate the in-hospital mortality after acute ischemic/hemorrhagic stroke and compare the factors associated with the mortality among stroke subtypes. All patients admitted to Kurashiki Central Hospital in Japan between January 2009 and December 2009, and diagnosed with acute ischemic/hemorrhagic stroke were included in this study. Demographics and clinical data pertaining to the patients were obtained from their medical records. Out of 738 patients who had an acute stroke, 53 (7.2%) died in the hospital. The in-hospital mortality was significantly lower in the cerebral infarction group than in the intracerebral hemorrhage and subarachnoid hemorrhage group (3.5%, 15.1%, and 17.9%, respectively; Phemorrhage group than in the other 2 groups. With regard to past history, diabetes mellitus was significantly found to be a complication in mortality cases of intracranial hemorrhage. Further investigation is needed to clarify the effect of diabetes on mortality after intracranial hemorrhage.

  5. Effect of the full moon on mortality among patients admitted to the intensive care unit

    International Nuclear Information System (INIS)

    Nadeem, R.; Madbouly, E.M.; Madbouly, E.M.; Molnar, J.; Morrison, J.L

    2014-01-01

    Objective: To determine the lunar effect on mortality among patients admitted to the intensive care unit. Methods: The retrospective study conducted at Rosalind Franklin University of Medicine and Science, North Chicago, and comprised data of 4387 patients in intensive care unit from December 2002 to November 2004. The subjects were divided into two groups: patients who died on full moon days (the 14th, 15th, and 16th days of the lunar month); and patients who died on the other days of the month. The mortality rates were calculated for patients in both groups. Parameters including patients' age, gender, acute physiology and chronic health evaluation scores, predicted mortality rates, type of intensive care unit, and actual mortality were compared, and non-parametric tests were performed to determine whether there were any differences between the groups. Results: Of the 4387 patients who were followed for 23 months, 297 patients died, including 31 on full moon days and 266 patients on the other days of the month. Both groups were similar in terms of mean age (73.6 +-14.59 vs. 71.07+-16.13 years; p=0.599), acute physiology and chronic health evaluation scores (82.06+-24.19 vs. 76.52+-27.42; p=0.258), and predicted mortality (0.405+-0.249 vs. 0.370+-0.268; p=0.305). There was no difference in the frequency of death between the full moon days and the other days (10.33+-0.58 vs. 9.8 +-3.46; p=0.845). Conclusions: The full moon does not affect the mortality of the patients in intensive care unit. (author)

  6. Increased Symptom Expression among Patients with Delirium Admitted to an Acute Palliative Care Unit.

    Science.gov (United States)

    de la Cruz, Maxine; Yennu, Sriram; Liu, Diane; Wu, Jimin; Reddy, Akhila; Bruera, Eduardo

    2017-06-01

    Delirium is the most common neuropsychiatric condition in very ill patients and those at the end of life. Previous case reports found that delirium-induced disinhibition may lead to overexpression of symptoms. It negatively affects communication between patients, family members, and the medical team and can sometimes lead to inappropriate interventions. Better understanding would result in improved care. Our aim was to determine the effect of delirium on the reporting of symptom severity in patients with advanced cancer. We reviewed 329 consecutive patients admitted to the acute palliative care unit (APCU) without a diagnosis of delirium from January to December 2011. Demographics, Memorial Delirium Assessment Scale, Eastern Cooperative Oncology Group (ECOG) Performance status, and Edmonton Symptom Assessment Scale (ESAS) on two time points were collected. The first time point was on admission and the second time point for group A was day one (+two days) of delirium. For group B, the second time point was within two to four days before discharge from the APCU. Patients who developed delirium and those who did not develop delirium during the entire course of admission were compared using chi-squared test and Wilcoxon rank-sum test. Paired t-test was used to assess if the change of ESAS from baseline to follow-up was associated with delirium. Ninety-six of 329 (29%) patients developed delirium during their admission to the APCU. The median time to delirium was two days. There was no difference in the length of stay in the APCU for both groups. Patients who did not have delirium expressed improvement in all their symptoms, while those who developed delirium during hospitalization showed no improvement in physical symptoms and worsening in depression, anxiety, appetite, and well-being. Patients with delirium reported no improvement or worsening symptoms compared to patients without delirium. Screening for delirium is important in patients who continue to report

  7. Age, gender and risk factor disparities in first-stroke Jewish and Arab patients in Israel undergoing rehabilitation.

    Science.gov (United States)

    Greenberg, Elina; Treger, Iuly; Schwarz, Juliana

    2011-11-01

    Little is known of the risk factor disparities in first stroke among Jewish and Arab patients undergoing rehabilitation in Israel. To investigate the age, gender and risk factor disparities in first stroke among Jewish (immigrant and non-immigrant) and Arab patients undergoing rehabilitation and to compare the prevalence and odds ratio of stroke risk factors in these patients. The database of the Department of Neurological Rehabilitation C at Loewenstein Rehabilitation Center was used to investigate first ischemic and hemorrhagic stroke patients admitted for hospital rehabilitation over a 15 year period, January 1993 to December 2008. Particular attention was paid to age, gender and risk factor disparities. The 2000 patients with first stroke who were included in the study were grouped as Jewish (immigrant and non-immigrant) orArab; there were 237 Arabs, 370 non-immigrant Jews and 1393 immigrant Jews. A high percentage of Arab patients were found to have hypertension and diabetes mellitus, while a high percentage of Jewish immigrants had stenosis of the internal carotid artery. The study demonstrated some differences in the effect of risk factors between the groups. It may be important to address such differences when developing stroke preventative strategies in this population of Jewish and Arab stroke survivors in Israel.

  8. Does the STAF score help detect paroxysmal atrial fibrillation in acute stroke patients?

    Science.gov (United States)

    Horstmann, S; Rizos, T; Güntner, J; Hug, A; Jenetzky, E; Krumsdorf, U; Veltkamp, R

    2013-01-01

    Detecting paroxysmal atrial fibrillation (pAF) soon after acute cerebral ischaemia has a major impact on secondary stroke prevention. Recently, the STAF score, a composite of clinical and instrumental findings, was introduced to identify stroke patients at risk of pAF. We aimed to validate this score in an independent study population. Consecutive patients admitted to our stroke unit with acute ischaemic stroke were prospectively enrolled. The diagnostic work-up included neuroimaging, neuroultrasound, baseline 12-channel electrocardiogram (ECG), 24-h Holter ECG, continuous ECG monitoring, and echocardiography. Presence of AF was documented according to the medical history of each patient and after review of 12-lead ECG, 24-h Holter ECG, or continuous ECG monitoring performed during the stay on the ward. Additionally, a telephone follow-up visit was conducted for each patient after 3 months to inquire about newly diagnosed AF. Items for each patient-age, baseline NIHSS, left atrial dilatation, and stroke etiology according to the TOAST criteria - were assessed to calculate the STAF score. Overall, 584 patients were enrolled in our analysis. AF was documented in 183 (31.3%) patients. In multivariable analysis, age, NIHSS, left atrial dilatation, and absence of vascular etiology were independent predictors for AF. The logistic AF-prediction model of the STAF score revealed fair classification accuracy in receiver operating characteristic curve analysis with an area under the curve of 0.84. STAF scores of ≥5 had a sensitivity of 79% and a specificity of 74% for predicting AF. The value of the STAF score for predicting the risk of pAF in stroke patients is limited. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  9. Acceptance of NCPAP in a sample of patients admitted for geriatric rehabilitation

    Directory of Open Access Journals (Sweden)

    Frohnhofen H

    2009-12-01

    Full Text Available Abstract Objective Sleep apnea syndrome (SAS is common in older people. Nasal continuous airway pressure (NCPAP therapy is the treatment of choice for sleep apnea, but is not always accepted by patients. The rate of successful initiation of NCPAP is unknown in geriatric patients. Methods All patients admitted for geriatric rehabilitation were considered for sleep studies. Sleep apnea was assessed using an Edentrace (Nellcor, Hayward, CA multi-channel recording system. SAS was defined as an apnea-hypopnea-index (AHI of more than five events per hour plus excessive daytime sleepiness, or an AHI of more than fifteen events per hour regardless of reported sleepiness. Disability was assessed using the Barthel Index of Activities of Daily Living. Results Two hundred sixty nine of 322 consecutive patients (84% had adequate sleep studies and gave informed consent. SAS was found in 169 subjects (68%. There was no gender difference in the prevalence of SAS. Six subjects (4% accepted NCPAP therapy. Individuals who accepted NCPAP were younger and less disabled (p Conclusion NCPAP should not be withheld in the elderly. However, initiation of treatment for SAS remains to be a great challenge in those patients. Geriatric assessment procedures may help better manage older subjects with sleep apnea syndrome.

  10. Sexual Behavior in Patients with Psychosis Admitted to a Hospital Unit.

    Science.gov (United States)

    Del Mar Baños-Martín, María; Márquez-Hernández, Verónica V; Gutiérrez-Puertas, Lorena; Aguilera-Manrique, Gabriel; Gutiérrez-Puertas, Vanesa; Granados-Gámez, Genoveva

    2017-06-01

    The sexual dimension is part of a person's functionality. Patients with mental disorders have the same sexual needs as any other person, although they may not always be recognized. This is a retrospective observational study to describe the information on sexuality of patients with mental disorders, admitted to an acute short-stay inpatient unit between 2011 and 2015. We analyzed 293 clinical histories of patients, comprising diagnoses in the ICD-10 (International Classification of Diseases) between F20 and F29, inclusively. The information collected corresponded to the beginning of hospitalization, its duration and discharge. The results showed that 24% of the patients had sexual delusions. These delusions were more frequent in women, who in turn had more emotional symptoms, persecutory deception being the most common. There were few reports found on sexual dysfunction. In conclusion, the lack of data in the reports shows little recognition of sexuality in hospitalized patients with mental disorder, highlighting the need to promote the training of health personnel.

  11. Predictors of disease severity in patients admitted to a cholera treatment center in urban Haiti.

    Science.gov (United States)

    Valcin, Claude-Lyne; Severe, Karine; Riche, Claudia T; Anglade, Benedict S; Moise, Colette Guiteau; Woodworth, Michael; Charles, Macarthur; Li, Zhongze; Joseph, Patrice; Pape, Jean W; Wright, Peter F

    2013-10-01

    Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010-July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.

  12. Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months.

    Science.gov (United States)

    Wagle, Jørgen; Farner, Lasse; Flekkøy, Kjell; Bruun Wyller, Torgeir; Sandvik, Leiv; Fure, Brynjar; Stensrød, Brynhild; Engedal, Knut

    2011-01-01

    To identify prognostic factors associated with functional outcome at 13 months in a sample of stroke rehabilitation patients. Specifically, we hypothesized that cognitive functioning early after stroke would predict long-term functional outcome independently of other factors. 163 stroke rehabilitation patients underwent a structured neuropsychological examination 2-3 weeks after hospital admittance, and their functional status was subsequently evaluated 13 months later with the modified Rankin Scale (mRS) as outcome measure. Three predictive models were built using linear regression analyses: a biological model (sociodemographics, apolipoprotein E genotype, prestroke vascular factors, lesion characteristics and neurological stroke-related impairment); a functional model (pre- and early post-stroke cognitive functioning, personal and instrumental activities of daily living, ADL, and depressive symptoms), and a combined model (including significant variables, with p value Stroke Scale; β = 0.402, p stroke cognitive functioning (Repeatable Battery of Neuropsychological Status, RBANS; β = -0.248, p = 0.001) and prestroke personal ADL (Barthel Index; β = -0.217, p = 0.002). Further linear regression analyses of which RBANS indexes and subtests best predicted long-term functional outcome showed that Coding (β = -0.484, p stroke cognitive functioning as measured by the RBANS is a significant and independent predictor of long-term functional post-stroke outcome. Copyright © 2011 S. Karger AG, Basel.

  13. Increased risk of stroke in contact dermatitis patients

    Science.gov (United States)

    Chang, Wei-Lun; Hsu, Min-Hsien; Lin, Cheng-Li; Chan, Po-Chi; Chang, Ko-Shih; Lee, Ching-Hsiao; Hsu, Chung-Yi; Tsai, Min-Tein; Yeh, Chung-Hsin; Sung, Fung-Chang

    2017-01-01

    Abstract Dermatologic diseases are not traditional risk factors of stroke, but recent studies show atopic dermatitis, psoriasis, and bullous skin disease may increase the risk of stroke and other cardiovascular diseases. No previous studies have focused on the association between contact dermatitis and stroke. We established a cohort comprised of 48,169 contact dermatitis patients newly diagnosed in 2000–2003 and 96,338 randomly selected subjects without the disorder, frequency matched by sex, age, and diagnosis year, as the comparison cohort. None of them had a history of stroke. Stroke incidence was assessed by the end of 2011 for both cohorts. The incidence stroke was 1.1-fold higher in the contact dermatitis cohort than in the comparison cohort (5.93 vs 5.37 per 1000 person-years, P contact dermatitis cohort increased with age, from 1.14 (95% CI, 1.03–1.27) for 65 to 74 years; to 1.27 (95% CI, 1.15–1.42) for 75 years and older. The aHR of stroke were 1.16 (95% CI, 1.07–1.27) and 1.09 (95% CI, 1.00–1.18) for men and women, respectively. This study suggests that patients with contact dermatitis were at a modestly increased risk of stroke, significant for ischemic stroke but not for hemorrhagic stroke. Comorbidity, particularly hypertension, increased the hazard of stroke further. PMID:28272195

  14. Ischemic stroke subtype is associated with outcome in thrombolyzed patients

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Ziegler; Svendsen, M L

    2017-01-01

    OBJECTIVES: The impact of ischemic stroke subtype on clinical outcome in patients treated with intravenous tissue-type plasminogen activator (IV-tPA) is sparsely examined. We studied the association between stroke subtype and clinical outcome in magnetic resonance imaging (MRI)-evaluated patients...... patients were more likely to achieve early neurological improvement and favorable outcome compared with LVD stroke following MRI-based IV-tPA treatment. This finding may reflect a difference in the effect of IV-tPA among stroke subtypes....

  15. Mortality Associated With Emergency Department Boarding Exposure: Are There Differences Between Patients Admitted to ICU and Non-ICU Settings?

    Science.gov (United States)

    Reznek, Martin A; Upatising, Benjavan; Kennedy, Samantha J; Durham, Natassia T; Forster, Richard M; Michael, Sean S

    2018-05-01

    Emergency Department (ED) boarding threatens patient safety. It is unclear whether boarding differentially affects patients admitted to intensive care units (ICUs) versus non-ICU settings. We performed a 2-hospital, 18-month, cross-sectional, observational, descriptive study of adult patients admitted from the ED. We used Kaplan-Meier estimation and Cox Proportional Hazards regression to describe differences in boarding time among patients who died during hospitalization versus those who survived, controlling for covariates that could affect mortality risk or boarding exposure, and separately evaluating patients admitted to ICUs versus non-ICU settings. We extracted age, race, sex, time variables, admission unit, hospital disposition, and Elixhauser comorbidity measures and calculated boarding time for each admitted patient. Among 39,781 admissions from the EDs (21.3% to ICUs), non-ICU patients who died in-hospital had a 1.2-fold risk (95% confidence interval, 1.03-1.36; P=0.016) of having experienced longer boarding times than survivors, accounting for covariates. We did not observe a difference among patients admitted to ICUs. Among non-ICU patients, those who died during hospitalization were more likely to have had incrementally longer boarding exposure than those who survived. This difference was not observed for ICU patients. Boarding risk mitigation strategies focused on ICU patients may have accounted for this difference, but we caution against interpreting that boarding can be safe. Segmentation by patients admitted to ICU versus non-ICU settings in boarding research may be valuable in ensuring that the safety of both groups is considered in hospital flow and boarding care improvements.

  16. Knowledge of stroke among stroke patients and their relatives in Northwest India.

    Science.gov (United States)

    Pandian, Jeyaraj Durai; Kalra, Guneet; Jaison, Ashish; Deepak, Sukhbinder Singh; Shamsher, Shivali; Singh, Yashpal; Abraham, George

    2006-06-01

    The knowledge of warning symptoms and risk factors for stroke has not been studied among patients with stroke in developing countries. We aimed to assess the knowledge of stroke among patients with stroke and their relatives. Prospective tertiary referral hospital-based study in Northwest India. Trained nurses and medical interns interviewed patients with stroke and transient ischemic attack and their relatives about their knowledge of stroke symptoms and risk factors. Univariable and multivariable logistic regression were used. Of the 147 subjects interviewed, 102 (69%) were patients and 45 (31%) were relatives. There were 99 (67%) men and 48 (33%) women and the mean age was 59.7+/-14.1 years. Sixty-two percent of respondents recognized paralysis of one side as a warning symptom and 54% recognized hypertension as a risk factor for stroke. In the multivariable logistic regression analysis, higher education was associated with the knowledge of correct organ involvement in stroke (OR 2.6, CI 1.1- 6.1, P =0.02), whereas younger age (OR 2.7, CI 1.1-7.0, P =0.04) and higher education (OR 4.1, CI 1.5-10.9, P =0.005) correlated with a better knowledge regarding warning symptoms of stroke. In this study cohort, in general, there is lack of awareness of major warning symptoms, risk factors, organ involvement and self-recognition of stroke. However younger age and education status were associated with better knowledge. There is an urgent need for awareness programs about stroke in this study cohort.

  17. The prognostic significance of ABPM in patients with acute stroke

    OpenAIRE

    Ewa Trzmielewska; Marta Jurdziak

    2016-01-01

    Hypertension is present in about 77% of patients with a first episode of stroke. Unlike the established benefit of lowering blood pressure for the primary and secondary prevention of stroke, the management of hypertension in patients with acute stroke remains controversial. ABPM is a diagnostic tool that has been proposed as a method of obtaining a more reliable assessment of patients’ blood pressure in comparison with OBPM. ABPM provides precise information about the BP values during the dai...

  18. Comparison of the Topography of Carotid Territory Stenosis in North American and Iranian Stroke Patients

    Directory of Open Access Journals (Sweden)

    A Shoayb

    2007-01-01

    Full Text Available Introduction: Atherosclerotic stenosis of carotid territory is the most common cause of ischemic stroke. A higher frequency of intracranial arterial stenosis has been reported in Africa and the Far East. Methods: 304 geriatric ischemic stroke patients admitted in Mackenzie hospital, Canada and the same number of geriatric ischemic stroke patients with similar sex ratio admitted in Valie-Asr hospital, Iran during 2003-2005 were enrolled in a double center and prospective study. Diagnosis of brain infarction in the carotid territory was made by stroke neurologists. All of the patients underwent transcranial and carotid doppler studies. Doppler studies performed were based on the standard method by a neurosonologist. Fisher exact test served for statistical analysis and p<0.05 was declared significant. Results: In Iranian group 71 patients (23.3% and in North American group 83 patients (27.3% had extracranial ICA stenosis without a significant difference df=1, p=0.305. Sever ³70% Extracranial ICA stenosis was found in 14 Iranian patients (4.6% and 23 North American patients (7.5% without a significant difference. df=1, p=0.17. In Iranian group, 14 cases (4.6% and in North American group 5 cases (1.6% had intracranial stenosis in carotid territory which was significantly different df=1, p=0.038. Mixed intracranial and extracranial carotid territory stenosis was present in 2 Iranian and 1 North American patient. Conclusion: Atherosclerotic stenosis of intracranial branches of carotid territory is more common in Iranian than North American populations.

  19. Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital.

    Science.gov (United States)

    Kilyewala, C; Alenyo, R; Ssentongo, R

    2017-07-06

    Blood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol. 112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused. 22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count 12,000/μL (p = 0.05). Pre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.

  20. A STUDY ON RISK FACTORS AND LIPID PROFILE PATTERN IN PATIENTS OF STROKE

    Directory of Open Access Journals (Sweden)

    Jawgam Umbon

    2016-07-01

    Full Text Available BACKGROUND Stroke is usually end result of predisposing conditions that originated years before the ictus. Creating awareness and treatment of its modifiable risk factors will reduce the incidence of stroke. OBJECTIVE To study the risk factors and lipid profile pattern in stroke patients. METHODS Patients with diagnosis of stroke comprising 50 consecutive patients each of ischaemic and haemorrhagic strokes who were admitted in Jorhat Medical College & Hospital, Assam over a period of 1 year (May 2015 - April 2016 included in the study, while patients on lipid lowering therapy were excluded from the study. History of risk factors like hypertension, diabetes mellitus, smoking and alcoholism were taken. To determine the subtype of stroke, clinical examination followed by CT scan/MRI of brain were done. A serum sample after 8 hours of overnight fasting was taken on the next day of admission for both groups of patients. Total serum cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol and HDL-cholesterol was determined, using enzymatic colorimetric method. RESULTS A total of 100 patients were studied, of whom 66 were males and 34 were females. The mean age for the ischaemic group was 62±12 years and for the haemorrhagic group were 55±14 years. In this study, dyslipidaemia was present in 58 (58% patients. Patients with high total cholesterol - 33 (18 ischaemic, 15 haemorrhagic, high LDL-cholesterol was found in 38 (22 ischaemic, 16 haemorrhagic, high triglycerides in 31 (14 ischaemic, 17 haemorrhagic and low HDL-cholesterol in 47 (29 ischaemic, 18 haemorrhagic. Among 100 patients, 66 had hypertension, 20 had diabetes mellitus, 18 had both diabetes and hypertension, 43 were smokers, 36 consumed alcohol and >2 risk factor were found in 44. CONCLUSION Dyslipidaemia was found in 58% of patients and most striating features were low HDL-cholesterol and elevated triglycerides level, indicating they are independent risk factors for stroke. No

  1. Stroke prevention in hospitalized patients with atrial fibrillation: a population-based study.

    Science.gov (United States)

    Nagpal, Seema; Anderson, David; Putnam, Wayne; Flowerdew, Gordon; Gardner, Martin; Cox, Jafna

    2003-01-01

    Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented in surveys of patients with atrial fibrillation. The present study examined current patterns of anticoagulant use for patients hospitalized with atrial fibrillation across an entire health care system. Improving Cardiovascular Outcomes in Nova Scotia (ICONS) is a prospective cohort study involving all patients hospitalized in Nova Scotia with atrial fibrillation, among other conditions. Consecutive inpatients with atrial fibrillation from October 15, 1997 to October 14, 1998 were studied. Detailed demographic and clinical data were collected and the proportion of patients using antithrombotic therapy was tabulated by risk category. Multivariate logistic regression was used to assess the relationship of various demographic and clinical factors with the use of antithrombotic agents. There were 2202 patients hospitalized with atrial fibrillation; 644 admitted specifically for this condition. Only 21% of patients admitted with atrial fibrillation were on warfarin sodium at admission and this increased by time of discharge. Diabetes was negatively correlated with warfarin sodium use. Histories of prosthetic valve replacement, stroke/transient ischemic attack, and heart failure were positively associated with anticoagulant use on admission. Patients with prosthetic valve replacement, heart failure, or hyperlipidemia were most likely to receive anticoagulants at discharge. Antithrombotic agents remain underused by patients with atrial fibrillation. While higher risk patients are generally targeted, this is not invariably the case; thus, diabetics remain under treated. Further work is needed to explain such anomalous practice and promote optimal antithrombotic therapy use.

  2. Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective.

    Science.gov (United States)

    Magidy, Mahnaz; Warrén-Stomberg, Margareta; Bjerså, Kristofer

    2016-04-01

    Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery. A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge. In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted. There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good. © 2015 John Wiley & Sons, Ltd.

  3. The Frequency, Characteristics, and Outcomes Among Cancer Patients With Delirium Admitted to an Acute Palliative Care Unit.

    Science.gov (United States)

    de la Cruz, Maxine; Ransing, Viraj; Yennu, Sriram; Wu, Jimin; Liu, Diane; Reddy, Akhila; Delgado-Guay, Marvin; Bruera, Eduardo

    2015-12-01

    Delirium is a common neuropsychiatric condition seen in patients with severe illness, such as advanced cancer. Few published studies are available of the frequency, course, and outcomes of standardized management of delirium in advanced cancer patients admitted to acute palliative care unit (APCU). In this study, we examined the frequency, characteristics, and outcomes of delirium in patients with advanced cancer admitted to an APCU. Medical records of 609 consecutive patients admitted to the APCU from January 2011 through December 2011 were reviewed. Data on patients' demographics; Memorial Delirium Assessment Scale (MDAS) score; palliative care specialist (PCS) diagnosis of delirium; delirium etiology, subtype, and reversibility; late development of delirium; and discharge outcome were collected. Delirium was diagnosed with MDAS score ≥7 and by a PCS using Diagnostic and Statistical Manual, 4th edition, Text Revision criteria. All patients admitted to the APCU received standardized assessments and management of delirium per best practice guidelines in delirium management. Of 556 patients in the APCU, 323 (58%) had a diagnosis of delirium. Of these, 229 (71%) had a delirium diagnosis on admission and 94 (29%) developed delirium after admission to the APCU. Delirium reversed in 85 of 323 episodes (26%). Half of patients with delirium (n = 162) died. Patients with the diagnosis of delirium had a lower median overall survival than those without delirium. Patients who developed delirium after admission to the APCU had poorer survival (p ≤ .0001) and a lower rate of delirium reversal (p = .03) compared with those admitted with delirium. More than half of the patients admitted to the APCU had delirium. Reversibility occurred in almost one-third of cases. Diagnosis of delirium was associated with poorer survival. ©AlphaMed Press.

  4. Phenomenology of delirium among patients admitted to a coronary care unit.

    Science.gov (United States)

    Lahariya, Sanjay; Grover, Sandeep; Bagga, Shiv; Sharma, Akhilesh

    2016-11-01

    To study the phenomenology and motor sub-types of delirium in patients admitted in a Coronary Care Unit (CCU). Three hundred and nine consecutive patients were screened for delirium, and those found positive for the same were evaluated by a psychiatrist on DSM-IVTR criteria to confirm the diagnosis. Those with a diagnosis of delirium were evaluated on the DRS-R-98 to study the phenomenology and on the amended Delirium Motor Symptom Scale (DMSS) to study the motor sub-types. Eighty-one patients were found to have delirium. Commonly seen symptoms of delirium included: disturbances in sleep-wake cycle, lability of affect, thought abnormality, disturbance in attention, disorientation, short-term memory, and long-term memory. Very few patients had delusions. More than half of the participants were categorized as having hyperactive (n = 46; 56.8%) followed by hypoactive sub-type (n = 21; 26%) and mixed sub-type (n = 9; 11.1%) of delirium. There were minor differences in the frequency and severity of symptoms of delirium between incidence and prevalence cases of delirium and those with different motoric sub-types. Delirium in CCU set-up is characterized by the symptoms of disturbances in sleep-wake cycle, lability of affect, thought abnormality, disturbance in attention, disorientation, short-term memory, and long-term memory. Hyperactive delirium is more common than hypoactive delirium.

  5. Variations in the intensive use of head CT for elderly patients with hemorrhagic stroke.

    Science.gov (United States)

    Bekelis, Kimon; Fisher, Elliott S; Labropoulos, Nicos; Zhou, Weiping; Skinner, Jonathan

    2015-04-01

    To investigate the variability in head computed tomographic (CT) scanning in patients with hemorrhagic stroke in U.S. hospitals, its association with mortality, and the number of different physicians consulted. The study was approved by the Committee for the Protection of Human Subjects at Dartmouth College. A retrospective analysis of the Medicare fee-for-service claims data was performed for elderly patients admitted for hemorrhagic stroke in 2008-2009, with 1-year follow-up through 2010. Risk-adjusted primary outcome measures were mean number of head CT scans performed and high-intensity use of head CT (six or more head CT scans performed in the year after admission). We examined the association of high-intensity use of head CT with the number of different physicians consulted and mortality. A total of 53 272 patients (mean age, 79.6 years; 31 377 women [58.9%]) with hemorrhagic stroke were identified in the study period. The mean number of head CT scans conducted in the year after admission for stroke was 3.4; 8737 patients (16.4%) underwent six or more scans. Among the hospitals with the highest case volume (more than 50 patients with hemorrhagic stroke), risk-adjusted rates ranged from 8.0% to 48.1%. The correlation coefficient between number of physicians consulted and rates of high-intensity use of head CT was 0.522 (P mortality was found for patients undergoing six or more head CT scans (odds ratio, 0.84; 95% confidence interval: 0.69, 1.02). High rates of head CT use for patients with hemorrhagic stroke are frequently observed, without an association with decreased mortality. A higher number of physicians consulted was associated with high-intensity use of head CT. © RSNA, 2014 Online supplemental material is available for this article.

  6. Thrombolytic treatment to stroke mimic patients via telestroke.

    Science.gov (United States)

    Asaithambi, Ganesh; Castle, Amy L; Sperl, Michael A; Ravichandran, Jayashree; Gupta, Aditi; Ho, Bridget M; Hanson, Sandra K

    2017-02-01

    The safety and outcomes of intravenous thrombolysis (IVT) to stroke patients via telestroke (TS) is similar to those presenting to stroke centers. Little is known on the accuracy of TS diagnosis among those receiving IVT. We sought to compare the rate of patients receiving IVT with diagnosis of ischemic stroke as opposed to stroke mimic (SM) in our TS network to those who presented to our comprehensive stroke center (CSC). Consecutive patients receiving IVT between August 2014 and June 2015 were identified at our CSC and TS network. We compared rates of SM, post-IVT symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, and discharge destination. We evaluated 131 receiving IVT were included in the analysis. Rates of SM receiving IVT were similar (CSC 12% versus 7% TS, p=0.33). Four stroke patients experienced sICH or in-hospital mortality; neither were found among SM patients. Discharge destination was similar between stroke and SM patients (p=0.9). SM patients had higher diagnoses of migraine (p=0.05) and psychiatric illness (p<0.01). The accuracy of diagnosing stroke in IVT-eligible patients evaluated via TS is similar to evaluations at our CSC. Continued efforts should be made to minimize exposure of SM patients to IVT in both settings. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Predictive factors of adrenal insufficiency in patients admitted to acute medical wards: a case control study

    Directory of Open Access Journals (Sweden)

    Oboni Jean-Baptiste

    2013-01-01

    Full Text Available Abstract Background Adrenal insufficiency is a rare and potentially lethal disease if untreated. Several clinical signs and biological markers are associated with glucocorticoid failure but the importance of these factors for diagnosing adrenal insufficiency is not known. In this study, we aimed to assess the prevalence of and the factors associated with adrenal insufficiency among patients admitted to an acute internal medicine ward. Methods Retrospective, case-control study including all patients with high-dose (250 μg ACTH-stimulation tests for suspected adrenal insufficiency performed between 2008 and 2010 in an acute internal medicine ward (n = 281. Cortisol values Results 32 patients (11.4% presented adrenal insufficiency; the others served as controls. Among all clinical and biological parameters studied, history of glucocorticoid withdrawal was the only independent factor significantly associated with patients with adrenal insufficiency (Odds Ratio: 6.71, 95% CI: 3.08 –14.62. Using a logistic regression, a model with four significant and independent variable was obtained, regrouping history of glucocorticoid withdrawal (OR 7.38, 95% CI [3.18 ; 17.11], p-value p-value 0.044, eosinophilia (OR 17.6, 95% CI [1.02; 302.3], p-value 0.048 and hyperkalemia (OR 2.41, 95% CI [0.87; 6.69], p-value 0.092. The AROC (95% CI was 0.75 (0.70; 0.80 for this model, with 6.3 (0.8 – 20.8 for sensitivity and 99.2 (97.1 – 99.9 for specificity. Conclusions 11.4% of patients with suspected adrenal insufficient admitted to acute medical ward actually do present with adrenal insufficiency, defined by an abnormal response to high-dose (250 μg ACTH-stimulation test. A history of glucocorticoid withdrawal was the strongest factor predicting the potential adrenal failure. The combination of a history of glucocorticoid withdrawal, nausea, eosinophilia and hyperkaliemia might be of interest to suspect adrenal insufficiency.

  8. Increased risk of developing stroke for patients with major affective disorder--a registry study

    DEFF Research Database (Denmark)

    Nilsson, Flemming M; Kessing, Lars V

    2004-01-01

    and cerebrovascular diseases in hospitalised patients. The main finding of this study was that patients with depression severe enough to be hospitalised, seem to be at an increased risk of developing cerebrovascular disease. The hazard ratio of getting a diagnosis of stroke after initially having been discharged......Only a few studies have evaluated depressive disorder as a risk factor for cerebrovascular disease. In a hospital discharge register with nation-wide coverage of all hospitals in Denmark we used linkage between the somatic and psychiatric registries to study comorbidity between affective disorders...... with a diagnosis of depression was found to be 1.22 (95% Confidence Interval: 1.06-1.41). In the group of patients with manic/bipolar disorder no association was found concerning development of stroke. In elderly with first time depression admitted to hospital, neurological disorders should be carefully evaluated...

  9. Seroprevalence of toxoplasma gondii infection among patients admitted to al-zahra hospital, isfahan, iran

    International Nuclear Information System (INIS)

    Mohaghegh, M.A.; Yazdani, H.; Hadipour, M.; Namdar, F.

    2015-01-01

    Toxoplasma gondii (T. gondii) infection is one of the most common parasitic infections among humans and other warm-blooded animals worldwide. The aim of this study was to evaluate toxoplasmosis status in patients admitted to Al-Zahra hospital, Isfahan, Iran. Methods: This cross-sectional study was conducted from October 2012 to January 2015. During this period, 716 patients referred to Al-Zahra hospital in Isfahan city, Iran, were studied to investigate the IgG and IgM antibodies against T. gondii using ELISA kit. The data were analysed by Chi-square and Fishers exact tests. In addition, the relation of data with age and sex were also examined. Results: Among 716 patients, 21 patients (2.9%) had positive IgM and 288 patients (40.2%) had positive IgG titer against T. gondii. Data analysis by Chi-square and Fishers exact tests revealed that there was no significant relationship between IgG titer and age (p>0.05). Additionally, there was no relationship between IgM titer and age (p>0.05). The data showed that there was no relationship between IgG and IgM antibody titer and sex (p>0.05). Conclusion: The prevalence of toxoplasmosis in Isfahan inhabitants seems fairly high but it can be concluded that the rate of seropositive patient is moderate comparing to other regions of country. Accordingly, the authors propose that all sensitive patients have to be tested for T. gondii antibody in order to prevent the consequences of disease. (author)

  10. Evaluating Fluoroquinolone Use in Patients Admitted to the Tuberculosis Outpatient Clinic

    Directory of Open Access Journals (Sweden)

    Sinem İliaz

    2016-08-01

    Full Text Available Objective: Inelaborate use of new quinolones with strong anti-tuberculosis (TB activity leads to difficulty in diagnosis and more importantly, quinolone-resistant Mycobacterium tuberculosis. We aimed to determine the frequency of quinolone use in patients who were referred to our hospital for suspected TB and to evaluate the association between quinolone use and different clinical laboratory parameters. Methods: Between November 15 and December 15, 2013, all patients who were admitted to the TB outpatient clinic with no previous diagnosis of TB were included in this study. Demographic and clinical laboratory findings and history of antibiotic use were recorded. Patients’ quinolone use were questioned by showing fluoroquinolone antibiotic boxes’ photographs available on the market. The departments of the doctors who prescribed quinolones were recorded. Results: The mean age of 179 patients included in the study was 37±16 (15–89 years. Among these, 113 patients (63.1% were male. Seventy five patients (41.9% were diagnosed as tuberculosis according to the clinical-radiological and/or bacteriological findings. Of 179 patients, 58.1% (n=104 had been prescribed antibiotics for current complaints before referral to our clinic. Sixteen patients (15% had been recommended fluoroquinolones. Fluoroquinolones were prescribed by seven internal medicine specialists, five pulmonologists, three emergency medicine specialists, and one family medicine practitioner. Among 16 fluoroquinolones prescribed, nine were moxifloxacin, four were levofloxacin, and three were gemifloxacin. Quinolone use revealed a significant inverse relationship only with the presence of hemoptysis (p=0.04. Conclusion: Besides increased educational activities regarding the rational use of antibiotics in recent years, the quinolone group of antibiotics is still prescribed for suspected TB cases. To avoid quinolone-resistant M. tuberculosis strains, further education is required.

  11. A RETROSPECTIVE STUDY OF MECHANICALLY-VENTILATED PATIENTS WITH SNAKEBITE ADMITTED IN ICU

    Directory of Open Access Journals (Sweden)

    Riyaz Ahamed

    2017-04-01

    Full Text Available BACKGROUND Snakebite is an important medical emergency, which results in the death or chronic disability of many active younger people. Despite its importance, there have been fewer proper clinical studies of snakebite than any other tropical disease. This study is done with the objective of studying the incidence of various types of snakebite patients requiring ventilator support and their outcome. MATERIALS AND METHODS This is a retrospective analysis of 62 patients with snakebite admitted in Adult Medical ICU between September 2012 and August 2015 in Chigateri General Hospital, Tertiary Healthcare Centre attached to J.J.M. Medical College, Davangere. Case records were analysed and details of each case was entered in a proforma with respect to demographic details like age, sex, time since bite to hospital presentation, type of snake, site of bite and ventilator outcome. RESULTS Out of 62 patients, 26cases (42% were females and 36 cases (58% were males. Incidence of snakebite was 45.16% among age group 18 to 30years, 35.48% among age group 31 to 50years and 19.35% were aged more than 50 years. Incidence of vasculotoxic and neurotoxic snakebites was found to be 25.8% and 74.2%, respectively.63% of patients were bitten on lower limb followed by 29% in upper limb and 8% on other sites. Recovery among vasculotoxic and neurotoxic bites were 62.5% and 82.6%, respectively. Recovery was 90.47% among those who presented to hospital within first 2hours of snakebite followed by 84.5% among those who presented between 2 to 4 hours and 12.5% among those who presented between 5 to 6 hours. CONCLUSION Most common snakebite patients requiring ventilator were males bitten by neurotoxic snakes. Shorter time since snakebite to hospital admission is found to be associated with better outcome. Neurotoxic snakebite patients had a better prognosis than vasculotoxic snakebite patients.

  12. Increase of Meningitis Risk in Stroke Patients in Taiwan

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    Chie-Hong Wang

    2018-03-01

    Full Text Available Background and purposeThe blood–brain barrier (BBB not only provides a physical obstruction but also recruits and activates neutrophils in cases of infection. Hemorrhagic or ischemic stroke reportedly induces the disruption of the BBB. However, few studies have reported a correlation between the incidence of meningitis in patients with a history of stroke. This study tested the hypothesis that patients with a history of stroke may be more vulnerable to meningitis.MethodsStroke and age-matched comparison (n = 29,436 and 87,951, respectively cohorts were recruited from the Taiwan National Health Insurance database (2000–2011. Correlations between the two cohorts were evaluated by Cox proportional hazard regression model, Kaplan–Meier curve, and log-rank tests.ResultsThe incidence of meningitis was higher in the stroke cohort compared to that in the comparison cohort [hazard ratio (HR, 2.89; 95% confidence interval (CI, 2.23–3.74, p < 0.001]. After adjusting for age, sex, and comorbidities, the estimated HR in the stroke cohort was 2.55-fold higher than that in the comparison cohort (CI, 1.94–3.37; p < 0.001. Notably, patients who had experienced hemorrhagic stroke had a higher incidence rate of meningitis than those with a history of ischemic stroke, except for patients older than 75 years (incidence rates in hemorrhagic/ischemic stroke patients, 3.14/1.48 in patients younger than 45 years, 1.52/0.41 in 45- to 64-year group, 1.15/0.90 in 65- to 74-year group, 0.74/0.93 in patients older than 75 years. Moreover, stroke patients who had undergone head surgery had the highest meningitis risk (adjusted HR, 8.66; 95% CI, 5.55–13.5; p < 0.001 followed by stroke patients who had not undergone head surgery (adjusted HR, 2.11; 95% CI, 1.57–2.82; p < 0.001.ConclusionOur results indicated that stroke patients have higher risks of meningitis. Compromised BBB integrity in stroke patients may lead to increased

  13. Association of serum 25-hydroxyvitamin D with symptoms of depression after 6 months in stroke patients.

    Science.gov (United States)

    Yue, Wei; Xiang, Lei; Zhang, Ya-Jing; Ji, Yong; Li, Xin

    2014-11-01

    Our aim was to determine whether there was a relationship between 25-hydroxyvitamin D (25[OH] D) and post-stroke depression (PSD). Two hundred and forty-four ischemic stroke patients admitted to the hospital within the first 24 h after stroke onset were consecutively recruited and followed up for 6 months. Clinical information was collected. Serum 25[OH] D levels were measured at baseline. Based on the symptoms, diagnoses of depression were made in accordance with DSM-IV criteria for depression at 6-month after stroke. At 6-month, 91 patients (37.3 %) showed depression and in 60 patients (24.6 %) this depression was classified as major. There was a significant difference in median serum 25[OH] D levels between PSD patients and no depression cases [8.3 (IQR, 6.8-9.5) vs. 15.6 (IQR, 13.2-20.3) ng/ml, respectively; P < 0.001]. Serum 25[OH] D levels ≤ 11.2 ng/ml were independently associated with PSD [odds ratio 10.32, 95 % confidence interval 4.97-28.63; P < 0.001], after adjusting for possible confounders. Serum 25[OH] D levels reduced at admission was found to be associated with PSD. Additional research is needed on vitamin D supplementation to improve the outcome of patients with PSD.

  14. Adherence to treatment of patients with past ischemic stroke.

    Directory of Open Access Journals (Sweden)

    V. Je. Azarenko

    2018-05-01

    Full Text Available The main task of the general practitioner is managing patients with the effects of ischemic stroke. The improvement of patients adherence to treatment in a significant way contributes to successful secondary prevention of ischemic stroke. Adherence to treatment can be determined through various questionnaires, including Morissky-Green. Currently, the adherence to a long-term drug therapy remains insufficient.

  15. An associative Brain-Computer-Interface for acute stroke patients

    DEFF Research Database (Denmark)

    Mrachacz-Kersting, Natalie; Stevenson, Andrew James Thomas; Aliakbaryhosseinabadi, Susan

    2016-01-01

    An efficient innovative Brain-Computer-Interface system that empowers chronic stroke patients to control an artificial activation of their lower limb muscle through task specific motor intent has been tested in the past. In the current study it was applied to acute stroke patients. The system...

  16. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    OpenAIRE

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulati...

  17. Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU.

    LENUS (Irish Health Repository)

    Owens, C

    2012-02-01

    BACKGROUND: Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes. METHODS: We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU. RESULTS: Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11\\/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died. CONCLUSIONS: While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

  18. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

    Directory of Open Access Journals (Sweden)

    Sørgaard Knut W

    2013-01-01

    Full Text Available Abstract Background We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. Method All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP. Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian with univariate and multivariate statistics. Results Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. Conclusion Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”. Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian.

  19. The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients.

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    Shiro Aoki

    Full Text Available Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period and after team organization (post period. Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01. Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19-0.84, p = 0.02. The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients.

  20. The outcomes of patients newly admitted to nursing homes after hip fracture.

    Science.gov (United States)

    Kiel, D P; Eichorn, A; Intrator, O; Silliman, R A; Mor, V

    1994-08-01

    The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. Mean patient age was 82 +/- 7 y; 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospitalized, 3% had died, and 61% remained in the nursing home. Characteristics significantly associated with morality included disorientation, functional dependency, neurologic diagnoses, and use of cardiac medications, antidepressants, or narcotics. Rehospitalization was significantly associated with age, gender, living with someone, being ambulatory, and functional dependency. Returning home was associated with younger age, living with someone, being ambulatory, and having no disorientation, functional dependency, or psychiatric or neurologic diagnoses, nor any pressure sores. Better-functioning persons and those with social support returned home; physically and cognitively impaired persons and those taking narcotics, cardiac medications, or antidepressants were likely to die; and younger men, those with social support, those with functional dependency, and those who were free of disorientation were more likely to be rehospitalized.

  1. Comparing the coding of complications in Queensland and Victorian admitted patient data.

    Science.gov (United States)

    Michel, Jude L; Cheng, Diana; Jackson, Terri J

    2011-08-01

    To examine differences between Queensland and Victorian coding of hospital-acquired conditions and suggest ways to improve the usefulness of these data in the monitoring of patient safety events. Secondary analysis of admitted patient episode data collected in Queensland and Victoria. Comparison of depth of coding, and patterns in the coding of ten commonly coded complications of five elective procedures. Comparison of the mean complication codes assigned per episode revealed Victoria assigns more valid codes than Queensland for all procedures, with the difference between the states being significantly different in all cases. The proportion of the codes flagged as complications was consistently lower for Queensland when comparing 10 common complications for each of the five selected elective procedures. The estimated complication rates for the five procedures showed Victoria to have an apparently higher complication rate than Queensland for 35 of the 50 complications examined. Our findings demonstrate that the coding of complications is more comprehensive in Victoria than in Queensland. It is known that inconsistencies exist between states in routine hospital data quality. Comparative use of patient safety indicators should be viewed with caution until standards are improved across Australia. More exploration of data quality issues is needed to identify areas for improvement.

  2. Dengue fever in patients admitted in tertiary care hospitals in Pakistan

    International Nuclear Information System (INIS)

    Munir, M. A.; Saqib, M. A. N.; Qureshi, H.; Alam, S. E.; Arif, A.; Khan, Z. U.; Saeed, Q.; Iqbal, R.

    2014-01-01

    Objectives: To assess the gaps in the diagnosis and management of dengue fever cases. Methods: The retrospective descriptive analytical study was done with a case record analysis of patients with dengue fever admitted from January to December 2010 at five tertiary care hospitals in different Pakistani cities. Using a questionnaire, information was gathered on demography, haematological profile, management, use of blood and platelet transfusions and the outcome. For comparison, data of serologically-confirmed dengue patients from a private laboratory in Islamabad was collected to see the age, gender and month-wise distribution of cases tested over the same period. SPSS 16 was used for statistical analysis. Results: Out of the 841 confirmed dengue cases, 514 (79%) were males and 139 (21%) females. The overall mean age was 31.3+-14.0 years. Dengue fever was seen in 653 (78%) and dengue haemorrhagic fever (DHF) in 188 (22%) patients. Most cases were between 20 and 49 years of age. A gradual increase in dengue fever and dengue haemorrhagic fever was seen from August, with a peak in October/November. Tourniquet test was done only in 20 (2.3%) cases, out of which 11 (55%) were positive and 9 (45%) were negative. Serial haematocrit was not done in any case. Total deaths were 5 (0.6%). Conclusions: Most cases were seen in October/November with the majority being in the 20-39 age group. Tourniquet test and serial haematocrit were infrequently used. No standard national guidelines were employed. (author)

  3. Child Supervision and Burn Outcome among Admitted Patients at Major Trauma Hospitals in the Gambia

    Directory of Open Access Journals (Sweden)

    Edrisa Sanyang

    2017-07-01

    Full Text Available Burn-related injuries are a significant burden in children, particularly in low- and middle-income countries (LMICs, where more than 90% of burn-related pediatric deaths occur. Lack of adult supervision of children is a major risk for pediatric burn injuries. The goal of this paper was to examine the general characteristics of burns and identify burn injury outcomes among adult-supervised children compared to those who were not supervised. The study examined burn injury and clinical characteristics among all burn patients admitted to two trauma hospitals in The Gambia, West Africa. At intake in the emergency room, the treating physician or nurse determined the need for admission based on body surface area burned (BSAB, depth of burn, and other clinical considerations such as co-occurring injuries and co-morbidities. During the study period of 1 April 2014 through 31 October 2016, 105 burn patients were admitted and data were collected by the treating physician for all of them. Information about supervision was only asked for children aged five years or less. More than half (51% of the burn patients were children under 18 years, and 22% were under 5 years. Among children under five, most (86.4% were supervised by an adult at the time of burn event. Of the 19 supervised children, 16 (84.2% had body area surface burned (BSAB of less than 20%. Two of the three children without adult supervision at the time of burn event had BSAB ≥ 20%. Overall, 59% of the patients had 20% + BSAB. Females (aOR = 1.25; 95% CI = 0.43–3.62, those burned in rural towns and villages (aOR = 2.29; 95% CI = 0.69–7.57, or burned by fire or flames (aOR = 1.47; 95% CI = 0.51–4.23 had increased odds of having a BSAB ≥ 20%, although these differences were not statistically significant. Children 0–5 years or 5–18 years (aOR = 0.04, 95% CI = 0.01–0.17; aOR = 0.07, 95% CI = 0.02–0.23, respectively were less likely to have BSAB ≥ 20% than adults. Those burned in a

  4. Treating hepatic encephalopathy in cirrhotic patients admitted to ICU with sodium phenylbutyrate: a preliminary study.

    Science.gov (United States)

    Weiss, Nicolas; Tripon, Simona; Lodey, Marion; Guiller, Elsa; Junot, Helga; Monneret, Denis; Mayaux, Julien; Brisson, Hélène; Mallet, Maxime; Rudler, Marika; Imbert-Bismut, Françoise; Thabut, Dominique

    2018-04-01

    Hepatic encephalopathy (HE) influences short-term and long-term prognoses. Recently, glycerol phenylbutyrate (PB), that lowers ammonia by providing an alternate pathway to urea for waste nitrogen excretion, has shown that it was effective in preventing the occurrence of HE in RCT. The aim was to assess the benefits of sodium PB in cirrhotic patients admitted to ICU for overt HE, in terms of ammonia levels decrease, neurological improvement, and survival. Cirrhotic patients who presented with overt HE, ammonia levels >100 μmol/L, and did not display any contra-indication were included. Sodium PB was administered at 200 mg/kg/day. Control group included historical controls treated by standard therapy, matched for age, sex, MELD score, and severity of HE. Eighteen patients were included and treated with sodium PB (age: 59 [45-68], male gender: 15 [83%], Child-Pugh B: 8 [44%], Child-Pugh C: 10 [56%], and MELD score: 16 [13-23]). Ammonia levels significantly decreased in the PB as compared to the control group from inclusion to 12 h and from inclusion to 48 h (P = 0.0201 and P = 0.0230, respectively). The proportion of patients displaying neurological improvement was only higher in the PB-treated group as compared to controls at ICU discharge (15 [83%] vs. 9 [50%], P = 0.0339). ICU discharge survival was significantly higher in patients treated with PB (17 [94%] vs. 9 [50%], P = 0.0017). In cirrhotic patients with overt HE, sodium PB could be effective in reducing ammonia levels and might be effective in improving neurological status and ICU discharge survival. More extensive data, especially a RCT, are mandatory. © 2017 Société Française de Pharmacologie et de Thérapeutique.

  5. Risk factors of mortality among dengue patients admitted to a tertiary care setting in Kerala, India

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    Aswath Karunakaran

    2014-03-01

    Full Text Available Dengue is one of the most serious and rapidly emerging tropical mosquito-borne diseases. The state of Kerala in India is hyperendemic for the disease and is one of the leading states in the reporting of deaths due to dengue. As primary prevention of dengue has had limited success, the prevention of mortality through the identification of risk factors and efficient patient management is of utmost importance. Hence, a record-based case control study was conducted in the Medical College Hospital in Thiruvananthapuram to identify the risk factors of mortality in patients admitted with dengue. Dengue patients over 40 years of age were 9.3 times (95% CI; 1.9–44.4 more likely to die compared with younger patients. The clinical features associated with mortality from dengue were altered sensorium (odds ratio (OR – 156, 95% CI; 12.575–1935.197, abnormal reflexes (OR – 8.5, 95% CI; 1.833–39.421 and edema (OR – 13.22, 95% CI; 2.651–65.951. Mortality was also higher in those patients with co-morbidities such as diabetes mellitus (OR – 26, 95% CI; 2.47–273.674 and hypertension (OR – 44, 95% CI; 6.23–315.499. The independent predictors of mortality were altered sensorium and hypertension. Dengue fever patients with these clinical features and those who are elderly should be more rigorously monitored and promptly referred from lower settings when required to reduce mortality. Keywords: Dengue, Mortality, Risk factors, Kerala, Thiruvananthapuram

  6. Improving admission medication reconciliation compliance using the electronic tool in admitted medical patients

    Science.gov (United States)

    Taha, Haytham; abdulhay, dana; Luqman, Neama; Ellahham, Samer

    2016-01-01

    Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity that is fully occupied most of the time. SKMC senior management has made a commitment to make quality and patient safety a top priority. Our governing body Abu Dhabi Health Services Company has identified medication reconciliation as a critical patient safety measure and key performance indicator (KPI). The medication reconciliation electronic form a computerized decision support tool was introduced to improve medication reconciliation compliance on transition of care at admission, transfer and discharge of patients both in the inpatient and outpatient settings. In order to improve medication reconciliation compliance a multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to enhance compliance with admission medication reconciliation and the outcomes of those interventions. We chose to conduct the pilot study in general medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from April 2014 till October 2015 and a total of 8576 patients were evaluated. The lessons learned were disseminated throughout the hospital. Our aim was to improve admission medication reconciliation compliance using the electronic form in order to ensure patient safety and reduce preventable harm in terms of medication errors. Admission medication reconciliation compliance improved in general medicine from 40% to above 85%, and this improvement was sustained for the last four months of the study period. PMID:27822371

  7. Relationship between stroke and mortality in dialysis patients.

    Science.gov (United States)

    Wetmore, James B; Phadnis, Milind A; Ellerbeck, Edward F; Shireman, Theresa I; Rigler, Sally K; Mahnken, Jonathan D

    2015-01-07

    Stroke is common in patients undergoing long-term dialysis, but the implications for mortality after stroke in these patients are not fully understood. A large cohort of dually-eligible (Medicare and Medicaid) patients initiating dialysis from 2000 to 2005 and surviving the first 90 days was constructed. Medicare claims were used to ascertain ischemic and hemorrhagic strokes occurring after 90-day survival. A semi-Markov model with additive hazard extension was generated to estimate the association between stroke and mortality, to calculate years of life lost after a stroke, and to determine whether race was associated with differential survival after stroke. The cohort consisted of 69,371 individuals representing >112,000 person-years of follow-up. Mean age±SD was 60.8±15.5 years. There were 21.1 (99% confidence interval [99% CI], 20.0 to 22.3) ischemic strokes and 4.7 (99% CI, 4.2 to 5.3) hemorrhagic strokes after cohort entry per 1000 patient-years. At 30 days, mortality was 17.9% for ischemic stroke and 53.4% for hemorrhagic stroke. The adjusted hazard ratio (AHR) depended on time since entry into the cohort; for patients who experienced a stroke at 1 year after cohort entry, for example, the AHR of hemorrhagic stroke for mortality was 25.4 (99% CI, 22.4 to 28.4) at 1 week, 9.9 (99% CI, 8.4 to 11.6) at 3 months, 5.9 (99% CI, 5.0 to 7.0) at 6 months, and 1.8 (99% CI, 1.5 to 2.1) at 24 months. The corresponding AHRs for ischemic stroke were 11.7 (99% CI, 10.2 to 13.1) at 1 week, 6.6 (99% CI, 6.4 to 6.7) at 3 months, and 4.7 (99% CI, 4.5 to 4.9) at 6 months, remaining significantly >1.0 even at 48 months. Median months of life lost were 40.7 for hemorrhagic stroke and 34.6 for ischemic stroke. For both stroke types, mortality did not differ by race. Dialysis recipients have high mortality after a stroke with corresponding decrements in remaining years of life. Poststroke mortality does not differ by race. Copyright © 2015 by the American Society of Nephrology.

  8. Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction.

    Science.gov (United States)

    Ogunbayo, Gbolahan O; Bidwell, Katrina; Misumida, Naoki; Ha, Le Dung; Abdel-Latif, Ahmed; Elayi, Claude S; Smyth, Susan; Messerli, Adrian W

    2018-04-19

    Studies have reported sex differences in the management of patients with acute myocardial infarction (AMI) in the general population. This observational study is designed to evaluate whether sex differences exist in the contemporary management of human immunodeficiency virus (HIV) patients admitted for diagnosis of AMI. There is no difference in management of HIV patients with AMI. Using the National Inpatient Sample database, we identified patients with a primary diagnosis of AMI and a secondary diagnosis of HIV. We described baseline characteristics and outcomes using NIS documentation. Our primary areas of interest were revascularization and mortality. Among 2 977 387 patients presenting from 2010 to 2014 with a primary diagnosis of AMI, 10907 (0.4%) had HIV (mean age, 54.1 ± 9.3 years; n = 2043 [18.9%] female). Females were younger, more likely to be black, and more likely to have hypertension, diabetes, obesity, and anemia. Although neither males nor females were more likely to undergo coronary angiography in multivariate analysis, revascularization was performed less frequently in females than in males (45.4% vs 62.7%; P < 0.01), driven primarily by lower incidence of PCI. In a multivariate model, females were less likely to undergo revascularization (OR: 0.59, 95% CI: 0.45-0.78, P < 0.01), a finding driven solely by PCI (OR: 0.64, 95% CI: 0.49-0.83, P < 0.01). All-cause mortality was similar in both groups. AMI was more common in males than females with HIV. Females with HIV were more likely to be younger and black and less likely to be revascularized by PCI. © 2018 Wiley Periodicals, Inc.

  9. Use of life support in acutely admitted ICU patients. An international cohort study

    DEFF Research Database (Denmark)

    Meyhoff, T S; Krag, M; Hjortrup, P B

    2017-01-01

    the first 3 days in ICU and the crude and adjusted association between its duration and 90-day mortality using logistic regression analyses. RESULTS: We included 690 patients; their 90-day mortality was 23%. During the first 3 days in ICU mechanical ventilation was used in 65%, vasopressors/inotropes in 57......% and renal replacement therapy in 13%. Renal replacement therapy for 3 days or more was associated with a higher 90-day mortality as compared with 1 day of renal replacement therapy [odds ratio 6.5 (95% confidence interval 1.3 to 32.8)]. For mechanical ventilation and vasopressors/inotropes the odds ratios...... were 2.2 [0.9 to 5.3] and 1.2 [0.5 to 2.6], respectively. CONCLUSIONS: Among acutely admitted adult ICU patients, a higher number of days of renal replacement therapy in the initial ICU stay were associated with increased risk of death within 90 days. We did not observe such an association...

  10. A Retrospective Analysis of Pediatric Patients Admitted to the Pediatric Emergency Service for Carbon Monoxide Intoxication

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    Metin Uysalol

    2011-09-01

    Full Text Available Objective: The aim of the study is to analyze the general aspects of cases with carbon monoxide intoxication in order to improve the approach to future patients. Material and Methods: The hospital records of 84 children (mean age 4.71±2.64 years; 48 male, 36 female who had been admitted to Paediatric Emergency Department for carbon monoxide intoxication between October 2007 and February 2009, were retrospectively evaluated in a descriptive analysis.Results: The source of carbon monoxide intoxication was heaters, waterheaters and fi re in 82.1%, 7.1% and 6% of cases, respectively. There was a statistically signifi cant difference between the carboxyhemoglobin levels of the patients according to the clinical classifi cation (p<0.05. The intoxication caused by heaters was observed signifi cantly in November, December and January (p<0.001, between 16:00-24:00 hours (p<0.001 and among more than one member of a family (p<0.001. A medium level correlation was detected between the treatment approach and clinical classifi cation (r=0.50, p<0.001. Conclusion: Carbon monoxide intoxication, in the presented series, was found to develop accidentally; mostly in the Winter season; during night hours when the family members gathered together. The carboxyhemoglobin levels were appropriate with the developing clinical findings. Carboxyhemoglobin level solely was not enough for achieving the diagnosis and planning the treatment.

  11. Predictors of ischemic versus hemorrhagic strokes in hypertensive patients

    International Nuclear Information System (INIS)

    Khealani, B.A.; Syed, N.A.; Maken, S.; Mapari, U.U.; Hameed, B.; Ali, S.; Qureshi, R.; Akhter, N.; Hassan, A.; Sonawalla, A.B.; Baig, S.M.; Wasay, M.

    2005-01-01

    Objective: To identify the factors that predispose to ischemic versus hemorrhagic stroke in hypertensive patients. Materials and Methods: All the hypertensive patients, who were registered in AKUH acute stroke outcome data base, over a period of 22 months, were identified and from this cohort the patients with first ever stroke were selected. The data regarding demographics, stroke type (ischemic vs. hemorrhagic), pre-existing medical problems, laboratory and radiological investigations was recorded and analyzed. Results: Five hundred and nineteen patients with either ischemic stroke or parenchymal hemorrhage were registered over a period of 22 months. Three hundred and forty-eight patients (67%) had hypertension and of these, 250 had first ever stroke at the time of admission. Presence of diabetes mellitus (OR: 3.76; Cl:1.67-8.46) and ischemic heart disease (OR: 6.97; Cl:1.57-30.98) were found to be independent predictors of ischemic strokes. Conclusion: Presence of diabetes mellitus and ischemic heart disease predict ischemic stroke in a patient with hypertension. (author)

  12. Risk factors for swallowing dysfunction in stroke patients

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    Anna Flávia Ferraz Barros Baroni

    2012-06-01

    Full Text Available CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

  13. Changes of resting cerebral activities in subacute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Ping Wu

    2015-01-01

    Full Text Available This study aimed to detect the difference in resting cerebral activities between ischemic stroke patients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunction and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks and 15 age-matched healthy participants. A resting-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely potential targets for the neural regeneration of subacute ischemic stroke patients.

  14. 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...

  15. Motivation factors for suicidal behavior and their clinical relevance in admitted psychiatric patients.

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    Naoki Hayashi

    Full Text Available Suicidal behavior (SB is a major, worldwide health concern. To date there is limited understanding of the associated motivational aspects which accompany this self-initiated conduct.To develop a method for identifying motivational features associated with SB by studying admitted psychiatric patients, and to examine their clinical relevance.By performing a factor analytic study using data obtained from a patient sample exhibiting high suicidality and a variety of SB methods, Motivations for SB Scale (MSBS was constructed to measure the features. Data included assessments of DSM-IV psychiatric and personality disorders, suicide intent, depressive symptomatology, overt aggression, recent life events (RLEs and methods of SB, collated from structured interviews. Association of identified features with clinical variables was examined by correlation analyses and MANCOVA.Factor analyses elicited a 4-factor solution composed of Interpersonal-testing (IT, Interpersonal-change (IC, Self-renunciation (SR and Self-sustenance (SS. These factors were classified according to two distinctions, namely interpersonal vs. intra-personal directedness, and the level of assumed influence by SB or the relationship to prevailing emotions. Analyses revealed meaningful links between patient features and clinical variables. Interpersonal-motivations (IT and IC were associated with overt aggression, low suicidality and RLE discord or conflict, while SR was associated with depression, high suicidality and RLE separation or death. Borderline personality disorder showed association with IC and SS. When self-strangulation was set as a reference SB method, self-cutting and overdose-taking were linked to IT and SS, respectively.The factors extracted in this study largely corresponded to factors from previous studies, implying that they may be useful in a wider clinical context. The association of these features with SB-related factors suggests that they constitute an integral part

  16. How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?

    Science.gov (United States)

    Doijiri, Ryosuke; Uno, Hisakazu; Miyashita, Kotaro; Ihara, Masafumi; Nagatsuka, Kazuyuki

    2016-10-01

    The sudden development of vertigo or dizziness without focal neurological symptoms is generally attributable to vestibular diseases such as benign paroxysmal positional vertigo. Isolated vertigo or dizziness attack needs more attention than vestibular diseases. This retrospective study was performed to elucidate the frequency of strokes in patients with isolated vertigo or dizziness attack. We enrolled 221 patients (men, 119; women, 102; mean age, 68.4 ± 10.3 years) who were admitted to our hospital over the last 10 years because of sudden isolated vertigo or dizziness attack without other neurological symptoms except for nystagmus, deafness, or tinnitus. We investigated the clinical features, final diagnosis, neuroimaging findings, and short- or long-term outcome of these patients. One hundred eighteen patients had vertigo whereas the other 103 had dizziness. Brain computed tomography or magnetic resonance imaging revealed recent stroke lesions in 25 patients (11.3%) (ischemic, 21; hemorrhagic, 4).The lesions were generally small and localized in the cerebellum (n = 21), pons (n = 1), medulla oblongata (n = 1), or corona radiata (n = 1). Of the 25 patients, 19 (76%) had dizzy-type spells; none had neurological dysfunction at the time of discharge. In the remaining 196 patients, no stroke was detected on computed tomography or magnetic resonance imaging. Stroke was found in 11% of patients with isolated vertigo or dizziness attack. The posterior inferior cerebellar artery area was the most frequently implicated for isolated vertigo or dizziness. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. [A comparison of stroke patients' characteristics between a sub-Saharan Africa population (Abidjan) and a French stroke unit (Amiens): An observational study].

    Science.gov (United States)

    Bugnicourt, J-M; Tchouata-Ngandjouc, L; Beugre, K; Chillon, J-M; Godefroy, O

    2013-03-01

    Stroke characteristics in Sub-Saharan Africa (SSA) differ from developed countries. However, SSA subjects undergo epidemiological and demographic transition and it appears that the prevalence of vascular risk factors (RF) increases in this population. Here we aimed to compare stroke patients' characteristics between a SSA hospital (Cocody University Hospital, Abidjan, Côte d'Ivoire) and a French stroke unit (Amiens University Hospital, Amiens, France). This retrospective study included all consecutive stroke patients admitted between January and May 2008 (Cocody University Hospital, Abidjan, Côte d'Ivoire) and between October and December 2008 (Amiens University Hospital, Amiens, France). We assessed each patient's demographic details, RF, and CT confirmed pathological stroke type. The glomerular filtration rate (GFR) was estimated using the four-component Modification of Diet in Renal Disease (MDRD) equation and CKD was defined as a GFR less than 60ml/min/1.73 m(2). One hundred and ninety five patients were included (Amiens: 92; Abidjan: 103) with a mean age of 63±14 years. Patients in Amiens had more known vascular RF than African patients, whereas African patients had more RF discovered during hospitalisation. Furthermore, CKD was significantly more common in SSA patients (43% vs 24%, P=0.001). More African than European patients had cerebral hemorrhage (34% vs 8%, Pstroke mortality and treatments at hospital discharge were similar between the two hospitals. Finally, a high proportion of patients in Abidjan suffered from cervical atherosclerosis, although it was significantly lower than patients in Amiens (37% vs 67%, Pstroke patients. These findings could partly explain the high prevalence of cervical atherosclerosis found in this population. These results warrant confirmation in prospective studies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  18. Early rehabilitation outcome in patients with middle cerebral artery stroke.

    Science.gov (United States)

    Balaban, Birol; Tok, Fatih; Yavuz, Ferdi; Yaşar, Evren; Alaca, Rıdvan

    2011-07-12

    Although important data on the prognosis and rehabilitation outcome in stroke patients have been reported, data on functional recovery according to stroke subtypes are limited. This retrospective study aimed to evaluate functional outcome in patients with middle cerebral artery (MCA) stroke-the most common subtype of ischemic stroke. The records of stroke patients that underwent the rehabilitation program at our brain injury rehabilitation service between January 2007 and December 2008 were reviewed, and those with MCA stroke were included in the study. Patient demographic and clinical data, and Barthel Index (BI) and Functional Independence Measure (FIM) scores at admission and discharge were collected. The study included 80 MCA stroke patients with a mean age of 63.54 years. FIM and BI scores improved significantly post rehabilitation (Prehabilitation had similar outcomes as those that had >1 month of inpatient rehabilitation (P>0.05). Length of time after stroke onset was not correlated with BI or FIM scores at admission. Regardless of initial functional status, prediction of discharge functional status was misleading. Physiatrists should keep in mind that functional improvement does not always increase with duration of inpatient therapy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. Management of arterial hypertension in patients with acute stroke.

    Science.gov (United States)

    Adeoye, Opeolu; Jauch, Edward C

    2006-11-01

    Management of arterial hypertension in the hyperacute period immediately after stroke ictus remains controversial. Extremes of blood pressure (BP) are associated with poor outcomes in all stroke subtypes. Severely hypertensive patients likely benefit from modest BP reductions, but aggressive BP reduction may worsen outcome. Although little evidence is currently available to definitively establish guideline recommendations for optimal BP goals at stroke presentation, recently published research is shedding some light on how to approach management of BP after stroke. Antihypertensive treatment should probably be deferred in ischemic stroke patients except in cases of severe hypertension or when thrombolytic therapy is warranted and the patient's BP is above acceptable levels. Hypertensive hemorrhagic stroke patients may benefit from modest BP reductions. Relative hypotension causing regional hypoperfusion is an increasingly understood concept immediately following ischemic or hemorrhagic stroke, emphasizing the need for careful titration of appropriate medications to minimize fluctuations in BP for treated patients. Ongoing trials will improve our current knowledge regarding BP management after ischemic and hemorrhagic stroke.

  20. Explicit memory and implicit memory in occipital lobe stroke patients.

    Science.gov (United States)

    Gong, Liang; Wang, JiHua; Feng, Lei; Wang, MeiHong; Li, Xiu; Hu, JiaYun; Wang, Kai

    2015-03-01

    Occipital stroke patients mainly showed cortical blindness and unilateral vision loss; memory is generally reserved. Recent reports from neuroimaging show the occipital lobe may be involved in the processing of implicit memory (IM), especially the perception type of IM processing. In this study, we explored the explicit memory (EM) and IM damage in occipital lobe stroke patients. A total of 25 occipital strokes and 29 years of age, educational level equivalent healthy controls (HCs), evaluated by using immediate recall, delayed recall, recognition for EM tasks, picture identification, and category exemplar generation for IM tasks. There was no significant difference between occipital stroke patients and HCs in EM tasks and category exemplar generation task. In the picture identification task, occipital lobe stroke group score was poorer than HC group, the results were statistically significant, but in the pictures identify rate, occipital stroke patients and normal control group had no significant difference. The occipital stroke patients may have IM damage, primarily damage the perception type of IM priming effects, which was unrelated with their cortical blindness. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Prehospital management and fluid resuscitation in hypotensive trauma patients admitted to Karolinska University Hospital in Stockholm.

    Science.gov (United States)

    Talving, Peep; Pålstedt, Joakim; Riddez, Louis

    2005-01-01

    Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated. This is a retrospective, descriptive study on consecutive, hypotensive trauma patients (systolic blood pressure Karolinska University Hospital in Stockholm, Sweden, during 2001-2003. The reported values are medians with interquartile ranges. Basic demographics, prehospital time intervals and interventions, injury severity scores (ISS), type and volumes of prehospital fluid resuscitation, and 30-day mortality were abstracted. The effects of the patient's age, gender, prehospital time interval, type of injury, injury severity, on-scene and emergency department blood pressure, and resuscitation fluid volumes on mortality were analyzed using the exact logistic regression model. In 102 (71 male) adult patients (age > or = 15 years) recruited, the median age was 35.5 years (range: 27-55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16-50). The on-scene time interval was 19 minutes (range: 12-24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0-20; 21-40; 41-75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21-40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact

  2. Assessment of medical resident's attention to the health literacy level of newly admitted patients

    Directory of Open Access Journals (Sweden)

    Cecile Karsenty

    2013-12-01

    Full Text Available Objectives: The objective of this study was to assess communication at the bedside in the emergency room between residents and their patients in order to identify common communication gaps. We also intended to evaluate whether residents for whom English is a second language (ESL residents communicate less effectively. Methods: A scorable checklist was developed in order to assess and identify communication gaps between the residents and their patients. Medical students observed the internal medicine and family medicine residents while they admitted patients to the medical service in the Emergency Room. Before this, medical students were trained for two weeks with a senior internist. The role of the medical student was not revealed; rather they were self-described as observers of the admission process. Results: Over an 8 week period, 71 observations were made of 27 medicine residents. 71 patient intakes were observed, evaluating 27 residents. In 52.1% of these interactions, the residents used medical acronyms when communicating with the patients. During 66.2% of interactions, technical medical terms or expressions were used during the history taking and in only 27.6% of those cases were the terms explained at least partially. Teach back technique was not observed in any of the interactions evaluated. Data was also analyzed based on whether the doctors were ESL residents or native English speakers. ESL residents tended to use significantly more technical language than the native English speakers, but the native English speakers tended to use more acronyms. Conclusions: How much patients understand of what their doctor says is called “health literacy.” Resident physicians often overestimate their patients’ health literacy, and this leads to communication gaps which have the potential to result in poorer health outcomes for the patients. The checklist developed for this pilot study assessed how well residents tailor their communication to

  3. Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service.

    Science.gov (United States)

    Lord, Kito; Parwani, Vivek; Ulrich, Andrew; Finn, Emily B; Rothenberg, Craig; Emerson, Beth; Rosenberg, Alana; Venkatesh, Arjun K

    2018-03-20

    Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality. A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p=0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p=0.003). Within the first 24h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding. Copyright © 2018 Elsevier Inc. All rights

  4. [Stroke in young adults: incidence and clinical picture in 280 patients according to their aetiological subtype].

    Science.gov (United States)

    Arboix, Adrià; Massons, Joan; García-Eroles, Luís; Oliveres, Montserrat

    2016-03-04

    To assess the clinical features and incidence rate of stroke in young adults (less than 55 years of age). Hospital-based descriptive study of 280 young inpatients consecutively admitted for stroke over a period of 24 years. We conducted a comparison with the remaining 4,312 patients admitted for stroke. Stroke in young adults represented 6.1% of all strokes, 5.7% of transient ischaemic attacks, 5.8% of cerebral infarctions and 8.4% of brain haemorrhages. However, reported minimal frequency of cardioembolic (2.1%) and atherothrombotic (3.4%) infarctions, accounted for 5.9% of lacunar and for 10.7% of essential infarctions and showed a maximum frequency in those infarctions of unusual aetiology (36%). Factors independently associated with stroke in young adults were cigarette smoking (OR 4.23; 95% CI 3.02-5.93; P=.000), unusual aetiology (OR 4.97; 95% CI 3.15-7.84; P=.000), headache (OR 4.57; 95% CI 2.59-8.07; P=.000), alcohol abuse (OR 3.93; 95% CI 2.46-6.29; P=.000), oral contraceptives (OR 14.07; 95% CI 2.37-83.40; P=.004), atrial fibrillation (OR 0.15; 95% CI 0.08-0.28; P=.000), arterial hypertension (OR 0.43; 95% CI 0.33-0.57; P=.000), COPD (OR 0.20; 95% CI 0.09-0.44; P=.000), atherothrombotic infarction (OR 0.51; 95% CI 0.34-0.77; P=.001), female sex (OR 0.71; 95% CI 0.52-0.97; P=.029), diabetes mellitus (OR 0.66; 95% CI 0.46-0.98; P=.030), ischaemic heart disease (OR 0.56; 95% CI 0.33-0.95; P=.032) and intermittent claudication (OR 0.48; 95% CI 0.24-0.94; P=.033). Stroke in young adults is infrequent (6.1% of the total), but represents the highest frequency of cerebral infarcts of unusual aetiology (36%). We conclude that stroke in younger patients presents its own and differentiated clinical profile. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  5. 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.

  6. Burden of Stroke in Qatar.

    Science.gov (United States)

    Ibrahim, Faisal; Deleu, Dirk; Akhtar, Naveed; Al-Yazeedi, Wafa; Mesraoua, Boulenouar; Kamran, Sadaat; Shuaib, Ashfaq

    2015-12-01

    Qatar is located on the northeastern coast of the Arabian Peninsula. The total population is over 2.1 million with around 15% being Qatari citizens. Hamad General Hospital (HGH) is the only tertiary referral governmental hospital in Qatar which admits acute (thrombolysis-eligible) stroke patients. To provide an overview of the burden of stroke in Qatar. Data from literature databases, online sources and our stroke registry were collated to identify information on the burden of stroke in Qatar. Overall, over 80% of all stroke patients in Qatar are admitted in HGH. In 2010, the age-standardized incidence for first-ever ischemic stroke was 51.88/100,000 person-years. To date our stroke registry reveals that 79% of all stroke patients are male and almost 50% of stroke patients are 50 years or less. Hypertension, diabetes and dyslipidemia are the main predisposing factors for stroke, with ischemic stroke being more common (87%) than hemorrhagic stroke (13%). Despite the lack of a stroke unit, 9% of ischemic stroke patients are being thrombolyzed. However the presence of a stroke ward allows swift turnover of patients with a length of stay of less than 5 days before discharge or, if required, transfer to the fully-equipped hospital-based rehabilitation service. Several community awareness programs are ongoing, in addition to several research programs funded by the Qatar National Research Fund and Hamad Medical Corporation. In a country where over 15% of the population suffers from diabetes there is continuous need for national community-based awareness campaigns, prevention and educational programs particularly targeting patients and health care workers. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Effects of a sexual rehabilitation intervention program on stroke patients and their spouses.

    Science.gov (United States)

    Song, HoSook; Oh, HyunSoo; Kim, HwaSoon; Seo, WhaSook

    2011-01-01

    The present study was conducted to examine whether a sexual rehabilitation intervention program, which was developed during the present study and designed for stroke patients and their spouses, was effective in terms of sexual knowledge and satisfaction and frequency of sexual activity at 1 month after intervention. The study subjects were conveniently selected from stroke patients admitted to the neurology department at a university hospital located in Incheon, South Korea. A total of 46 subjects (12 couples for the experimental group and 11 couples for the control group) were included. Sexual knowledge, sexual satisfaction, frequency of sexual activity, level of cognitive function, and performance with respect to daily living activities were measured. The results obtained demonstrated that the devised sexual rehabilitation intervention program significantly increased sexual satisfaction and frequency of sexual activity, but that it did not promote sexual knowledge. The present study has meaning because the intervention program could be used as a practical guideline for post-stroke sexual rehabilitation. In addition, the findings of this study provide evidence regarding the usefulness of sexual education and counseling on the sexual health of post-stroke patients and their spouses.

  8. In-hospital mortality and treatment patterns in acute myocardial infarction patients admitted during national cardiology meeting dates.

    Science.gov (United States)

    Mizuno, Seiko; Kunisawa, Susumu; Sasaki, Noriko; Fushimi, Kiyohide; Imanaka, Yuichi

    2016-10-01

    Many hospitals experience a reduction in the number of available physicians on days when national scientific meetings are conducted. This study investigates the relationship between in-hospital mortality in acute myocardial infarction (AMI) patients and admission during national cardiology meeting dates. Using an administrative database, we analyzed patients with AMI admitted to acute care hospitals in Japan from 2011 to 2013. There were 3 major national cardiology meetings held each year. A hierarchical logistic regression model was used to compare in-hospital mortality and treatment patterns between patients admitted on meeting dates and those admitted on identical days during the week before and after the meeting dates. We identified 6,332 eligible patients, with 1,985 patients admitted during 26 meeting days and 4,347 patients admitted during 52 non-meeting days. No significant differences between meeting and non-meeting dates were observed for in-hospital mortality (7.4% vs. 8.5%, respectively; p=0.151, unadjusted odds ratio: 0.861, 95% confidence interval: 0.704-1.054) and the proportion of percutaneous coronary intervention (PCI) performed on the day of admission (75.9% vs. 76.2%, respectively; p=0.824). We also found that some low-staffed hospitals did not treat AMI patients during meeting dates. Little or no "national meeting effect" was observed on in-hospital mortality in AMI patients, and PCI rates were similar for both meeting and non-meeting dates. Our findings also indicated that during meeting dates, AMI patients may have been consolidated to high-performance and sufficiently staffed hospitals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Effect of White Noise on Sleep in Patients Admitted to a Coronary Care.

    Science.gov (United States)

    Farokhnezhad Afshar, Pouya; Bahramnezhad, Fatemeh; Asgari, Parvaneh; Shiri, Mahmoud

    2016-01-01

    Sleep disorders are a common problem in patients in the critical care unit. The objective of the present study was to determine the effect of white noise on the quality of sleep in patients admitted to the CCU. The present study was single-blind, quasi-experimental study. A total of 60 patients were selected using the purposive sampling method. Quality of sleep was measured with PSQI on the first day in admission, then after three nights of admission without any intervention for control group and for the experimental group quality of sleep measured by white noise with intensity of 50-60 dB then Quality of sleep was measured with PSQI. Data were analyzed by SPSS 13 software. The average total sleep time in the control group before the study reached from 7.08 (0.8) to 4.75 (0.66) hours after three nights of hospitalization, while in the experimental group, no significant changes were seen in the average sleep hours (6.69 ± 0.84 vs. 6.92 ± 0.89, P = 0.15).The average minutes of sleep in the control group before the study reached from 12.66 (7.51) to 25.83 (11.75) minutes after a three- night stay, while in the experimental group, no significant changes were observed in the average sleep duration (12.16 ± 7.50 vs. 11 ±6. 07, P = 0.16). The use of white noise is recommended as a method for masking environmental noises, improving sleep, and maintaining sleep in the coronary care unit.

  10. Extracranial cerebral arterial atherosclerosis in Iranian patients suffering ischemic strokes

    Directory of Open Access Journals (Sweden)

    Sayed Ali Mousavi

    2006-12-01

    Full Text Available BACKGROUND: To determine the distribution and severity of extracranial carotid arterial atherosclerosis in Iranian patients with ischemic stroke. METHODS: 328 patients with ischemic stroke were included in this study. Doppler ultrasound was used for evaluation of atherosclerosis in extracranial carotid arteries. The NASCET criteria were used to measure carotid stenosis. RESULTS: Ninety of 328 patients (27.4% were found to have atherosclerotic plaques; 40 of these patients were women and 50 were men. Sixty-eight patients (20.7% had artery stenosis <50%, 13 patients (3.95% had 50-70 % artery stenosis and 6 (1.8% had >70% artery stenosis. CONCLUSIONS: Extracranial atherosclerosis is not rare in Iranian patients with ischemic stroke, but most carotid artery lesions were plaques with <50% stenosis. KEY WORDS: Atherosclerosis, ischemic stroke, carotid stenosis.

  11. Prevalence of Cigarette Smoking in Schizophrenic Patients Compared to Other Hospital Admitted Psychiatric Patients

    OpenAIRE

    Ziaaddini, Hassan; Kheradmand, Ali; Vahabi, Mostafa

    2009-01-01

    Background: This study aimed to estimate the prevalence of cigarette smoking and some of the related factors among schizophrenic and other hospitalized psychiatric patients. Methods: This was a cross-sectional study on 120 patients hospitalized in Shahid Beheshti hospital in Kerman in 2005. Patients were equally devided in two groups of schizophrenia and other psychiatric disorders. Sampling was based on statistical census and data were collected using a questionnaire including 27 questions o...

  12. Occupational therapy for stroke patients - A systematic review

    NARCIS (Netherlands)

    Steultjens, E.M.J.; Dekker, J.; Bouter, L.M.; van de Nes, J.C.M.; Cup, E.H.C.; van den Ende, C.H.M.

    2003-01-01

    Background and Purpose - Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for stroke patients. Methods - An extensive search in MEDLINE, CINAHL, EMBASE, AMED,

  13. Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

    Science.gov (United States)

    Atalay, Ayce; Turhan, Nur

    2009-01-01

    The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

  14. Substance abuse in patients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Anne Opsal

    2011-12-01

    Full Text Available Background: Substance abuse and mental disorder comorbidity is high among patients admitted to acute psychiatric wards. The aim of the study was to identify this co-occurrence as a reason for involuntary admission and if specific substance use-related diagnoses were associated with such admissions.Methods: The study was a part of a multicentre, cross-sectional national study carried out during 2005-2006 within a research network of acute mental health services. Seventy-five percent of Norwegian hospitals providing acute in-patient treatment participated. Substance use was measured using the Clinician Rating Scale and the ICD-10 diagnoses F10-19. Diagnostic assessments were performed by the clinicians during hospital stay.Results: Overall, 33.2% (n=1,187 of the total patient population (3,506 were abusing alcohol or drugs prior to admission according to the Clinician Rating Scale. No difference in the overall prevalence of substance abuserelated diagnoses between the two groups was found. Overall, 310 (26% of the admissions, 216 voluntarily and 94 involuntarily admitted patients received a double diagnosis. Frequent comorbid combinations among voluntarily admitted patients were; a combination of alcohol and either mood disorder (40% or multiple mental disorders (29%. Among involuntarily admitted patients, a combination of poly drug use and schizophrenia was most frequent (47%. Substance abusing patients diagnosed with mental and behavioral disorders due to the use of psychoactive stimulant substances had a significantly higher risk of involuntary hospitalization (OR 2.3.Conclusion: Nearly one third of substance abusing patients are involuntarily admitted to mental hospitals, in particular stimulant drug use was associated with involuntarily admissions.

  15. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

    2017-01-01

    not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat......Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity...... and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...

  16. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  17. One fourth of acutely admitted patients use over-the-counter-drugs 24 hours prior to hospitalisation

    DEFF Research Database (Denmark)

    Pedersen, Magnus; Brabrand, Mikkel

    2014-01-01

    to hospitalisation and the effects of this intake. MATERIAL AND METHODS: Junior physicians on call interviewed patients admitted to the medical admission unit at South-West Jutland Hospital in Esbjerg using a modified chart template. Adult patients aged 15 and older admitted during a two-week period in August 2012...... were included. Patients were asked about consumed OTC drugs, dosage, indication and effect. RESULTS: From a total of 349 admissions, 188 usable chart templates were registered (54%), and information on OTC usage was registered on 165 of these (88%). The patients where elderly (median: 70 years) and 43......, 60% felt an effect of the intake and the majority felt an effect on pain symptoms. CONCLUSION: One in four patients used OTC drugs 24 hours prior to hospitalisation and primarily analgesics were used. Most patients used OTC drugs relevantly and half with a positive effect. The intake is poorly...

  18. Medication coaching program for patients with minor stroke or TIA: A pilot study

    Directory of Open Access Journals (Sweden)

    Sides Elizabeth G

    2012-07-01

    Full Text Available Abstract Background Patients who are hospitalized with a first or recurrent stroke often are discharged with new medications or adjustment to the doses of pre-admission medications, which can be confusing and pose safety issues if misunderstood. The purpose of this pilot study was to assess the feasibility of medication coaching via telephone after discharge in patients with stroke. Methods Two-arm pilot study of a medication coaching program with 30 patients (20 intervention, 10 control. Consecutive patients admitted with stroke or TIA with at least 2 medications changed between admission and discharge were included. The medication coach contacted intervention arm patients post-discharge via phone call to discuss risk factors, review medications and triage patients’ questions to a stroke nurse and/or pharmacist. Intervention and control participants were contacted at 3 months for outcomes. The main outcomes were feasibility (appropriateness of script, ability to reach participants, and provide requested information and participant evaluation of medication coaching. Results The median lengths of the coaching and follow-up calls with requested answers to these questions were 27 minutes and 12 minutes, respectively, and participant evaluations of the coaching were positive. The intervention participants were more likely to have seen their primary care provider than were control participants by 3 months post discharge. Conclusions This medication coaching study executed early after discharge demonstrated feasibility of coaching and educating stroke patients with a trained coach. Results from our small pilot showed a possible trend towards improved appointment-keeping with primary care providers in those who received coaching.

  19. Emergency Overcrowding Impact on the Quality of Care of Patients Presenting with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Mehdi Momeni

    2017-12-01

    Full Text Available Introduction: Emergency overcrowding is defined as when the amount of care required for patients overcomes the available amount. This can cause delays in delivering critical care in situations like stroke. Objective: The aim of this study was to assess the possible impact of emergency department (ED crowding on the quality of care for acute stroke patients. Methods: In this cross-sectional prospective study, all patients with symptoms of acute stroke presenting to the ED of educational hospitals were enrolled. All patients were assessed and examined by the emergency medicine (EM residents on shift and a questionnaire was filled out for them. The amount of time that passed from the first triage to performing the required interventions and delivering health services were recorded by the triage nurse. ED crowding was measured by the occupancy rate. Then, the correlation between all of the variables and ED crowding level were calculated. Results: The average daily bed occupancy rate was 184.9 ± 54.3%. The median time passed from the first triage to performing the interventions were as follows: the first EM resident visit after 34 min, the first neurologic visit after 138 min, head CT after 134 min, ECG after 104 min and ASA administration after 210 min. There was no statistically significant relationship between the ED occupancy rate and the time elapsed before different required health services in the management of stroke patients either throughout an entire day or during each 8-hour interval (p > 0.05. Conclusion: In the current study, the ED occupancy rate was not significantly correlated with the time frame associated with management of admitted acute stroke patients.

  20. Consciousness Level and Off‐Hour Admission Affect Discharge Outcome of Acute Stroke Patients: A J‐ASPECT Study

    Science.gov (United States)

    Kamitani, Satoru; Nishimura, Kunihiro; Nakamura, Fumiaki; Kada, Akiko; Nakagawara, Jyoji; Toyoda, Kazunori; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Matsuda, Shinya; Miyamoto, Yoshihiro; Iwata, Michiaki; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Morita, Kenichi; Kobayashi, Yasuki; Iihara, Koji

    2014-01-01

    Background Poor outcomes have been reported for stroke patients admitted outside of regular working hours. However, few studies have adjusted for case severity. In this nationwide assessment, we examined relationships between hospital admission time and disabilities at discharge while considering case severity. Methods and Results We analyzed 35 685 acute stroke patients admitted to 262 hospitals between April 2010 and May 2011 for ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). The proportion of disabilities/death at discharge as measured by the modified Rankin Scale (mRS) was quantified. We constructed 2 hierarchical logistic regression models to estimate the effect of admission time, one adjusted for age, sex, comorbidities, and number of beds; and the second adjusted for the effect of consciousness levels and the above variables at admission. The percentage of severe disabilities/death at discharge increased for patients admitted outside of regular hours (22.8%, 27.2%, and 28.2% for working‐hour, off‐hour, and nighttime; P<0.001). These tendencies were significant in the bivariate and multivariable models without adjusting for consciousness level. However, the effects of off‐hour or nighttime admissions were negated when adjusted for consciousness levels at admission (adjusted OR, 1.00 and 0.99; 95% CI, 1.00 to 1.13 and 0.89 to 1.10; P=0.067 and 0.851 for off‐hour and nighttime, respectively, versus working‐hour). The same trend was observed when each stroke subtype was stratified. Conclusions The well‐known off‐hour effect might be attributed to the severely ill patient population. Thus, sustained stroke care that is sufficient to treat severely ill patients during off‐hours is important. PMID:25336463

  1. 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.

  2. Improving pain assessment and managment in stroke patients.

    Science.gov (United States)

    Nesbitt, Julian; Moxham, Sian; Ramadurai, Gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.

  3. [Neuroplasticity as a basis for early rehabilitation of stroke patients].

    Science.gov (United States)

    Putilina, M V

    2011-01-01

    The review is devoted to the current state of the problem of early rehabilitation of stroke patients. The rate of primary disability in patients after stroke is 3.2 per 10000 population but only 20% of previously working patients return to work. Early rehabilitation is treatment actions during a period following stroke. Adequate treatment during this period may decrease the extent of brain damage and improve disease outcome. The complexity of rehabilitation consists in using several complementary pharmacological and non-pharmacological rehabilitation measures. Appearance of new techniques of rehabilitation treatment aimed at neuroplasticity stimulation increases treatment potential of rehabilitative technologies.

  4. Thrombophilia testing in young patients with ischemic stroke.

    Science.gov (United States)

    Pahus, Sidse Høst; Hansen, Anette Tarp; Hvas, Anne-Mette

    2016-01-01

    The possible significance of thrombophilia in ischemic stroke remains controversial. We aimed to study inherited and acquired thrombophilias as risk factors for ischemic stroke, transient ischemic attack (TIA) and amaurosis fugax in young patients. We included patients aged 18 to 50 years with ischemic stroke, TIA or amaurosis fugax referred to thrombophilia investigation at Aarhus University Hospital, Denmark from 1 January 2004 to 31 December 2012 (N=685). Clinical information was obtained from the Danish Stroke Registry and medical records. Thrombophilia investigation results were obtained from the laboratory information system. Absolute thrombophilia prevalences and associated odds ratios (OR) with 95% confidence intervals (95% CI) were reported for ischemic stroke (N=377) and TIA or amaurosis fugax (N=308). Thrombophilia prevalences for the general population were obtained from published data. No strong associations were found between thrombophilia and ischemic stroke, but patients with persistent presence of lupus anticoagulant (3%) had an OR at 2.66 (95% CI 0.84-9.15) for ischemic stroke. A significantly higher risk of TIA/amaurosis fugax was found for factor V Leiden heterozygote (12%) (OR: 1.99 (95% CI 1.14-3.28)). No other inherited or acquired thrombophilia was associated with ischemic stroke, TIA or amaurosis fugax. In young patients, thrombophilia did not infer an increased risk of ischemic stroke. Only factor V Leiden heterozygote patients had an increased risk of TIA/amaurosis fugax, and persistent presence of lupus anticoagulant was likely associated with ischemic stroke. We suggest the testing restricted to investigation of persistent presence of lupus anticoagulant. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Effect of Virtual Reality on Cognition in Stroke Patients

    OpenAIRE

    Kim, Bo Ryun; Chun, Min Ho; Kim, Lee Suk; Park, Ji Young

    2011-01-01

    Objective To investigate the effect of virtual reality on the recovery of cognitive impairment in stroke patients. Method Twenty-eight patients (11 males and 17 females, mean age 64.2) with cognitive impairment following stroke were recruited for this study. All patients were randomly assigned to one of two groups, the virtual reality (VR) group (n=15) or the control group (n=13). The VR group received both virtual reality training and computer-based cognitive rehabilitation, whereas the cont...

  6. Brisk walking can promote functional recovery in chronic stroke patients

    OpenAIRE

    Batcho, Sèbiyo Charles; Stoquart, Gaëtan; Thonnard, Jean-Louis

    2013-01-01

    Objective: To determine whether regular brisk walking can promote functional recovery in community-dwelling stroke patients. Patients: A total of 44 chronic stroke patients, recruited in Belgium and Benin, respectively European high-income and African low-income countries. Methods: This longitudinal, single-cohort, observational study with 1 intervention period and 4 time-points of assessments (2 baseline, 1 post-intervention and 1 follow-up) was structured in 3 periods: pre-intervention peri...

  7. Development and validation of an ICD-10-based disability predictive index for patients admitted to hospitals with trauma.

    Science.gov (United States)

    Wada, Tomoki; Yasunaga, Hideo; Yamana, Hayato; Matsui, Hiroki; Fushimi, Kiyohide; Morimura, Naoto

    2018-03-01

    There was no established disability predictive measurement for patients with trauma that could be used in administrative claims databases. The aim of the present study was to develop and validate a diagnosis-based disability predictive index for severe physical disability at discharge using the International Classification of Diseases, 10th revision (ICD-10) coding. This retrospective observational study used the Diagnosis Procedure Combination database in Japan. Patients who were admitted to hospitals with trauma and discharged alive from 01 April 2010 to 31 March 2015 were included. Pediatric patients under 15 years old were excluded. Data for patients admitted to hospitals from 01 April 2010 to 31 March 2013 was used for development of a disability predictive index (derivation cohort), while data for patients admitted to hospitals from 01 April 2013 to 31 March 2015 was used for the internal validation (validation cohort). The outcome of interest was severe physical disability defined as the Barthel Index score of predictive index for each patient was defined as the sum of the scores. The predictive performance of the index was validated using the receiver operating characteristic curve analysis in the validation cohort. The derivation cohort included 1,475,158 patients, while the validation cohort included 939,659 patients. Of the 939,659 patients, 235,382 (25.0%) were discharged with severe physical disability. The c-statistics of the disability predictive index was 0.795 (95% confidence interval [CI] 0.794-0.795), while that of a model using the disability predictive index and patient baseline characteristics was 0.856 (95% CI 0.855-0.857). Severe physical disability at discharge may be well predicted with patient age, sex, CCI score, and the diagnosis-based disability predictive index in patients admitted to hospitals with trauma. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Antifungal susceptibility testing of Candida species isolated from the immunocompromised patients admitted to ten university hospitals in Iran

    NARCIS (Netherlands)

    Badiee, P.; Badali, H.; Boekhout, T.; Diba, K.; Moghadam, A.G.; Hossaini Nasab, A.; Jafarian, H.; Mohammadi, R.; Mirhendi, H.; Najafzadeh, M.J.; Shamsizadeh, A.; Soltani, J.

    2017-01-01

    Background Antifungal susceptibility testing is a subject of interest in the field of medical mycology. The aim of the present study were the distributions and antifungal susceptibility patterns of various Candida species isolated from colonized and infected immunocompromised patients admitted to

  9. Atrial fibrillation is not uncommon among patients with ischemic stroke and transient ischemic stroke in China.

    Science.gov (United States)

    Yang, Xiaomeng; Li, Shuya; Zhao, Xingquan; Liu, Liping; Jiang, Yong; Li, Zixiao; Wang, Yilong; Wang, Yongjun

    2017-12-04

    Atrial fibrillation (AF) is reported to be a less frequent cause of ischemic stroke in China than in Europe and North America, but it is not clear whether this is due to underestimation. Our aim was to define the true frequency of AF-associated stroke, to determine the yield of 6-day Holter ECG to detect AF in Chinese stroke patients, and to elucidate predictors of newly detected AF. Patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled in a prospective, multicenter cohort study of 6-day Holter monitoring within 7 days after stroke onset at 20 sites in China between 2013 and 2015. Independent predictors of newly-detected AF were determined by multivariate analysis. Among 1511 patients with ischemic stroke and TIA (mean age 63 years, 33.1% women), 305 (20.2%) had either previously known (196, 13.0%) or AF newly-detected by electrocardiography (53, 3.5%) or by 6-day Holter monitoring (56/1262, 4.4%). A history of heart failure (OR = 4.70, 95%CI, 1.64-13.5), advanced age (OR = 1.06, 95%CI, 1.04-1.09), NIHSS at admission (OR = 1.06, 95%CI, 1.02-1.10), blood high density lipoprotein (HDL) (OR = 1.52, 95%CI, 1.09-2.13), together with blood triglycerides (OR = 0.64, 95%CI, 0.45-0.91) were independently associated with newly-detected AF. Contrary to previous reports, AF-associated stroke is frequent (20%) in China if systemically sought. Prolonged noninvasive cardiac rhythm monitoring importantly increases AF detection in patients with recent ischemic stroke and TIA in China. Advanced age, history of heart failure, and higher admission NIHSS and higher level of HDL were independent indicators of newly-detected AF. NCT02156765 (June 5, 2014).

  10. The aesthetic and cultural pursuits of patients with stroke.

    Science.gov (United States)

    O'Connell, Clare; Cassidy, Aoife; O'Neill, Desmond; Moss, Hilary

    2013-11-01

    There has been an increasing interest in the arts in health care, with a suggestion that the arts and aesthetics can augment patient outcomes in stroke and other illnesses. Designing such programmes requires better knowledge of the artistic, aesthetic, and cultural pursuits of people affected by stroke. The aim of this study was to obtain the insights of this group about the profile of art and aesthetic activities in their lives and the influence of stroke on these aspects. Patients attending a stroke service were administered questions adapted from the Irish Arts Council's 2006 questionnaire on participation in aesthetics and cultural pursuits. Information was also collected on stroke type and present functional and cognitive status. Thirty-eight patients were interviewed. Of these, 20 were inpatients in hospital at the time of the interview and 18 were interviewed in an outpatient setting. Popular activities included mainstream cinema, listening to music, dancing, attending plays or musicals, and being outdoors. Many patients ceased these activities after their stroke, mostly because of health issues and inaccessibility. Most of the patients valued the importance of the arts in the health-care setting. This study gives a perspective for the first time on the aesthetic and cultural pursuits of stroke patients before their stroke. It portrays a wide variety of cultural and leisure activities and the cessation of these poststroke. It revealed the restrictions patients felt on gaining access to leisure pursuits both while in hospital and following discharge. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. A thematic framework of illness narratives produced by stroke patients.

    Science.gov (United States)

    Pluta, A; Ulatowska, H; Gawron, N; Sobanska, M; Lojek, E

    2015-01-01

    The present study aims at elucidating the impact of stroke on psychosocial functioning of stroke survivors. Data were investigated using interpretative thematic analysis of illness stories produced by 29 patients. Eight themes emerged from the data: Medical Information; Interpersonal Changes; Cognitive, Physical and Emotional Functioning; Strategies of Coping; Social Support; and Information Irrelevant to the Question. The most frequent organization of the themes followed the course of medical intervention and rehabilitation. Narrations of individual patients varied in terms of the presence of particular themes, the amount of information on each topic and organization. The results suggest that the analysis of non-guided illness narratives can be effectively used to identify the thematic areas important to individual stroke patients. The thematic content analysis of stroke stories can allow health professionals to better understand the patient's state of knowledge related to illness as well as his or her socio-psychological functioning which may be useful in the course of planning further assessment and rehabilitation of patients with stroke. Implications for Rehabilitation Experience of illness and life changes following stroke should be recognized as central to the provision of targeted rehabilitation. To understand the subjective perspective a content analysis of the content narrative is recommended. Our study highlights seven general thematic categories that may be regarded as key. The categories may be useful for clinicians to help individuals to clarify their main concerns following a stroke.

  12. Stroke rehabilitation and patients with multimorbidity: a scoping review protocol

    Directory of Open Access Journals (Sweden)

    Michelle L.A. Nelson

    2015-02-01

    Full Text Available Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing “best practice” stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy’s Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.

  13. Head movement during CT brain perfusion acquisition of patients with suspected acute ischemic stroke

    International Nuclear Information System (INIS)

    Fahmi, F.; Beenen, L.F.M.; Streekstra, G.J.; Janssen, N.Y.; Jong, H.W. de; Riordan, A.; Roos, Y.B.; Majoie, C.B.; Bavel, E. van; Marquering, H.A.

    2013-01-01

    Objective: Computed Tomography Perfusion (CTP) is a promising tool to support treatment decision for acute ischemic stroke patients. However, head movement during acquisition may limit its applicability. Information of the extent of head motion is currently lacking. Our purpose is to qualitatively and quantitatively assess the extent of head movement during acquisition. Methods: From 103 consecutive patients admitted with suspicion of acute ischemic stroke, head movement in 220 CTP datasets was qualitatively categorized by experts as none, minimal, moderate, or severe. The movement was quantified using 3D registration of CTP volume data with non-contrast CT of the same patient; yielding 6 movement parameters for each time frame. The movement categorization was correlated with National Institutes of Health Stroke Scale (NIHSS) score and baseline characteristic using multinomial logistic regression and student's t-test respectively. Results: Moderate and severe head movement occurred in almost 25% (25/103) of all patients with acute ischemic stroke. The registration technique quantified head movement with mean rotation angle up to 3.6° and 14°, and mean translation up to 9.1 mm and 22.6 mm for datasets classified as moderate and severe respectively. The rotation was predominantly in the axial plane (yaw) and the main translation was in the scan direction. There was no statistically significant association between movement classification and NIHSS score and baseline characteristics. Conclusions: Moderate or severe head movement during CTP acquisition of acute stroke patients is quite common. The presented registration technique can be used to automatically quantify the movement during acquisition, which can assist identification of CTP datasets with excessive head movement

  14. Head movement during CT brain perfusion acquisition of patients with suspected acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Fahmi, F., E-mail: f.fahmi@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Beenen, L.F.M., E-mail: l.f.beenen@amc.uva.nl [Department of Radiology, AMC, Amsterdam (Netherlands); Streekstra, G.J., E-mail: g.j.streekstra@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Janssen, N.Y., E-mail: n.n.janssen@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Jong, H.W. de, E-mail: H.W.A.M.deJong@umcutrecht.nl [Department of Radiology, UMC Utrecht, 3584CX, Utrecht (Netherlands); Riordan, A., E-mail: alan.riordan@gmail.com [Department of Radiology, UMC Utrecht, 3584CX, Utrecht (Netherlands); Roos, Y.B., E-mail: y.b.roos@amc.uva.nl [Department of Neurology, AMC, Amsterdam (Netherlands); Majoie, C.B., E-mail: c.b.majoie@amc.uva.nl [Department of Radiology, AMC, Amsterdam (Netherlands); Bavel, E. van, E-mail: e.vanbavel@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Marquering, H.A., E-mail: h.a.marquering@amc.uva.nl [Department of Biomedical Engineering and Physics, AMC, Amsterdam (Netherlands); Department of Radiology, AMC, Amsterdam (Netherlands)

    2013-12-01

    Objective: Computed Tomography Perfusion (CTP) is a promising tool to support treatment decision for acute ischemic stroke patients. However, head movement during acquisition may limit its applicability. Information of the extent of head motion is currently lacking. Our purpose is to qualitatively and quantitatively assess the extent of head movement during acquisition. Methods: From 103 consecutive patients admitted with suspicion of acute ischemic stroke, head movement in 220 CTP datasets was qualitatively categorized by experts as none, minimal, moderate, or severe. The movement was quantified using 3D registration of CTP volume data with non-contrast CT of the same patient; yielding 6 movement parameters for each time frame. The movement categorization was correlated with National Institutes of Health Stroke Scale (NIHSS) score and baseline characteristic using multinomial logistic regression and student's t-test respectively. Results: Moderate and severe head movement occurred in almost 25% (25/103) of all patients with acute ischemic stroke. The registration technique quantified head movement with mean rotation angle up to 3.6° and 14°, and mean translation up to 9.1 mm and 22.6 mm for datasets classified as moderate and severe respectively. The rotation was predominantly in the axial plane (yaw) and the main translation was in the scan direction. There was no statistically significant association between movement classification and NIHSS score and baseline characteristics. Conclusions: Moderate or severe head movement during CTP acquisition of acute stroke patients is quite common. The presented registration technique can be used to automatically quantify the movement during acquisition, which can assist identification of CTP datasets with excessive head movement.

  15. Management and survival of patients admitted with an exacerbation of COPD: comparison of two Danish patient cohorts

    DEFF Research Database (Denmark)

    Eriksen, Nanna; Vestbo, Jørgen

    2010-01-01

    INTRODUCTION:  The aim of this study was to describe the management and prognosis related to a hospital admission for acute exacerbation of chronic obstructive pulmonary disease and to compare results to an earlier study. OBJECTIVES AND METHODS:  This is a retrospective study of 300 consecutively...... discharged patients admitted in 2006-2007 with an exacerbation of chronic obstructive pulmonary disease from three respiratory departments. Data were collected from patient charts and compared with a replicate study done in 2001. RESULTS:  The mean age was 72.1years; 61.7% were women. Mean forced expiratory...... volume in 1s was 37.6% of predicted. On admission, 11.3% were treated with non-invasive ventilation, and 84.3% were given systemic corticosteroids. In-hospital mortality was 4.7%. At discharge, treatment with inhaled corticosteroids or at least one long-acting bronchodilator was given to 86.7% and 89...

  16. Management and survival of patients admitted with an exacerbation of COPD: comparison of two Danish patient cohorts

    DEFF Research Database (Denmark)

    Eriksen, Nanna; Vestbo, Jørgen

    2010-01-01

    INTRODUCTION: The aim of this study was to describe the management and prognosis related to a hospital admission for acute exacerbation of chronic obstructive pulmonary disease and to compare results to an earlier study. OBJECTIVES AND METHODS: This is a retrospective study of 300 consecutively...... discharged patients admitted in 2006-2007 with an exacerbation of chronic obstructive pulmonary disease from three respiratory departments. Data were collected from patient charts and compared with a replicate study done in 2001. RESULTS: The mean age was 72.1years; 61.7% were women. Mean forced expiratory...... volume in 1s was 37.6% of predicted. On admission, 11.3% were treated with non-invasive ventilation, and 84.3% were given systemic corticosteroids. In-hospital mortality was 4.7%. At discharge, treatment with inhaled corticosteroids or at least one long-acting bronchodilator was given to 86.7% and 89...

  17. The epidemiological profile of pediatric patients admitted to the general intensive care unit in an Ethiopian university hospital

    Directory of Open Access Journals (Sweden)

    Abebe T

    2015-01-01

    Full Text Available Teshome Abebe, Mullu Girmay, Girma G/Michael, Million Tesfaye Department of Anesthesia, Jimma University, Jimma, Ethiopia Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH, Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009–2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%, with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10–14 years (38.8%. Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3% of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively. Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. Keywords: trauma, critical care, pediatric, ICU, ventilation, oxygenation

  18. Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study.

    Science.gov (United States)

    Luma, Henry Namme; Eloumou, Servais Albert Fiacre Bagnaka; Mboligong, Franklin Ngu; Temfack, Elvis; Donfack, Olivier-Tresor; Doualla, Marie-Solange

    2017-07-03

    Malnutrition is common in acutely ill patients occurring in 30-50% of hospitalized patients. Awareness and screening for malnutrition is lacking in most health institutions in sub-Saharan Africa. This study aimed at screening for malnutrition using anthropometric and laboratory indices in patients admitted to the internal medicine wards. A cross-sectional study. We screened for malnutrition in 251 consecutive patients admitted from January to March 2013 in the internal medicine wards. Malnutrition defined as body mass index (BMI) less than 18.5 kg/m 2 and/or mid upper arm circumference (MUAC) less than 22 cm in women and 23 cm in men. Weight loss greater than 10% in the last 6 months prior to admission, relevant laboratory data, diagnosis at discharge and length of hospital stay (LOS) were also recorded. Mean age was 47 (SD 16) years. 52.6% were male. Mean BMI was 24.44 (SD 5.79) kg/m 2 and MUAC was 27.8 (SD 5.0) cm. Median LOS was 7 (IQR 5-12) days. 42.4% of patients reported weight loss greater than 10% in the 6 months before hospitalization. MUAC and BMI correlated significantly (r = 0.78; p malnutrition by the two methods showed moderate agreement (κ = 0.56; p malnutrition was 19.34% (35/251). Blood albumin and hemoglobin were significantly lower in malnourished patients. Malnourished patients had a significantly longer LOS (p = 0.019) when compared to those with no malnutrition. Malnutrition was most common amongst patients with malignancy. Malnutrition is common in patients admitted to the medical wards of the Douala General Hospital. Nutritional screening and assessment should be integrated in the care package of all admitted patients.

  19. Use of acupuncture therapy as a supplement to conventional medical treatments for acute ischaemic stroke patients in an academic medical centre in Korea.

    Science.gov (United States)

    Chang, Hyejung; Kwon, Young Dae; Yoon, Sung Sang

    2011-10-01

    Acupuncture has served as a major complementary and alternative therapy that supplements conventional medicine and is the subject of growing public interest. This study was conducted to estimate the usage rate of acupuncture as a supplemental treatment in acute ischaemic stroke patients and to identify factors associated with the choice to use this therapy. Using the registry of stroke patients admitted to an academic medical centre in Korea, the use of acupuncture therapy was recorded and analysed, along with the patients' socio-demographic characteristics, hospital access variables, risk factors for ischaemic stroke and clinical characteristics. The data were analysed using descriptive statistics, chi-square tests and multiple logistic regression analyses. Of 2167 patients, 18% received acupuncture therapy. The choice of acupuncture therapy was significantly associated with stroke severity as well as gender, age, geographical residence and previous history of stroke. After controlling for other significant factors, there was an approximately 3.4-fold greater usage in patients with moderately severe strokes (95% confidence interval (CI)=2.5-4.6) and 4.1-fold greater usage in patients with severe strokes (95% CI=2.7-6.4). The findings provide a better understanding of patients' utilization of acupuncture therapy as a supplement to conventional medical treatments and of factors associated with the utilization of acupuncture in patients with acute ischemic stroke. Strategic implications of acupuncture therapy are suggested for both health-care providers and policy makers. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Diagnostic accuracy of guys Hospital stroke score (allen score) in acute supratentorial thrombotic/haemorrhagic stroke

    International Nuclear Information System (INIS)

    Zulfiqar, A.; Toori, K. U.; Khan, S. S.; Hamza, M. I. M.; Zaman, S. U.

    2006-01-01

    A consecutive series of 103 patients, 58% male with mean age of 62 year (range 40-75 years), admitted with supratentorial stroke in our teaching hospital were studied. All patients had Computer Tomography scan brain done after clinical evaluation and application of Allen stroke score. Computer Tomography Scan confirmed thrombotic stroke in 55 (53%) patients and haemorrhagic stroke in 48 (47%) patients. Out of the 55 patients with definitive thrombotic stroke on Computer Tomography Scan, Allen stroke score suggested infarction in 67%, haemorrhage in 6% and remained inconclusive in 27% of cases. In 48 patients with definitive haemorrhagic stroke on Computer Tomography Scan, Allen stroke score suggested haemorrhage in 60%, infarction in 11% and remained inconclusive in 29% of cases. The overall accuracy of Allen stroke score was 66%. (author)

  1. The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care.

    Science.gov (United States)

    Asplund, Kjell; Hulter Åsberg, Kerstin; Appelros, Peter; Bjarne, Daniela; Eriksson, Marie; Johansson, Asa; Jonsson, Fredrik; Norrving, Bo; Stegmayr, Birgitta; Terént, Andreas; Wallin, Sari; Wester, Per-Olov

    2011-04-01

    Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Annually, approximately 25,000 patients are included. In 2009, approximately 320,000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

  2. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, P K; Damsgaard, Else Marie; Husted, Steen

    2007-01-01

    INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...... focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery...... and 6 months. Nutritional status was evaluated by body weight, body mass index (BMI), mid upper arm circumference (MAC), triceps skinfold thickness (TSF) and serum concentrations of albumin and transferrin. Malnutrition was defined if the patients had 2 or more abnormal nutritional variables. RESULTS...

  3. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    N.J.A. van Exel (Job); M.A. Koopmanschap (Marc); J.D.H. van Wijngaarden (Jeroen); W.J.M. Scholte op Reimer (Wilma)

    2003-01-01

    textabstractBackground. Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses

  4. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)

    2003-01-01

    textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients.

  5. Knowledge of stroke risk factors amongst black diabetic, hypertensive and stroke patients

    Directory of Open Access Journals (Sweden)

    G. Bogoshi

    2003-01-01

    knowledge of black patients diagnosed with hypertension, diabetes and stroke about the risk factors for stroke.  Four groups made up of 33 subjects (hypertensive, diabetic, stroke and control group were interviewed using open-ended questions and a structured questionnaire. Qualitative coding, frequencies and proportions were used to determine their knowledge.  Groups were compared with respect to percentage knowledge using the chi-square statistic at a 0.05 level of significance.  Stress was mentioned as the most important risk factor in all groups.  Although identification of stroke risk factors was  inadequate, the diabetic group was found to be significantly better in  identifying some of the risk factors (salt - p =0,05; sugar - p = 0,001; fat - p = 0,004; moderate smoking - p = 0,05; weight - p = 0,002

  6. One fourth of acutely admitted patients use over-the-counter-drugs 24 hours prior to hospitalisation

    DEFF Research Database (Denmark)

    Pedersen, Magnus; Brabrand, Mikkel

    2014-01-01

    INTRODUCTION: Use of over-the-counter (OTC) drugs is increasing and is poorly registered, which can lead to complications. The most commonly used OTC drugs are analgesics, and their usage is highest among elderly patients. Our study investigates the use of OTC drugs 24 hours prior to hospitalisat......INTRODUCTION: Use of over-the-counter (OTC) drugs is increasing and is poorly registered, which can lead to complications. The most commonly used OTC drugs are analgesics, and their usage is highest among elderly patients. Our study investigates the use of OTC drugs 24 hours prior...... to hospitalisation and the effects of this intake. MATERIAL AND METHODS: Junior physicians on call interviewed patients admitted to the medical admission unit at South-West Jutland Hospital in Esbjerg using a modified chart template. Adult patients aged 15 and older admitted during a two-week period in August 2012...

  7. Sexual function in post-stroke patients: considerations for rehabilitation.

    Science.gov (United States)

    Rosenbaum, Talli; Vadas, Dor; Kalichman, Leonid

    2014-01-01

    While the rehabilitation goals of post-stroke patients include improving quality of life and returning to functional activities, the extent to which sexual activity is addressed as part of the standard rehabilitation process is unknown. Moreover, the specific sexual concerns of stroke patients, including the effect of stroke on intimate relationships and sexuality of the partner, the ability to physically engage in sex, and the effect of psychological components such as role identity, depression, and anxiety on sexuality, all warrant examination by rehabilitation professionals. The aim of this study is to examine the existing literature on sexuality and stroke patients in order to better understand how the sexual lives of stroke patients and their partners are affected and to provide recommendations to rehabilitation professionals for addressing sexuality as part of treatment. Narrative review, PubMed, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2012) were searched for the key words "stroke," "sexual dysfunction," "sexuality," "quality of life," and their combination. All relevant articles in English and secondary references were reviewed. We report the results of the literature review. Sexual dysfunction and decreased sexual satisfaction are common in the post-stroke population and are related to physical, psychosocial, and relational factors. However, they are not adequately addressed in post-stroke rehabilitation. As sexual function is an important component to quality of life and activities of daily living, physicians and rehabilitation specialists, including physical, occupational, and speech therapists, should receive training in addressing sexuality in the treatment of post-stroke patients. Sexologists and sex therapists should be an integral part of the rehabilitation team. © 2013 International Society for Sexual Medicine.

  8. Characteristics, clinical course, and outcomes of homeless and non-homeless patients admitted to ICU: A retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Orla M Smith

    Full Text Available Little is known about homeless patients in intensive care units (ICUs.To compare clinical characteristics, treatments, and outcomes of homeless to non-homeless patients admitted to four ICUs in a large inner-city academic hospital.63 randomly-selected homeless compared to 63 age-, sex-, and admitting-ICU-matched non-homeless patients.Compared to matched non-homeless, homeless patients (average age 48±12 years, 90% male, 87% admitted by ambulance, 56% mechanically ventilated, average APACHE II 17 had similar comorbidities and illness severity except for increased alcohol (70% vs 17%,p<0.001 and illicit drug(46% vs 8%,p<0.001 use and less documented hypertension (16% vs 40%,p = 0.005 or prescription medications (48% vs 67%,p<0.05. Intensity of ICU interventions was similar except for higher thiamine (71% vs 21%,p<0.0001 and nicotine (38% vs 14%,p = 0.004 prescriptions. Homeless patients exhibited significantly lower Glasgow Coma Scores and significantly more bacterial respiratory cultures. Longer durations of antibiotics, vasopressors/inotropes, ventilation, ICU and hospital lengths of stay were not statistically different, but homeless patients had higher hospital mortality (29% vs 8%,p = 0.005. Review of all deaths disclosed that withdrawal of life-sustaining therapy occurred in similar clinical circumstances and proportions in both groups, regardless of family involvement. Using multivariable logistic regression, homelessness did not appear to be an independent predictor of hospital mortality.Homeless patients, admitted to ICU matched to non-homeless patients by age and sex (characteristics most commonly used by clinicians, have higher hospital mortality despite similar comorbidities and illness severity. Trends to longer durations of life supports may have contributed to the higher mortality. Additional research is required to validate this higher mortality and develop strategies to improve outcomes in this vulnerable population.

  9. Prevalence of risk factors for ischaemic stroke and their treatment among a cohort of stroke patients in Dublin.

    LENUS (Irish Health Repository)

    McDonnell, R

    2000-10-01

    The majority of strokes are due to ischaemia. Risk factors include atrial fibrillation, hypertension and smoking. The incidence can be reduced by addressing these risk factors. This study examines the prevalence of risk factors and their treatment in a cohort of patients with ischaemic stroke registered on a Dublin stroke database.

  10. Systematic Review of Hospital Readmissions in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Ahsan Rao

    2016-01-01

    Full Text Available Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science. Results. There were a total of 24 studies (n=2,126,617 included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter. Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users.

  11. Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis.

    Science.gov (United States)

    Jamal Talabani, A; Endreseth, B H; Lydersen, S; Edna, T-H

    2017-01-01

    The study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain. The probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain. Of 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively. This prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.

  12. Functional recovery differences after stroke rehabilitation in patients with uni- or bilateral hemiparesis

    Science.gov (United States)

    Bindawas, Saad M.; Mawajdeh, Hussam M.; Vennu, Vishal S.; Alhaidary, Hisham M.

    2017-01-01

    Objective: To examine the functional recovery differences after stroke rehabilitation in patients with uni- or bilateral hemiparesis. Methods: In this retrospective study, we included data from the medical record of all 383 patients with uni- or bilateral hemiparesis after stroke who were admitted to King Fahad Medical City-Rehabilitation Hospital between 2008 and 2014 in Riyadh, Kingdom of Saudi Arabia. According to the site of hemiparesis, we classified patients into 3 groups: right hemiparesis (n=208), left hemiparesis (n=157), and bilateral hemipareses (n=18). The patients (n=49) who did not have either site of hemiparesis were excluded. The Functional Independence Measures (FIM) instrument was used to assess the score at admission and discharge. A post hoc test was conducted to examine the functional recovery differences between groups. Multiple regression analyses were used to confirm the findings. Results: Amongst the three groups, there were significant (phemiparesis group. Multiple regression analyses also confirmed that the site of hemiparesis significantly (phemiparesis after stroke. PMID:28678212

  13. Effect of a care plan based on Roy adaptation model biological dimension on stroke patients' physiologic adaptation level.

    Science.gov (United States)

    Alimohammadi, Nasrollah; Maleki, Bibi; Shahriari, Mohsen; Chitsaz, Ahmad

    2015-01-01

    Stroke is a stressful event with several functional, physical, psychological, social, and economic problems that affect individuals' different living balances. With coping strategies, patients try to control these problems and return to their natural life. The aim of this study is to investigate the effect of a care plan based on Roy adaptation model biological dimension on stroke patients' physiologic adaptation level. This study is a clinical trial in which 50 patients, affected by brain stroke and being admitted in the neurology ward of Kashani and Alzahra hospitals, were randomly assigned to control and study groups in Isfahan in 2013. Roy adaptation model care plan was administered in biological dimension in the form of four sessions and phone call follow-ups for 1 month. The forms related to Roy adaptation model were completed before and after intervention in the two groups. Chi-square test and t-test were used to analyze the data through SPSS 18. There was a significant difference in mean score of adaptation in physiological dimension in the study group after intervention (P adaptation in the patients affected by brain stroke in the study and control groups showed a significant increase in physiological dimension in the study group by 47.30 after intervention (P adaptation model biological dimension care plan can result in an increase in adaptation in patients with stroke in physiological dimension. Nurses can use this model for increasing patients' adaptation.

  14. Hypertension unawareness among Chinese patients with first-ever stroke

    Directory of Open Access Journals (Sweden)

    Qinqin Cao

    2016-02-01

    Full Text Available Abstract Background The low rates of hypertension treatment and control, partly due to its unawareness, are the main causes of the high stroke incidence in China. The purpose of this study was to evaluate hypertension unawareness amongst patients with first-ever stroke and to detect factors associated with its unawareness. Methods We selected those diagnosed with hypertension from patients with first-ever stroke registered in the Nanjing Stroke Registry Program between 2004 and 2014. These hypertensives were divided as being aware or unaware of their hypertension by using a brief questionnaire conducted shortly after the stroke. Multivariate logistic regression analysis was performed to identify potential factors associated with hypertension unawareness. Results Of the 5309 patients with first-ever stroke, 3732 (70.3 % were diagnosed with hypertension. Among which, 593 (15.9 % were unaware of their hypertension at the time of stroke onset. Lower-level of education (primary school or illiteracy and smoking were associated positively with hypertension unawareness; while advanced age, overweight, diabetes mellitus, heart diseases and family history of stroke were associated negatively with hypertension unawareness. Annual data analyzed indicated that the rate of hypertension awareness increased during the past 11 years (r = 0.613, P = 0.045 for trends. Conclusions A substantial proportion (15.9 % of Chinese patients with hypertension had not been aware of this covert risk until an overt stroke occurred. Hypertension unawareness was associated with lower educational levels and smoking, which address the importance of health education especially in these individuals.

  15. Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach?

    Science.gov (United States)

    Morreale, Manuela; Marchione, Pasquale; Pili, Antonio; Lauta, Antonella; Castiglia, Stefano F; Spallone, Aldo; Pierelli, Francesco; Giacomini, Patrizia

    2016-02-01

    Early/intensive mobilization may improve functional recovery after stroke but it is not clear which kind of "mobilization" is more effective. Proprioceptive neuromuscular facilitation (PNF) and cognitive therapeutic exercise (CTE) are widespread applied in post-stroke rehabilitation but their efficacy and safety have not been systematically investigated. To compare PNF and CTE methods in a two different time setting (early versus standard approach) in order to evaluate different role of time and techniques in functional recovery after acute ischemic stroke. We designed a prospectical multicenter blinded interventional study of early versus standard approach with two different methods by means of both PNF and CTE. A discrete stroke-dedicated area for out-of-thrombolysis patients, connected with two different comprehensive stroke centres in two different catchment areas. Three hundred and forty consecutive stroke patient with first ever sub-cortical ischemic stroke in the mean cerebral artery (MCA) territory and contralateral hemiplegia admitted within 6 and 24 hours from symptoms onset. All patients were randomly assigned by means of a computer generated randomization sequence in blocks of 4 to one to the 4 interventional groups: early versus delayed rehabilitation programs with Kabat's schemes or Perfetti's technique. Patients in both delayed group underwent to a standard protocol in the acute phase. disability at 3-12 months. Disability measures: modified Rankin Score and Barthel Index. Safety outcome: immobility-related adverse events. Six-Minute Walking Test, Motricity Index, Mini-Mental State Examination, Beck Depression Inventory. Disability was not different between groups at 3 months but Barthel Index significantly changed between early versus delayed groups at 12 months (P=0.01). Six-Minute Walking Test (P=0.01) and Motricity Index in both upper (P=0.01) and lower limbs (P=0.001) increased in early versus delayed groups regardless rehabilitation schedule. A

  16. Cognition and Comorbidity Behavior in Hospitalized Patients Suffering from Stroke. Seychelles 2010-2011

    Directory of Open Access Journals (Sweden)

    Armando Carlos Roca Socarras

    2012-10-01

    Full Text Available Background: cognitive impairment and high comorbidity are common health problems in patients with cerebrovascular disease. Objective: to describe the behavior of cognitive impairment and comorbidity in hospitalized patients suffering from stroke. Method: descriptive study of 77 patients with ischemic stroke admitted from April 2010 to December 2011, in Seychelles General Hospital. The behavior of this disease in relation to variables such as age, presence of chronic noncommunicable diseases, cognitive impairment, educational level, affected cerebral hemisphere and time of evolution was analyzed. Results: 68,9 % of patients presented cognitive impairment, their average age was 74,2 (± 9,19 years old compared to 62,4 (± 14,2 years old for those with no cognitive impairment. We found a higher frequency of chronic noncommunicable diseases in cognitively impaired patients with a Charlson comorbidity index of 2,11 (± 0,97. 18 patients with cognitive impairment and 23 patients with no cognitive impairment were diagnosed with depression. Conclusions: more than half of hospitalized patients experienced cognitive impairment and in most cases previous to cerebrovascular disease. Male patients predominated. There was an increase in age, severity of depression, as well as in the frequency of chronic noncommunicable diseases, and myocardial infarction of considerable size, in respect to patients with no cognitive impairment.

  17. Hyponatremia in stroke

    Directory of Open Access Journals (Sweden)

    Sheikh Saleem

    2014-01-01

    Full Text Available Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH or cerebral salt wasting syndrome (CSWS. We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l. The data was analysed using Chi-square test using SPSS (Statistical package for social science software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67% had SIADH and 115 (33% had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate.

  18. Evaluation methods on the nutritional status of stroke patients.

    Science.gov (United States)

    Wang, J; Luo, B; Xie, Y; Hu, H-Y; Feng, L; Li, Z-N

    2014-01-01

    This study was designed to assess the effect of particular tools on the nutritional status of patients with stroke risk factors; to analyze these risk factors; to construct an assessment table; and to enable nurses to conduct fast and accurate assessment of the nutritional status of patients with stroke. Various nutritional assessment tools were employed to assess the nutritional status of stroke patients [(Nutritional Risk Screening 2002, NRS2002); (mini nutritional assessment, MNA), (subjective global assessment SGA), (malnutrition universal screening, MUST); (body composition, BCA)]. The leading disease-related factors of cerebral apoplexy were observed in patients with malnutrition. And a statistical analysis was conducted. The significant risk factors of cerebral apoplexy in malnourished patients older than 70 years were swallowing dysfunctions, disturbance of consciousness and reliance or half-reliance on feeding practices. The significant risk factors of malnutrition in patients with cerebral apoplexy were the decline in upper limb muscle strength, decline in the performance of various activities, loss of appetite and gastrointestinal symptoms. Disorders that affect the nutritional status of stroke patients can be used as evaluation tools, as described in the evaluation table. The clinical relevance of this study includes the following: to enable the clinical nursing staff to easily assess the patient's nutritional status in a timely manner; to improve compliance with nutritional evaluation; to provide clinical nutrition support to patients with stroke; and to provide a scientific basis for the improvement of the clinical outcomes of patients with cerebral apoplexy.

  19. Beyond stroke : Description and evaluation of an effective intervention to support family caregivers of stroke patients

    NARCIS (Netherlands)

    Schure, Lidwien M.; van den Heuvel, Elisabeth T. P.; Stewart, Roy E.; Sanderman, Robbert; de Witte, Luc P.; Meyboom-de Jong, Betty

    Objective: The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients. It also examined the best fit between intervention variant and family caregiver and patient characteristics. van den

  20. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    Science.gov (United States)

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into “a training package”, based on the patient’s functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients. PMID:25133141

  1. Is air transport of stroke patients faster than ground transport?

    DEFF Research Database (Denmark)

    Hesselfeldt, Rasmus; Gyllenborg, Jesper; Steinmetz, Jacob

    2014-01-01

    BACKGROUND: Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. METHODS: In this prospective controlled...... observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre....... Secondary endpoints included modified Rankin Scale at 3 months, 30-day and 1-year mortality. RESULTS: A total of 330 patients were included; 265 with ground transport and 65 with helicopter, of which 87 (33%) and 22 (34%), received thrombolysis, respectively (p=0.88). Time from contact to triaging...

  2. Rorschach Inkblot Method data at baseline and after 2 years treatment of consecutively admitted patients with first-episode schizophrenia

    DEFF Research Database (Denmark)

    Rosenbaum, Bent; Andersen, Palle Bent; Knudsen, Per Bjerregaard

    2012-01-01

    Background: The Rorschach Inkblot Method is regarded as an important clinical instrument for detailed diagnostic description of the integrative capacities of individuals in psychotic states and as an instrument for measuring progression in the course of treatment. Aims: To describe relevant...... Rorschach variables at baseline in a group of consecutively admitted patients with first-episode schizophrenia. Furthermore, to describe the changes in these variables from baseline to year 2 for the group of patients given psychiatric standard treatment, and to compare these changes with changes in other...... outcome measures [Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Strauss-Carpenter and socio-demographic variables]. Methods: In a prospective study, 34 patients consecutively admitted to treatment for a first episode of schizophrenia were tested using Exner...

  3. Infections and use of antibiotics in patients admitted for severe acute pancreatitis: data from the EPIC II study.

    Science.gov (United States)

    De Waele, Jan J; Rello, Jordi; Anzueto, Antonio; Moreno, Rui; Lipman, Jeffrey; Sakr, Yasser; Pickkers, Peter; Leone, Marc; Ferguson, Andrew; Oud, Lavi; Vincent, Jean-Louis

    2014-08-01

    Infectious complications are frequent in severe acute pancreatitis (SAP) but multinational epidemiologic data are lacking. The aim of the study was to analyze the characteristics of the infectious complications and antimicrobial use in this setting. One-day point prevalence study of infection in critically ill patients (Extended Prevalence of Infection in the ICU-II study), performed in 1,265 ICUs in 75 countries. Of the 13,796 patients in the study, 159 were admitted with SAP. One-hundred sixteen (73%) had infections: 31% intra-abdominal, 16% extra-abdominal, and 26% both. Gram-negative bacteria were more prevalent than gram-positive organisms, anaerobes, or fungi. Therapeutically, penicillins and other beta-lactams were used most frequently. Prophylactic antibiotics were administered to 24% of the patients with SAP. Infections are frequent in patients admitted with SAP; most are intra-abdominal infections. Microbiology is diverse with gram-negative micro-organisms most frequently isolated. Most patients admitted to the ICU for SAP receive antibiotics at some point.

  4. Investigating admitted patients' satisfaction with nursing care at Debre Berhan Referral Hospital in Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Sharew, Nigussie Tadesse; Bizuneh, Hailegiorgis Teklegiorgis; Assefa, Hilina Ketema; Habtewold, Tesfa Dejenie

    2018-05-17

    The aims of the study were (1) to assess the level of patient satisfaction with nursing care and (2) to identify factors influencing patient satisfaction. A hospital-based, cross-sectional study was conducted with 252 admitted patients in the medical, surgical and paediatric wards. Debre Berhan Referral Hospital, Debre Berhan, Ethiopia, with a catchment population of 2.8 million. All patients admitted at least for 2 days and capable of independent communication were included. However, patients were excluded on any one of the following conditions: admitted for less than 2 days, cannot understand Amharic language, with critical illness or cognitive impairment that affects judgement, or inability to provide written informed consent. The mean age of the patients was 37.9 (SD=12.9) years, and half (50.4%) of them were male. Patient satisfaction with nursing care, measured by the Newcastle Satisfaction with Nursing Scale, was the outcome variable. Using a mean split approach, patient satisfaction scores were dichotomised into 'satisfied' and 'unsatisfied'. 49.2% of patients were satisfied with nursing care. Educational status and history of admission were significant factors influencing patient satisfaction with nursing care. Patients who had high educational status were 80% less satisfied compared with those who had no formal education (p=0.01, OR=0.2, 95% CI 0.1 to 0.7). Patients who had a history of admission were 2.2 times more satisfied compared with those who had no history of admission (p=0.02, OR=2.2, 95% CI 1.2 to 4.2). About half the admitted patients were satisfied with the nursing care. Satisfaction differed significantly by patients' educational attainment and history of admission. This study provided evidence on patient satisfaction with nursing care in Ethiopia. This information may be useful in comparative studies of patient satisfaction and in identifying characteristics that may explain or predict patient satisfaction. © Article author(s) (or

  5. Patient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy.

    Science.gov (United States)

    Leffert, Lisa R; Clancy, Caitlin R; Bateman, Brian T; Cox, Margueritte; Schulte, Phillip J; Smith, Eric E; Fonarow, Gregg C; Schwamm, Lee H; Kuklina, Elena V; George, Mary G

    2015-10-01

    Hospitalizations for pregnancy-related stroke are rare but increasing. Hemorrhagic stroke (HS), ie, subarachnoid hemorrhage and intracerebral hemorrhage, is more common than ischemic stroke in pregnant versus nonpregnant women, reflecting different phenotypes or risk factors. We compared stroke risk factors and outcomes in pregnant versus nonpregnant HS in the Get With The Guidelines-Stroke Registry. Using medical history or International Classification of Diseases-Ninth Revision codes, we identified 330 pregnant and 10 562 nonpregnant female patients aged 18 to 44 years with HS in Get With The Guidelines-Stroke (2008-2014). Differences in patient and care characteristics were compared by χ(2) or Fisher exact test (categorical variables) or Wilcoxon rank-sum (continuous variables) tests. Conditional logistic regression assessed the association of pregnancy with outcomes conditional on categorical age and further adjusted for patient and hospital characteristics. Pregnant versus nonpregnant HS patients were younger with fewer pre-existing stroke risk factors and medications. Pregnant versus nonpregnant subarachnoid hemorrhage patients were less impaired at arrival, and less than half met blood pressure criteria for severe preeclampsia. In-hospital mortality was lower in pregnant versus nonpregnant HS patients: adjusted odds ratios (95% CI) for subarachnoid hemorrhage 0.17 (0.06-0.45) and intracerebral hemorrhage 0.57 (0.34-0.94). Pregnant subarachnoid hemorrhage patients also had a higher likelihood of home discharge (2.60 [1.67-4.06]) and independent ambulation at discharge (2.40 [1.56-3.70]). Pregnant HS patients are younger and have fewer risk factors than their nonpregnant counterparts, and risk-adjusted in-hospital mortality is lower. Our findings suggest possible differences in underlying disease pathophysiology and challenges to identifying at-risk patients. © 2015 American Heart Association, Inc.

  6. Stroke

    Science.gov (United States)

    ... doctor Preventing falls Stroke - discharge Swallowing problems Images Brain Carotid stenosis, x-ray of the left artery Carotid stenosis, x-ray of the right artery Stroke Brainstem function Cerebellum - function Circle of Willis Left cerebral hemisphere - ...

  7. Changes in Nutritional and Functional Status in Longer Stay Patients Admitted to a Geriatric Evaluation and Management Unit.

    Science.gov (United States)

    Whitley, A; Skliros, E; Graven, C; McIntosh, R; Lasry, C; Newsome, C; Bowie, A

    2017-01-01

    Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days. A prospective, observational study. Two GEM units at St Vincent's Hospital Melbourne, Australia. Patients admitted to the GEM units who stayed longer than 21 days were included in the study. Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS). Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (pnutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (pnutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.

  8. Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital.

    Science.gov (United States)

    Nip, W F R; Perry, L; McLaren, S; Mackenzie, A

    2011-10-01

    Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Few (n = 9; 10%) consumed ≥100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes stroke patients to improve rehabilitation outcomes. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  9. Women Sex Importance in Stroke Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cemile Handan Mısırlı

    2014-08-01

    Full Text Available OBJECTIVE: It was shown the differences in age, risk factors and treatment between women and men in stroke patients with atrial fibrillation METHODS: The stroke patients with atrial fibrillation who were hospitalized in our department at the last 2 years were seperated into 2 groups of aged above 75 and below 75, investigated with CHADS2 and CHA2DS2VASc scores and looked at the sex differences of women and men. RESULTS: Stroke ratio according to sex was statistically meaningful especially in women above the age of 75. Risc factors also were founded in elderly women and CHA2DS2VASc scores were higher in women than men so more anticoagulan treatment were begun. No differences were shown between sexes at lone atrial fibrillation and no treatment were begun. CONCLUSION: Women with atrial fibrillation had more risk factors, higher stroke rate and higher anticoagulation treatment.

  10. Counterregulatory hormones in insulin-treated diabetic patients admitted to an accident and emergency department with hypoglycaemia

    DEFF Research Database (Denmark)

    Hvidberg, A; Christensen, N J; Hilsted, Jannik

    1998-01-01

    The aim of the study was (1) to describe hormone responses in insulin-induced hypoglycaemia and (2) to investigate if a combined treatment with intravenous glucose and intramuscular glucagon (group A) would improve glucose recovery as compared to treatment with intravenous glucose alone (group B)...... significantly elevated concentrations of adrenaline and glucagon were found in diabetic patients admitted with severe hypoglycaemia to an Accident and Emergency Department.......). Eighteen adult patients with insulin-treated diabetes mellitus admitted to the Accident and Emergency Department with hypoglycaemia (plasma glucose 1.23 +/- 0.15 mmol l(-1) on admission) were randomized to one of the above treatments and plasma glucose and counterregulatory hormones were measured before...

  11. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N

    2014-01-01

    , and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA2DS2-VASc......], 1.1-6.6), CHA2DS2-VASc score (HR 1.4 per unit; 95% CI, 1.1-1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI, 1.1-1.8), and AVR with concomitant coronary artery bypass grafting (HR, 3.2; 95% CI, 1.4-7.2, all P≤0.026) were independently associated with stroke. Incident stroke predicted...

  12. Use of biomarkers in triage of patients with suspected stroke.

    Science.gov (United States)

    Vanni, Simone; Polidori, Gianluca; Pepe, Giuseppe; Chiarlone, Melisenda; Albani, Alberto; Pagnanelli, Adolfo; Grifoni, Stefano

    2011-05-01

    The absence of a rapidly available and sensitive diagnostic test represents an important limitation in the triage of patients with suspected stroke. The aim of the present study was to investigate the triage accuracy of a novel test that measures blood-borne biomarkers (triage stroke panel, TSP) and to compare its accuracy with that of the Cincinnati Prehospital Stroke Scale (CPSS). Consecutive patients with suspected stroke presenting to the Emergency Departments of three Italian hospitals underwent triage by a trained nurse according to the CPSS and had blood drawn for TSP testing. The TSP simultaneously measures four markers (B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100β) presenting a single composite result, the Multimarker Index (MMX). Stroke diagnosis was established by an expert committee blinded to MMX and CPSS results. There were 155 patients enrolled, 87 (56%) of whom had a final diagnosis of stroke. The area under the receiver operating characteristic (ROC) curve for CPSS was 0.77 (95% confidence interval [CI] 0.70-0.84) and that of MMX was 0.74 (95% CI 0.66-0.82) (p = 0.285). Thus, both tests, when used alone, failed to recognize approximately 25% of strokes. The area under the ROC curve of the combination of the two tests (0.86, 95% CI 0.79-0.91) was significantly greater than that of either single test (p = 0.01 vs. CPSS and p vs. TSP). In an emergency care setting, a panel test using multiple biochemical markers showed triage accuracy similar to that of CPSS. Further studies are needed before biomarkers can be introduced in the clinical work-up of patients with suspected stroke. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. REHABILITATION BALANCE ASSESSMENT IN STROKE PATIENTS USING BAROPODOMETRY

    Directory of Open Access Journals (Sweden)

    Danelciuc Francisc Tadeus

    2011-12-01

    Full Text Available Coordinative capabilities develops under different formes, one of them being the capability of self balance, which have an important role în stance, gait and in performing the activities of daily living of the persons with stroke. This study aims to emphasize the advantages offered by an appropriate equipment properly used in stroke patients rehabilitation, both for balance assessment by electronic baropodometry and for its rehabilitation by using MBT devices.

  14. [Therapy costs of adult patients admitting to emergency unit of a university hospital with asthma acute attack].

    Science.gov (United States)

    Serinken, Mustafa; Dursunoğlu, Neşe; Cimrin, Arif H

    2009-01-01

    In the present study, hospital costs of patients who admitted to the emergency department with asthma attack and several variables that could effect this cost were analyzed and data were collected in order to reduce economical burden of that disease was aimed. Between September 2005 and February 2007 patients with acute asthma attack, admitted to Pamukkale University Hospital Emergency Department were retrospectively evaluated. Totally 108 patients who met the inclusion criteria admitted to the emergency department with asthma acute attack. Of those 97 were women (89.8%). Forty mild, 51 moderate, 15 severe and 2 life-threatening attacks were detected. Severe and life-threatening attacks were more frequent in patients graduated from primary school compared with the other groups. Mean therapy costs of the patients who were hospitalized and treated in the emergency department were 836.60 +/- 324.30 TL (Turkish Lira) and 170.66 +/- 86.71 TL respectively. Treatment procedures consisted of 45.8% of and 38.5% hospital costs for patients treated in the emergency department and for patients hospitalized respectively. There was a statistically significant difference in the comparison of costs according to the attack severity (p= 0.0001). Education level of the patients had a significant effect on hospital costs (p= 0.025). Comorbidities were found a significant increasing factor of treatment costs (p= 0.017). There were no effects of sex, age, medical insurance or duration of asthma disease on the hospital costs. The relation between low-education level, living in the rural area and admissions with severe attacks of asthma to emergency department show the importance of treatment success with patient compliance. Positive and negative factors effecting disease control should be detected by evaluating larger populations to reduce economical burden of asthma.

  15. Oropharyngeal flora in patients admitted to the medical intensive care unit: clinical factors and acid suppressive therapy.

    Science.gov (United States)

    Frandah, Wesam; Colmer-Hamood, Jane; Mojazi Amiri, Hoda; Raj, Rishi; Nugent, Kenneth

    2013-05-01

    Acid suppression therapy in critically ill patients significantly reduces the incidence of stress ulceration and gastrointestinal (GI) bleeding; however, recent studies suggest that proton pump inhibitors (PPIs) increase the risk of pneumonia. We wanted to test the hypothesis that acid suppressive therapy promotes alteration in the bacterial flora in the GI tract and leads to colonization of the upper airway tract with pathogenic species, potentially forming the biological basis for the observed increased incidence of pneumonia in these patients. This was a prospective observational study on patients (adults 18 years or older) admitted to the medical intensive care unit (MICU) at a tertiary care centre. Exclusion criteria included all patients with a diagnosis of pneumonia at admission, with infection in the upper airway, or with a history of significant dysphagia. Oropharyngeal cultures were obtained on day 1 and days 3 or 4 of admission. We collected data on demographics, clinical information, and severity of the underlying disease using APACHE II scores. There were 110 patients enrolled in the study. The mean age was 49±16 years, 50 were women, and the mean APACHE II score was 9.8 ± 6.5. Twenty per cent of the patients had used a PPI in the month preceding admission. The first oropharyngeal specimen was available in 110 cases; a second specimen at 72-96 h was available in 68 cases. Seventy-five per cent of the patients admitted to the MICU had abnormal flora. In multivariate logistic regression, diabetes mellitus and PPI use were associated with abnormal oral flora on admission. Chronic renal failure and a higher body mass index reduced the frequency of abnormal oral flora on admission. Most critically ill patients admitted to our MICU have abnormal oral flora. Patients with diabetes and a history of recent PPI use are more likely to have abnormal oral flora on admission.

  16. Poor long-term functional outcome after stroke among adults aged 18 to 50 years: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study.

    Science.gov (United States)

    Synhaeve, Nathalie E; Arntz, Renate M; Maaijwee, Noortje A M; Rutten-Jacobs, Loes C A; Schoonderwaldt, Henny C; Dorresteijn, Lucille D A; de Kort, Paul L M; van Dijk, Ewoud J; de Leeuw, Frank-Erik

    2014-04-01

    Stroke in young adults has a dramatic effect on life; therefore, we investigated the long-term functional outcome after transient ischemic attack, ischemic stroke, or intracerebral hemorrhage in adults aged 18 to 50 years. We studied 722 young patients with first-ever stroke admitted between January 1, 1980, and November 1, 2010. Functional outcome was assessed by stroke subtype with the modified Rankin Scale and Instrumental Activities of Daily Living scale. After a mean follow-up of 9.1 (SD, 8.2) years, 32.0% of all patients had a poor functional outcome (modified Rankin Scale, >2); for ischemic stroke, this was 36.5%, for intracerebral hemorrhage 49.3%, and for transient ischemic attack 16.8%. At follow-up, 10.8% of transient ischemic attack, 14.6% of ischemic stroke, and 18.2% of intracerebral hemorrhage patients had a poor outcome as assessed by Instrumental Activities of Daily Living (ischemic stroke or intracerebral hemorrhage in young adults, 1 of 8 survivors is still dependent in daily life.

  17. Increased Risk of Ischemic Stroke in Young Nasopharyngeal Carcinoma Patients

    International Nuclear Information System (INIS)

    Lee, Ching-Chih; Su, Yu-Chieh; Ho, Hsu-Chueh; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Chou, Pesus; Huang, Yung-Sung

    2011-01-01

    Purpose: Radiation/chemoradiotherapy-induced carotid stenosis and cerebrovascular events in patients with nasopharyngeal carcinoma (NPC) can cause severe disability and even death. This study aimed to estimate the risk of ischemic stroke in this patient population over more than 10 years of follow-up. Methods and Materials: The study cohorts consisted of all patients hospitalized with a principal diagnosis of NPC (n = 1094), whereas patients hospitalized for an appendectomy during 1997 and 1998 (n = 4376) acted as the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the stroke-free survival rate between the two cohorts after adjusting for possible confounding and risk factors. Results: Of the 292 patients with ischemic strokes, 62 (5.7%) were from the NPC cohort and 230 (5.3%) were from the control group. NPC patients ages 35–54 had a 1.66 times (95% CI, 1.16–2.86; p = 0.009) higher risk of ischemic stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. There was no statistical difference in ischemic stroke risk between the NPC patients and appendectomy patients ages 55–64 years (hazard ratio = 0.87; 95% CI, 0.56–1.33; p = 0.524) after adjusting for other factors. Conclusions: Young NPC patients carry a higher risk for ischemic stroke than the general population. Besides regular examinations of carotid duplex, different irradiation strategies or using new technique of radiotherapy, such as intensity modulated radiation therapy or volumetric modulated arc therapy, should be considered in young NPC patients.

  18. Anti-inflammatory treatment and risk for depression after first-time stroke in a cohort of 147 487 Danish patients

    DEFF Research Database (Denmark)

    Wium-Andersen, Ida Kim; Wium-Andersen, Marie Kim; Jørgensen, Martin Balslev

    2017-01-01

    after stroke. METHODS: A register-based cohort including all patients admitted to hospital with a first-time stroke from Jan. 1, 2001, through Dec. 31, 2011, and a nonstroke population with a similar age and sex distribution was followed for depression until Dec. 31, 2014. Depression was defined...... stroke but a higher risk for late depression. This suggests that inflammation contributes differently to the development of depression after stroke depending on the time of onset.......BACKGROUND: Depression is a common complication after stroke, and inflammation may be a pathophysiological mechanism. This study examines whether anti-inflammatory treatment with acetylsalicylic acid (ASA), nonsteroid anti-inflammatory drugs (NSAIDs) or statins influence the risk of depression...

  19. The cardiovascular status of the black stroke patient

    International Nuclear Information System (INIS)

    Joubert, J.; Van Gelder, A.L.; Pilloy, W.J.; Darazs, B.

    1989-01-01

    The cardiac status of 102 consecutive black stroke patients entered to the Medunsa Stroke Databank was determined. Cardiological examination, echocardiography and a gated blood pool scan revealed structural and/or functional cardiac abnormalities in 73,6% of patients. Rheumatic heart disease was diagnosed in 15,6%, mitral valve prolapse in 5,8% and mitral annulus calcification in 4,9% of cases. 'Possible' cardiac sources of cerebral embolism were detected in 22,5% and 'definite' sources in 23,5% of patients. Hypertensive heart disease was diagnosed in 35,2% and cardiomyopathy in 13,7% of the study population. Ischaemic heart disease was present in 6,86%. Ultrasonography revealed ventricular bands in 29,4% of patients. The high incidence of structural cardiac abnormalities detected by non-invasive means is in keeping with recent studies in white stroke patients. 32 refs., 11 tabs., 2 figs

  20. Early warning score predicts acute mortality in stroke patients

    DEFF Research Database (Denmark)

    Liljehult, J; Christensen, Thomas

    2016-01-01

    OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study wa...... tool for identifying patients at risk of dying after acute stroke. Readily available physiological parameters are converted to a single score, which can guide both nurses and physicians in clinical decision making and resource allocation.......OBJECTIVES: Clinical deterioration and death among patients with acute stroke are often preceded by detrimental changes in physiological parameters. Systematic and effective tools to identify patients at risk of deterioration early enough to intervene are therefore needed. The aim of the study...

  1. FERMENTED SOYBEAN CAKE AND ALBUMIN FORMULA AS NUTRITIONAL SUPPORT PREVENTS PROTEIN ENERGY MALNUTRITION AND AKI IN STROKE PATIENTS

    Directory of Open Access Journals (Sweden)

    Nanny Djaya

    2012-06-01

    Full Text Available Stroke is the leading cause of death in every hospital in Indonesia. The death rate of newly formed or recurrent stroke is estimated around 750.000 case every year nation wide, 200.000 of which are recurrent stroke. Stroke patients have higher risk to develop another stroke attack. In 5 years time, the recurrence of stroke attack is estimated around 30–43%. In many cases, elderly stroke patients who were admitted to the hospital with recurrent stroke attack also suffer from anorexia which leads to hypoalbuminemia, hyponatremia, hypokalemia and impaired renal function marked by a rise in ureum level with or without elevation in blood creatinin levels. This study uses pre and post nutrition intervention method. Hospital’s fermented soybean cake and albumin blend formula was given through nasogastric tube. The amount of calorie was adjusted according to basal needs x 1,3 and consisted of carbohydrate, protein 1 gram/kg BB (albumin : fermented soybean cake=3:1 and 25% fat. This formula was given to 11 stroke patients who had been admitted to Atma Jaya Hospital for at least 10 days and met the inclusion & exclusion criteria, such as did not receive parenteral blood and albumin transfusion without history of renal failure. All the patients’ intake and fluid balance were monitored. The average albumin level of these patients was ±3,1 mg/dL(pre intervention. After receiving nutrition (NGT and fluid (parenteral nutrition intervention, the result is as follows: There was an average of±5 mg increase in Natrium level during day 3–5 of hospital stay. There was an average of±0,3 mg increase in Kalium level during day 2–3 of hospital stay. There was an average of ±15 mg reduction of Ureum level during day 5–7 of hospital stay When there was inadequate calorie intake, protein from muscle might be broken down marked by a rise in blood ureum level with or without an increase in creatinin level. In this condition, electrolyte level, such as

  2. Is higher body temperature beneficial in ischemic stroke patients with normal admission CT angiography of the cerebral arteries?

    Science.gov (United States)

    Kvistad, Christopher Elnan; Khanevski, Andrej; Nacu, Aliona; Thomassen, Lars; Waje-Andreassen, Ulrike; Naess, Halvor

    2014-01-01

    Low body temperature is considered beneficial in ischemic stroke due to neuroprotective mechanisms, yet some studies suggest that higher temperatures may improve clot lysis and outcomes in stroke patients treated with tissue plasminogen activator (tPA). The effect of increased body temperature in stroke patients treated with tPA and with normal computed tomography angiography (CTA) on admission is unknown. We hypothesized a beneficial effect of higher body temperature in the absence of visible clots on CTA, possibly due to enhanced lysis of small, peripheral clots. Patients with ischemic stroke admitted to our Stroke Unit between February 2006 and April 2013 were prospectively registered in a database (Bergen NORSTROKE Registry). Ischemic stroke patients treated with tPA with normal CTA of the cerebral arteries were included. Outcomes were assessed by the modified Rankin Scale (mRS) after 1 week. An excellent outcome was defined as mRS=0, and a favorable outcome as mRS=0-1. A total of 172 patients were included, of which 48 (27.9%) had an admission body temperature ≥37.0°C, and 124 (72.1%) had a body temperature temperature ≥37.0°C was independently associated with excellent outcomes (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.24-6.46; P=0.014) and favorable outcomes (OR: 2.8; 95% CI: 1.13-4.98; P=0.015) when adjusted for confounders. We found an association between higher admission body temperature and improved outcome in tPA-treated stroke patients with normal admission CTA of the cerebral arteries. This may suggest a beneficial effect of higher body temperature on clot lysis in the absence of visible clots on CTA.

  3. The importance of the patient's subjective experience in stroke rehabilitation.

    Science.gov (United States)

    Prigatano, George P

    2011-01-01

    Kaufman's observation that the patients' reactions to their impairments and disabilities need to be addressed in stroke rehabilitation has been shown to be an accurate and perceptive statement. In this article, 3 levels of stroke rehabilitation are outlined, and the importance of focusing on the third level (the level of subjective experience) is emphasized. Identification of the patients' subjective experience allows one to understand what is most frustrating to them. After addressing those frustrations, patients are more eager to engage the rehabilitation process. Within the context of this rehabilitation process, helping patients clarify what their subjective or phenomenological state is as it relates to their stroke is crucial in having them not only engage the rehabilitation process, but ultimately find meaning in life in the face of their stroke. This can be a difficult task because patients often do not have the words to clarify what their inner psychological experiences are following a stroke. Helping to provide guidelines for this can result in a meaningful experience for both the patient and the therapists involved in their care.

  4. What factors on admission influence ICU mortality in adult patients admitted to the intensive care unit with severe pneumonia?

    International Nuclear Information System (INIS)

    Mansoor, F.; Akhtar, A.; Qadeer, A.; Ali, Z.; Kaleem, B.; Sikandar, I.

    2016-01-01

    Objective: To identity the risk factors on intensive care unit (ICU) admission that are linked with ICU mortality in patients with severe pneumonia. Study Design: A retrospective observational study. Place and Duration of Study: Patients admitted to the medical ICU in Shifa International Hospital, Islamabad, between October 2013 and March 2014. Material and Methods: Adult patients admitted to the ICU with the suspected diagnosis of severe pneumonia were studied. In addition to the co-morbidities, presence or absence of septic shock and acute kidney injury, PaO/sub 2//FiO/sub 2/ ratio and type of mechanical ventilation were recorded on ICU admission. This data was initially recorded on paper forms and latter entered in the SPSS. Bivariate analysis was performed to study the relationship between these risk factors and their effect on the ICU mortality. Results: We evaluated a total number of 82 patients with severe pneumonia. ICU mortality was 14.8 percent (12 patients). Statistical analysis showed that patients with severe acute respiratory distress syndrome (ARDS), septic shock, history of chronic liver disease and human immunodeficiency virus (HIV) neutropenic sepsis and those who received invasive mechanical ventilation were at higher risk of mortality. We did not find any direct correlation between age, presence of acute kidney injury, history of diabetes mellitus and risk of death in the ICU. Conclusion: In adult patients, septic shock, severe ARDS, history of chronic liver disease, neutropenic sepsis and presence of HIV, and invasive mechanical ventilation are associated with a higher risk of ICU mortality in patients admitted with severe pneumonia. (author)

  5. Antibiotic Prescription, Organisms and its Resistance Pattern in Patients Admitted to Respiratory ICU with Respiratory Infection in Mysuru.

    Science.gov (United States)

    Mahendra, M; Jayaraj, B S; Lokesh, K S; Chaya, S K; Veerapaneni, Vivek Vardhan; Limaye, Sneha; Dhar, Raja; Swarnakar, Rajesh; Ambalkar, Shrikant; Mahesh, P A

    2018-04-01

    Respiratory infections account for significant morbidity, mortality and expenses to patients getting admitted to ICU. Antibiotic resistance is a major worldwide concern in ICU, including India. It is important to know the antibiotic prescribing pattern in ICU, organisms and its resistance pattern as there is sparse data on Indian ICUs. We conducted a prospective study from August 2015 to February 2016. All patients getting admitted to RICU with respiratory infection who were treated with antibiotics were included into study. Demographic details, comorbidities, Clinco-pathological score (CPI) on day1 and 2 of admission, duration of ICU admission, number of antibiotics used, antibiotic prescription, antimicrobial resistance pattern of patients were collected using APRISE questionnaire. During study period 352 patients were screened and 303 patients were included into study. Mean age was 56.05±16.37 and 190 (62.70%) were men. Most common diagnosis was Pneumonia (66%). Piperacillin-tazobactam was most common empirical antibiotic used. We found 60% resistance to piperacillin-tazobactam. Acinetobacter baumanii was the most common organism isolated (29.2%) and was highly resistant to Carbapenem (60%). Klebsiella pneumoniae was resistant to Amikacin (45%), piperacillin (55%) and Ceftazidime (50%). Piperacillin-tazobactam was the most common antibiotic prescribed to patients with respiratory infection admitted to ICU. More than half of patients (60%) had resistance to the empirical antibiotic used in our ICU, highlighting the need for antibiogram for each ICU. Thirty six percent of patient had prior antibiotic use and had mainly gram negative organisms with high resistance to commonly used antibiotics.

  6. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye

    2011-01-01

    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  7. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta

    2014-01-01

    Full Text Available Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  8. Recovery of Dysphagia in lateral medullary stroke.

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  9. Recovery of Dysphagia in Lateral Medullary Stroke

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function. PMID:25045555

  10. Assessment of pattern and treatment outcome of patients admitted to pediatric intensive care unit, Ayder Referral Hospital, Tigray, Ethiopia, 2015.

    Science.gov (United States)

    Haftu, Hansa; Hailu, Tedrose; Medhaniye, Araya; G/Tsadik, Teklit

    2018-05-24

    To describe admission pattern and outcome with its predictor variable on the mortality of children admitted to pediatric intensive care unit (PICU), Ayder Referral Hospital, Northern Ethiopia, from September 2012 to August 2014. From 680 admitted patients, 400 patients were analyzed. Average age at admission was 62.99 ± 60.94 months, with F:M ratio of 1:1.2. Overall (from infectious and non-infectious) the most commonly affected systems were respiratory (90/400 pts., 22.5%) and central nervous system (83/400 pts., 20.75%). Most were admitted due to meningitis (44/400 pts., 11%), post-operative (43/400 pts., 10.8%) and acute glomerulonephritis (41/400 pts., 10.3%). The overall mortality rate was 8.5%. Multivariable logistic regression shows, use of inotropes (p = 0.000), need for mechanical ventilator (p = 0.007) and presence of comorbid illness (p = 0.002), infectious cause (p = 0.015) and low level of Glasgow coma scale less than eight (p = 0.04) were independent predictors of mortality. From this study, common cause of PICU admission and death was meningitis. This highlights the importance of focusing on the preventable methods in the public such as vaccine, creating awareness about hygiene, and expanding ICU for early detection and for treatment acutely ill children.

  11. Hypoalbuminemia is a strong predictor of 30-day all-cause mortality in acutely admitted medical patients

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Henriksen, Daniel Pilsgaard; Hallas, Peter

    2014-01-01

    (precision of predictions) for hypoalbuminemia was determined. RESULTS: We included 5,894 patients and albumin was available in 5,451 (92.5%). A total of 332 (5.6%) patients died within 30 days of admission. Median plasma albumin was 40 g/L (IQR 37-43). Crude 30-day mortality in patients with low albumin......OBJECTIVE: Emergency patients with hypoalbuminemia are known to have increased mortality. No previous studies have, however, assessed the predictive value of low albumin on mortality in unselected acutely admitted medical patients. We aimed at assessing the predictive power of hypoalbuminemia on 30...... follow-up. Patients were divided into three groups according to their plasma albumin levels (0-34, 35-44 and ≥45 g/L) and mortality was identified for each group using Kaplan-Meier survival plot. Discriminatory power (ability to discriminate patients at increased risk of mortality) and calibration...

  12. Delirium assessed by Memorial Delirium Assessment Scale in advanced cancer patients admitted to an acute palliative/supportive care unit.

    Science.gov (United States)

    Mercadante, Sebastiano; Adile, Claudio; Ferrera, Patrizia; Cortegiani, Andrea; Casuccio, Alessandra

    2017-07-01

    Delirium is often unrecognized in cancer patients. The aim of this study was to investigate the prevalence of delirium assessed by the Memorial Delirium Assessment Scale (MDAS) and possible associated factors on admission to an acute palliative/supportive care unit (APSCU). The secondary outcome was to assess changes in MDAS and symptom burden at time of discharge. A consecutive sample of advanced cancer patients who were admitted to an APSCU was prospectively assessed for a period of 10 months. Patient demographics, including age, gender, primary diagnosis, Karnofsky status, stage of disease, and educational level were collected. The Edmonton Symptom Assessment Scale (ESAS) and the MDAS were measured at hospital admission and discharge. A total of 314 patients were surveyed. Of 292 patients with MDAS available at T0, 74 (25.3%) and 24 (8.2%) had a MDAS of 7-12 and ≥13, respectively. At discharge, there was a significant decrease in the number of patients with a MDAS ≥7/30. Higher values of MDAS were associated with age (p = .028), a lower Karnofsky status (p symptoms (p = .026), hospital stay (p = .038) and death (p Delirium is highly prevalent in patients admitted to APSCU, characterized by a low mortality due to early referral. Comprehensive assessment and treatment may allow a decrease in the level of cognitive disorders and symptom burden.

  13. Mechanism of troponin elevations in patients with acute ischemic stroke

    DEFF Research Database (Denmark)

    Jensen, Jesper K.; Atar, Dan; Mickley, Hans

    2007-01-01

    the introduction of troponin in the diagnosis of acute myocardial infarction, this marker has been measured in a number of other conditions as well. One of these conditions is acute ischemic stroke, causing diagnostic dilemmas for clinicians. Because various electrocardiographic alterations have also been reported...... in these patients, it has been suggested that elevated troponin levels are somehow neurologically mediated, thus not caused by direct cardiac release. In conclusion, this review examines the available studies that systematically measured troponin in patients with acute ischemic stroke to properly interpret troponin...... elevations in these patients Udgivelsesdato: 2007-Mar-15...

  14. Mortality and use of psychotropic medication in patients with stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Baandrup, Lone; Iversen, Helle K

    2016-01-01

    with a diagnosis of stroke and either no drug use or preindex use of psychotropic medication (n=49,968) and compared with control subjects (n=86,100) matched on age, gender, marital status and community location. PRIMARY OUTCOME MEASURE: All-cause mortality. RESULTS: All-cause mortality was higher in patients...... about psychotropic medication use was obtained from the Danish Register of Medicinal Product Statistics. OBJECTIVES: We aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in patients with stroke and matched controls. PARTICIPANTS: Patients...

  15. Hyponatremia And Disability, Prevalence And Prognosis In Babol Stroke Patients.

    Directory of Open Access Journals (Sweden)

    Alijan Ahmadi Ahangar

    2017-02-01

    Full Text Available Background: Stroke is the leading cause of serious long-term disability. In recent studies hyponatremia as a risk factor for stroke. Methods: This cross-sectional descriptive study was to evaluate serum zinc level in serum sodium over the first 24 hours after the onset of stroke. Different intensities were determined on Stroke Scale NIH (National Institute of Health (mild 4-1 and (average moderate 15-5 and (moderate to severe 20-16 and (extreme severe 42- 21. Determination intensity of stroke after admission and discharge with Modified Rankin Scale and Barthel index. Blood serum concentrations of sodium 0.5 mL of venous blood were taken and sodium serum level was performed with Latex particle agglutination test in Ayatollah Rouhani Hospital. That normal range was defined 136-146 meq / L Findings: 125 patients were entered into this study; the prevalence of hyponatremia in female was 70% vs 60% in male. Of stroke patients included in this study 66% of them had hyponatremia and the frequency of hyponatremia in ischemic and hemorrhagic was 82% and 63%, respectively. Increase in hyponatremia with disability period of admission had statistically significant (10(12 mild vs 40(32 moderate, 32(25.6 severe, p=0.01 also with disability before discharge (24(19.2 mild, 26(20.8 moderate, 32(25.6 severe, p=0.03. Conclusions: Hyponatremia can effect on severity of the stroke and can be considered as a predictor of increased stroke severity and disability at admission and discharge.

  16. Multicomponent Intervention for Patients Admitted to an Emergency Unit for Suicide Attempt: An Exploratory Study

    Directory of Open Access Journals (Sweden)

    Sebastien Brovelli

    2017-09-01

    Full Text Available Suicide is a major cause of premature deaths worldwide and belongs to the top priority public health issues. While suicide attempt is the most important risk factor for completed suicide, intervention for suicide attempters (SA have produced mixed results. Since an important proportion of SA request medical care, emergency units (EU are an opportune setting to implement such interventions. This exploratory study evaluated the feasibility and acceptability of a multicomponent intervention for SA admitted to an EU. The intervention consisted of coordination by a case manager of a joint crisis plan (JCP, an early meeting with relatives and the existing care network, as well as phone contacts during 3 months after suicide attempt. Among 107 SA admitted to the emergency unit during the study period, 51 could not be included for logistical reason, 22 were excluded, and intervention was offered to 34. Of these, 15 refused the intervention, which was thus piloted with 19 SA. First-time attempters most frequently declined the intervention. Feasibility and acceptability of phone contacts and case manager were good, while JCPs and meetings were difficult to implement and perceived as less acceptable. Refusal pattern questions the global acceptability and is discussed: JCPs and meetings will have to be modified in order to improve their feasibility and acceptability, especially among first-time attempters.

  17. Horner's syndrome in patients admitted to the intensive care unit that have undergone central venous catheterization: a prospective study.

    Science.gov (United States)

    Butty, Z; Gopwani, J; Mehta, S; Margolin, E

    2016-01-01

    PurposeCentral venous catheterization (CVC) is estimated to be performed in millions of patients per year. Swan-Ganz catheters used for CVC are most often inserted into the internal jugular vein and during this procedure they may come into contact with the sympathetic chain. This study aims to determine the incidence of Horner's syndrome in patients admitted to intensive care unit that have undergone internal jugular CVC insertion during their admission and to determine whether ultrasonography-assisted insertion has decreased the frequency of this complication.Patients and methodsA total of 100 prospective patients admitted to the ICU were examined for the presence of anisocoria and ptosis after undergoing recent CVC. Presence of Horner's syndrome was confirmed by testing with 0.5% apraclonidine and looking for the reversal of anisocoria.ResultsFrequency of Horner's syndrome after CVC was 2% in a sample of 100 prospectively examined patients.ConclusionHorner's syndrome remains a relatively rare but definitive complication of CVC. ICU physicians should be educated about its existence and prevalence and ophthalmologists should inquire about any history of ICU admission necessitating CVC insertion in any patient presenting with Horner's syndrome.

  18. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

    DEFF Research Database (Denmark)

    Matzen, Lars E; Jepsen, Ditte B; Ryg, Jesper

    2012-01-01

    ABSTRACT: BACKGROUND: Functional decline is associated with increased risk of mortality in geriatric patients.Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission wasstudied as a predictor of survival in older patients admitted to an acute geriatric unit. METHODS......: All first admissions of patients with age >65 years between January 1st 2005 and December31st 2009 were included. Data on BI, sex, age, and discharge diagnoses were retrieved fromthe hospital patient administrative system, and data on survival until September 6th 2010 wereretrieved from the Civil...... Personal Registry. Co-morbidity was measured with Charlson ComorbidityIndex (CCI). Patients were followed until death or end of study. RESULTS: 5,087 patients were included, 1,852 (36.4%) men and 3,235 (63.6%) women with mean age(SD) 82.0 (6.8) and 84.0 (7.0) years respectively. The median [IQR] length...

  19. Health-Related Quality of Life in the Family Caregivers of Stroke Survivors

    Science.gov (United States)

    Chen, Yangkun

    2010-01-01

    The objective of this cross-sectional study was to identify the factors associated with health-related quality of life (HRQOL) of family caregivers of Chinese stroke patients. One hundred and twenty-three stroke patients consecutively admitted to a stroke clinic and their 123 family caregivers were recruited. The caregivers' HRQOLs were assessed…

  20. Early Home Supported Discharge of Stroke Patients:

    DEFF Research Database (Denmark)

    Larsen, Torben; Olsen, T. Skyhøj; Sørensen, Jan

    2006-01-01

    OBJECTIVES: A comprehensive and systematic assessment (HTA) of early home-supported discharge by a multidisciplinary team that plans, coordinates, and delivers care at home (EHSD) was undertaken and the results were compared with that of conventional rehabilitation at stroke units. METHODS......: A systematic literature search for randomized trials (RCTs) on "early supported discharge" was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline...... are discussed. CONCLUSIONS: EHSD is evidenced as a dominant health intervention. However, financial barriers between municipalities and health authorities have to be overcome. For qualitative reasons, a learning path of implementation is recommended where one stroke unit in a region initiates EHSD...

  1. Cervicocranial fibromuscular dysplasia in Taiwanese ischemic stroke patients.

    Science.gov (United States)

    Liu, Chi-Hung; Wu, Dean; Chin, Shy-Chyi; Fu, Ser-Chen; Wu, Tai-Cheng; Chang, Chien-Hung; Peng, Tsung-I; Chang, Yeu-Jhy; Lee, Tsong-Hai

    2012-01-01

    Clinical research of cervicocranial fibromuscular dysplasia (FMD) is rare in Asian populations. Our study reviewed Taiwanese ischemic stroke patients with cervicocranial FMD and compared them with previous reports. Between 2000 and 2011, we collected 19 consecutive cervicocranial FMD patients who received demographic registration, a blood test for excluding vasculitis, and comprehensive angiography. Cerebral ultrasound, vascular images and clinical outcomes (Barthel index, modified Rankin scale, recurrent stroke, or death) were monitored during follow-up. Of the 19 patients, 16 (84%) had carotid FMD, while 7 (37%) had vertebral FMD. Only 2 investigated patients (13%) had renal FMD and 1 (5%) had cerebral aneurysm. 14 (74%) presented acute arterial dissection. All patients received medical treatment and had neither recurrent stroke nor dissection during follow-up. In the literature review of 225 FMD patients, 3.6% had recurrent stroke during follow-up, and some reported surgical procedure or angioplasty could give a good clinical outcome in progressing ischemia irrelevant to the cause of stenosis. In Taiwanese cervicocranial FMD patients, arterial dissection was one of the most common clinical presentations. Most of our patients had isolated involvement of the cervicocranial artery and carried a favorable outcome under medical treatment. Copyright © 2012 S. Karger AG, Basel.

  2. A System for Monitoring Stroke Patients in a Home Environment

    NARCIS (Netherlands)

    Klaassen, Bart; van Beijnum, Bernhard J.F.; Weusthof, Marcel H.H.; Hofs, D.H.W.; van Meulen, Fokke; Luinge, Hendrik J.; Lorussi, Frederico; Hermens, Hermanus J.; Veltink, Petrus H.

    2014-01-01

    Currently, the changes of functional capacity and performance of stroke patients after returning home from a rehabilitation hospital is unknown for a physician, having no objective information about the intensity and quality of a patient's daily-life activities. Therefore, there is a need to develop

  3. Effects of edaravone on early outcomes in acute ischemic stroke patients treated with recombinant tissue plasminogen activator.

    Science.gov (United States)

    Wada, Tomoki; Yasunaga, Hideo; Inokuchi, Ryota; Horiguchi, Hiromasa; Fushimi, Kiyohide; Matsubara, Takehiro; Nakajima, Susumu; Yahagi, Naoki

    2014-10-15

    We investigated whether edaravone could improve early outcomes in acute ischemic stroke patients treated with recombinant tissue plasminogen activator (rtPA). We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database. We identified patients admitted with a primary diagnosis of ischemic stroke from 1 July 2010 to 31 March 2012 and treated with rtPA on the same day of stroke onset or the following day. Thereafter, we selected those who received edaravone on the same day of rtPA administration (edaravone group), and those who received rtPA without edaravone (control group). The primary outcomes were modified Rankin Scale (mRS) scores at discharge. One-to-one propensity-score matching was performed between the edaravone and control groups. An ordinal logistic regression analysis for mRS scores at discharge was performed with adjustment for possible variables as well as clustering of patients within hospitals using a generalized estimating equation. We identified 6336 eligible patients for inclusion in the edaravone group (n=5979; 94%) and the control group (n=357; 6%) as the total population. In 356 pairs of the propensity-matched population, the ordinal logistic regression analysis showed that edaravone was significantly associated with lower mRS scores of patients at discharge (adjusted odds ratio: 0.74; 95% confidence interval: 0.57-0.96). Edaravone may improve early outcomes in acute ischemic stroke patients treated with rtPA. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Transcranial Direct Current Stimulation Improves Audioverbal Memory in Stroke Patients.

    Science.gov (United States)

    Kazuta, Toshinari; Takeda, Kotaro; Osu, Rieko; Tanaka, Satoshi; Oishi, Ayako; Kondo, Kunitsugu; Liu, Meigen

    2017-08-01

    The aim of this study was to investigate whether anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance in stroke patients. Twelve stroke patients with audioverbal memory impairment participated in a single-masked, crossover, and sham-controlled experiment. The anodal or sham transcranial direct current stimulation was applied during the Rey Auditory Verbal Learning Test, which evaluates the ability to recall a list of 15 heard words over five trials. The number of correctly recalled words was compared between the anodal and sham conditions and the influence of transcranial direct current stimulation on serial position effect of the 15 words was also examined. The increase in the number of correctly recalled words from the first to the fifth trial was significantly greater in the anodal condition than in the sham condition (P transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance and induced the primacy effect in stroke patients.

  5. Excessive sedentary time during in-patient stroke rehabilitation.

    Science.gov (United States)

    Barrett, Matthew; Snow, John Charles; Kirkland, Megan C; Kelly, Liam P; Gehue, Maria; Downer, Matthew B; McCarthy, Jason; Ploughman, Michelle

    2018-04-03

    Background and Purpose Previous research suggests that patients receiving inpatient stroke rehabilitation are sedentary although there is little data to confirm this supposition within the Canadian healthcare system. The purpose of this cross-sectional study was to observe two weeks of inpatient rehabilitation in a tertiary stroke center to determine patients' activity levels and sedentary time. Methods Heart rate (HR) and accelerometer data were measured using an Actiheart monitor for seven consecutive days, 24 h/day, on the second week and the last week of admission. Participants or their proxies completed a daily logbook. Metabolic equivalent (MET) values were calculated and time with MET rehabilitation, there was excessive sedentary time and therapy sessions were less frequent and of lower intensity than recommended levels. Conclusions In this sample of people attending inpatient stroke rehabilitation, institutional structure of rehabilitation rather than patient-related factors contributed to sedentary time.

  6. Prior antiplatelet drug use and short-term mortality in older patients with acute ischemic stroke (AIS).

    Science.gov (United States)

    Zuliani, Giovanni; Galvani, Matteo; Bonetti, Francesco; Prandini, Stefano; Magon, Stefania; Gasperini, Beatrice; Ruggiero, Carmelinda; Cherubini, Antonio

    2012-01-01

    Some studies suggest that previous treatment with antiplatelet agents (AA) might reduce ischemic stroke severity and improve outcomes in terms of clinical deficits or mortality. We evaluated the effect of the prior chronic use of AA on short-term (30 days) mortality in a sample of consecutive patients with AIS. Four hundred thirty-nine older patients (>65 years) with "major" AIS (modified Rankin scale ≥ 3) consecutively admitted to the University ward of Internal Medicine or Geriatrics were enrolled. Stroke was classified according to Oxfordshire Community Stroke Project (OCSP). Data recorded included: (1) clinical features; (2) medical history including home therapies, and vascular risk factors; (3) routine clinical chemistry analyzes (verb)/analyses (noun). Short-term (30 days) mortality was 27.6%. One hundred fifteen subjects (26.2%) were taking AA before admission. Compared with subjects not treated, subjects taking AA were characterized by higher prevalence of recurrent stroke (35% vs. 22%). In this group, a trend toward a higher prevalence of congestive heart failure (CHF), smoking, and altered levels of consciousness (ALC) was noted. Stroke type and short-term mortality (33% vs. 26.2%; odds ratio=OR=1.25; 95% confidence interval=CI=0.75-2.10, age and gender adjusted) were not different between the two groups. Adjustment for glucose, CHF, previous stroke, smoking, and ALC did not change mortality risk (OR=0.83; 95%CI=0.40-1.72). We conclude that in older patients hospitalized for "major" AIS, prior use of AA was not associated with any benefit in terms of short-term mortality both in patients with first, as well as in those with recurrent ischemic stroke. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

    DEFF Research Database (Denmark)

    Mard, Shan; Nielsen, Finn Erland

    2010-01-01

    To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF.......To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF....

  8. Constipation - prevalence and incidence among medical patients acutely admitted to hospital with a medical condition

    DEFF Research Database (Denmark)

    Noiesen, Eline; Trosborg, Ingelise; Bager, Louise

    2014-01-01

    To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients.......To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients....

  9. Patient-specific prediction of functional recovery after stroke.

    Science.gov (United States)

    Douiri, Abdel; Grace, Justin; Sarker, Shah-Jalal; Tilling, Kate; McKevitt, Christopher; Wolfe, Charles DA; Rudd, Anthony G

    2017-07-01

    Background and aims Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patient-specific prognostic model for monitoring recovery after stroke and assessed its clinical utility. Methods Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients' functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis. Results Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R 2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6-97.4]) and 93% [90.8-95.3], respectively, with a potential clinical utility measured by likelihood ratios (LR+:17 [10.8-26.8] at three months and LR+:11 [6.5-17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes. Conclusions A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.

  10. Does reporting of plain chest radiographs affect the immediate management of patients admitted to a medical assessment unit?

    International Nuclear Information System (INIS)

    Grosvenor, L.J.; Verma, R.; O'Brien, R.; Entwisle, J.J.; Finlay, D.

    2003-01-01

    AIM: The purpose of our study was to investigate whether reporting of plain chest radiographs affects immediate management of patients admitted to a medical assessment unit. MATERIALS AND METHODS: During a 3 month period we prospectively evaluated 200 patients who had a plain chest radiograph on admission. After the post on-call ward round, an independent medical specialist registrar reviewed the notes, retrieving relevant clinical details. The plain chest films were reported independently by a trainee radiologist and consultant, reaching a consensus report. RESULTS: There was 93% agreement between trainee and consultant radiologists (95% CI=89-96%). Seventy percent had documented reports by the on-call medical team. There was disagreement between radiology and medical reports in 49% of reported films (95% CI=40-57%). The radiologist's report led to a direct change in the immediate management of 22 patients (11%). CONCLUSION: Only 70% of films had documented reports in the clinical notes despite this being a legal requirement. Radiology reporting does cause a direct change in patient management. Chest radiographs of patients admitted to a medical admissions unit should be reported by a radiologist with the minimum of delay

  11. Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture.

    Science.gov (United States)

    Drevet, S; Bioteau, C; Mazière, S; Couturier, P; Merloz, P; Tonetti, J; Gavazzi, G

    2014-10-01

    One percent of falls in over-75 years old cause hip fracture (HF). Protein-energy malnutrition (PEM) is associated with falls and fracture. PEM screening and perioperative nutritional management are recommended by the European Society of Parenteral and Enteral Nutrition, yet data on nutritional status in elderly HF patients are sparse. The Mini Nutritional Assessment (MNA) score is presently the most effective screening tool for PEM in over-75 years old. The principal objective of the present study was to determine the prevalence on MNA of PEM in patients aged over 75 years admitted for HF. Secondary objectives were to identify factors associated with PEM and its role as a factor of evolution. A prospective observational epidemiological study included 50 patients aged over 75 years admitted for HF in an 8-bed orthopedic surgery department with a geriatric follow-up unit. PEM was defined by MNApatients was 86.1 years (range, 77-94 years). Prevalence of PEM was 28%; a further 58% of patients were at risk for PEM. PEM was associated with elevated CIRS-G (Ppatients aged over 75 years, supporting longer hospital stay. MNA is a diagnostic gold standard, not to be replaced by albuminemia or body-mass index in this perioperative clinical situation. Given the present economic stakes relating to geriatric trauma patients' hospital stay, it is essential to prevent, diagnose and treat PEM in elderly subjects. Level IV; prospective cohort study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Prevalence of hepatitis B and C infection in patients admitted at tertiary eye care centre: a hospital based study

    International Nuclear Information System (INIS)

    Junejo, S.A.; Khan, N.A.; Lodhi, A.A.

    2009-01-01

    Objective: To determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and the risk factors in patients admitted for ocular treatment at a tertiary eye care centre in Sindh Pakistan. Methodology: Nine hundred thirty one patients admitted at Liaquat University Eye Hospital Hyderabad for ocular treatment, were screened for HBV and HCV. Patients of either sex, with more than thirty years of age were included. Screening for HBV surface antigen (HBsAg) and antibodies against HCV (anti-HCV) was performed through chromatography method. Samples repeatedly reactive for HBsAg or anti-HCV were considered positive. Results: Out of 931 registered patients, 497 (53.3%) were male and 434 (46.7%) female. Hepatitis B and C was detected in 167 (17.9%) subjects. The overall seroprevalence of HBV infection within the study period was 4.6%, HCV 13.3%, and for HBV and HCV both was 3.9%. Regarding the predisposing factors, past history of blood transfusion was present in 08.3% subjects, needle injection 89.2%, barber shaving 52.6%, and 46 (27.5%) patients presented with past history of surgery. Conclusion: For the prevention of transmission of HBV and HCV infection, the community awareness regarding vaccination against Hepatitis B and risk factors for spread of HBV and HCV, implementation of population based screening and vaccination for HBV on large scale should be ensured. (author)

  13. Systemic risk score evaluation in ischemic stroke patients (SCALA): a prospective cross sectional study in 85 German stroke units.

    Science.gov (United States)

    Weimar, Christian; Goertler, Michael; Röther, Joachim; Ringelstein, E Bernd; Darius, Harald; Nabavi, Darius Günther; Kim, In-Ha; Theobald, Karlheinz; Diener, Han-Christoph

    2007-11-01

    Stratification of patients with transient ischemic attack (TIA) or ischemic stroke (IS) by risk of recurrent stroke can contribute to optimized secondary prevention. We therefore aimed to assess cardiovascular risk factor profiles of consecutive patients hospitalized with TIA/IS to stratify the risk of recurrent stroke according to the Essen Stroke Risk Score (ESRS) and of future cardiovascular events according to the ankle brachial index (ABI) as a marker of generalized atherosclerosis In this cross-sectional observational study, 85 neurological stroke units throughout Germany documented cardiovascular risk factor profiles of 10 consecutive TIA/IS patients on standardized questionnaires. Screening for PAD was done with Doppler ultrasonography to calculate the ABI. A total of 852 patients (57% men) with a mean age of 67+/-12.4 years were included of whom 82.9 % had IS. The median National Institutes of Health stroke sum score was 4 (TIA: 1). Arterial hypertension was reported in 71%, diabetes mellitus in 26%, clinical PAD in 10%, and an ABI or = 3 was observed in 58%, which in two previous retrospective analyses corresponded to a recurrent stroke risk of > or = 4%/year. The correlation between the ESRS and the ABI was low (r = 0.21). A high proportion of patients had asymptomatic atherosclerotic disease and a considerable risk of recurrent stroke according to the ABI and ESRS category. The prognostic accuracy as well as the potential benefit of various risk stratification scores in secondary stroke prevention require validation in a larger prospective study.

  14. A chart review of human immunodeficiency virus status in patients admitted with psychosis in Durban, South Africa

    Directory of Open Access Journals (Sweden)

    Sellwane M. Mere

    2018-04-01

    Full Text Available Background: Comorbid human immunodeficiency virus (HIV infection among patients with psychotic disorders is associated with a poorer outcome. Understanding the association of HIV infection with demographic and clinical variables may provide clues to modify risk factors and outcomes. Aim: To describe and compare the socio-demographic and clinical profile of patients admitted with psychotic disorders with and without HIV infection. Method: A retrospective chart review of 100 adult patients consecutively admitted with psychosis and HIV infection and compared to 101 patients with psychosis without HIV infection. Results: HIV-infected patients with psychotic disorders were more likely to be females (74.0%, younger than 50 years (94.0% and less likely to have secondary education than HIV- negative patients with psychotic disorders (56.0% vs. 72.0%. HIV-infected patients were also less likely to be diagnosed as having schizophrenia (33.0%, had higher rates of medical (73.0% and psychiatric (21.0% comorbid disorders and were less likely to report lifetime nicotine and cannabis use (p = 0.047 and p = 0.011. HIV-negative patients with psychotic disorders were more likely to be readmitted to the unit in the next 12 months (p < 0.05. HIV-infected patients with psychotic disorders had increased abnormal haematological results (33.0%. Conclusion: Patients with psychotic disorders and HIV infection had several negative prognostic factors such as younger age, increased rates of medical and psychiatric comorbidity, abnormal haematological results and longer length of admission periods. This suggests the need to target HIV prevention programmes at young females with mental illness and provide an integrated healthcare service with medical and psychiatric assessment and care for patients with HIV and psychosis.

  15. Preventive Ceftriaxone in Patients with Stroke Treated with Intravenous Thrombolysis: Post Hoc Analysis of the Preventive Antibiotics in Stroke Study

    NARCIS (Netherlands)

    Vermeij, Jan-Dirk; Westendorp, Willeke F.; Roos, Yvo B.; Brouwer, Matthijs C.; van de Beek, Diederik; Nederkoorn, Paul J.

    2016-01-01

    The Preventive Antibiotics in Stroke Study (PASS), a randomized open-label masked endpoint trial, showed that preventive ceftriaxone did not improve functional outcome at 3 months in patients with acute stroke (adjusted common OR 0.95; 95% CI 0.82-1.09). Post-hoc analyses showed that among patients

  16. Use of antibiotics in patients admitted to the hospital due to acute exacerbation of chronic obstructive pulmonary disease (COPD)

    DEFF Research Database (Denmark)

    Jacobsen, S K.; Weis, N; Almdal, T

    2002-01-01

    BACKGROUND: The purpose of this study was to assess to what extent symptoms and signs of bacterial infection are present and evaluated in patients admitted to the hospital for exacerbation of chronic obstructive pulmonary disease (COPD) in relation to initiation of antibiotic treatment. METHODS......: All adult patients (>18 years of age) discharged from a department of internal medicine in Copenhagen in 1997 with a diagnosis of exacerbation of COPD were included in our study and their reports were retrospectively reviewed. Gender, age, number of admissions and length of hospital stay, use...... was the initial antibiotic of choice. The median hospital stay was 6 days for the entire group of patients. CONCLUSION: These data suggest that, in patients with acute exacerbation of COPD, a relatively high number of patients with only weak symptoms or signs of bacterial infection are treated with antibiotics....

  17. Clinical and laboratory profile of dengue fever patients admitted in combined military hospital rawalpindi in year 2015

    International Nuclear Information System (INIS)

    Rehman, M. M. U.; Zakaria, M.; Mustafvi, S. A.

    2017-01-01

    Objective: The purpose of this study was to determine the pattern of clinical presentations, haematological and biochemical abnormalities, and outcome of dengue fever patients admitted in Combined Military Hospital (CMH) Rawalpindi in year 2015. Study Design: A descriptive cross sectional study. Place and Duration of Study: Department of Medicine, CMH Rawalpindi, from January 2015 to December 2015. Material and Methods: Patients meeting the inclusion criteria were admitted at CMH Rawalpindi and blood serology was done to confirm the diagnosis of dengue fever. Cases with positive dengue serology were included in the study. Clinical symptoms, signs, investigations and outcome of these patients were recorded on a proforma. Blood samples were taken for analysis. Chest X-Ray and ultrasound abdomen were done on required basis. Results: Out of forty confirmed cases of dengue fever, there were 25 (62.5 percent) males and 15 (37.5 percent) females. Mean age was 40 years. There were 39 cases (97.5 percent) of dengue fever and one case (2.5 percent) of dengue shock syndrome.There was no case of dengue haemorrhagic syndrome. Maximum cases were seen in the month of October 2015.The clinical features noted were: headache and myalgias 62.5 percent, chills and rigors 57.5 percent, retro-orbital pain 42.5 percent, vomiting 35.0 percent, pruritus 27 percent, skin rash 20 percent, abdominal pain 20 percent, diarrhoea 10 percent, bleeding 2.5 percent, ascites and pleural effusion 2.5 percent, and hepatomegaly 15 percent. The laboratory findings were: leucopenia 85 percent and thrombocytopenia 92.5 percent. Serum alanine transaminase (ALT), urea, and creatinine were raised in 30 percent, 2.5 percent and 7.5 percent cases respectively. Mortality was 2.5 percent. Conclusion: This study showed that patients admitted to CMH hospital had a milder presentation of dengue fever in the year 2015. (author)

  18. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    Directory of Open Access Journals (Sweden)

    Ersin Kasım Ulusoy

    2015-08-01

    Full Text Available Emery-Dreifuss muscular dystrophy (EDMD is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t have regular cardiac follow-up was reported and the importance of the treatment of cardiac diseases which could play a role in ischemic stroke etiology and the implantation of pace-maker was mentioned.

  19. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  20. Carotid artery calcification in ischemic stroke patients detected in standard dental panoramic radiographs - a preliminary study

    International Nuclear Information System (INIS)

    Christou, P.; Kiliaridis, S.; Leemann, B.; Schimmel, M.; Muller, F.

    2010-01-01

    Purpose: Examine the prevalence of carotid artery calcifications in standard dental panoramic radiographs (OPT), their association to gender, medical history and oral status. Assess the predictive value of a dental OPT in early diagnosis of carotid artery calcifications. Material and Methods: Fourteen patients admitted to Geneva University Hospital for recent ischemic stroke and stenosis of the carotid artery confirmed by Duplex sonography. All OPTs were digitised and subsequently assessed independently by two operators. Results: From 21 carotid artery calcifications detected with Doppler sonography 15 were visible on the corresponding OPT, most of them on the right side (n=11). No correlation was found between the side of calcification and cerebral lesion. Hypertension and periodontal disease were the most prevalent cardiovascular risk factors. Conclusions: Dentists who either detect carotid artery calcifications in OPTs or see patients with severe periodontitis should consider a prophylactic specialist examination. (authors)

  1. Impact of naturalistic lighting on hospitalized stroke patients in a rehabilitation unit

    DEFF Research Database (Denmark)

    West, Anders; Jennum, Poul; Simonsen, Sofie Amalie

    2017-01-01

    Introduction and rationale: Stroke is a major cause of acquired cerebral disability among adults, frequently accompanied by depression, anxiety, cognitive impairment, disrupted sleep and fatigue. New ways of intervention to prevent these complications are therefore needed. The major circadian...... a positive impact on the health of poststroke patients admitted to rehabilitation. We test specifically for improved sleep and less fatigue (questionnaires, polysomnography, Actiwatch), improved well-being (questionnaires), lessen anxiety and depression (questionnaires), improved cognition (tests...... on patients during long-term hospitalization in a real hospital setting. The hypotheses are based on preclinical research, as studies using naturalistic light have never been performed before. Investigating the effects of naturalistic light in a clinical setting is therefore much needed....

  2. Noonan Syndrome and Stroke: A Case Report

    Directory of Open Access Journals (Sweden)

    Ebru Nur Mıhçı

    2012-03-01

    Full Text Available Noonan syndrome is an autosomal dominant genetic disease characterized by short stature, webbed neck, typical facial appearance and congenital heart disease. Here we report a 24 year old woman patient with the diagnosis of Noonan syndrome who admitted to our clinic with ischemic stroke caused by atrial fibrillation secondary to hypertrophic cardiomyopathy. Noonan syndrome patients with stroke due to vascular malformations have been reported, but non-obstructive hypertrophic cardiomyopathy is a rare cause for stroke in patients with Noonan syndrome. Our aim of presenting the case emphasize that Noonan syndrome should be thought as a differential diagnosis in patients with stroke at a young age and dysmorphic facial appearance

  3. Noonan Syndrome and Stroke: A Case Report

    Directory of Open Access Journals (Sweden)

    Ebru Nur Mıhçı

    2012-03-01

    Full Text Available Noonan syndrome is an autosomal dominant genetic disease characterized by short stature, webbed neck, typical facial appearance and congenital heart disease. Here we report a 24 year old woman patient with the diagnosis of Noonan syndrome who admitted to our clinic with ischemic stroke caused by atrial fibrillation secondary to hypertrophic cardiomyopathy. Noonan syndrome patients with stroke due to vascular malformations have been reported, but non-obstructive hypertrophic cardiomyopathy is a rare cause for stroke in patients with Noonan syndrome. Our aim of presenting the case emphasize that Noonan syndrome should be thought as a differential diagnosis in patients with stroke at a young age and dysmorphic facial appearance.

  4. Use of computerized tomography in brain stroke

    Energy Technology Data Exchange (ETDEWEB)

    Landmark, K.; Aursnes, I.; Eldvik, P.; Lilleaas, F.G.

    1988-04-01

    In a retrospective study in 115 patients consecutively admitted to a ''stroke unit'', 108 were found to have been subjected to one or more cerebral CT-scans, of which ten revealed cerebral haemorrhage, two tumor cerebri and one subdural haematoma. The latter patient was successfully operated upon. The clinical diagnosis of stroke in progression was made in seven patients, whereas embolic stroke was diagnosed in 22. After haemorrhage had been excluded by CT, anticoagulant therapy (warfarin/heparin) was started for various reasons in 35 patients altogether. It is concluded that CT, if available locally, should be performed routinely during the first days following acute stroke.

  5. Use of computerized tomography in brain stroke

    International Nuclear Information System (INIS)

    Landmark, K.; Aursnes, I.; Eldvik, P.; Lilleaas, F.G.

    1988-01-01

    In a retrospective study in 115 patients consecutively admitted to a ''stroke unit'', 108 were found to have been subjected to one or more cerebral CT-scans, of which ten revealed cerebral haemorrhage, two tumor cerebri and one subdural haematoma. The latter patient was successfully operated upon. The clinical diagnosis of stroke in progression was made in seven patients, whereas embolic stroke was diagnosed in 22. After haemorrhage had been excluded by CT, anticoagulant therapy (warfarin/heparin) was started for various reasons in 35 patients altogether. It is concluded that CT, if available locally, should be performed routinely during the first days following acute stroke

  6. [Acute ethanol intoxication among children and adolescents. A retrospective analysis of 173 patients admitted to a university children hospital].

    Science.gov (United States)

    Schöberl, S; Nickel, P; Schmutzer, G; Siekmeyer, W; Kiess, W

    2008-01-01

    In the last time the alcohol consumption among children and adolescents is a big theme in all kind of media. The ethanol consumption among children and adolescents has risen during the last years, but also new hazardous drinking patterns like "binge-drinking" are increasing. These drinking episodes are responsible for many hospital presentations of children and adolescents with acute ethanol intoxication. This study is a retrospective analysis of 173 patients admitted to the university children hospital of Leipzig due to acute ethanol intoxication during the period 1998-2004. Investigated parameters were: socio-demographic factors, clinical presentation and management as well as quantity and type of alcohol. During the years 1998-2004 the rate of alcohol intoxicated patients in this study increased, from 1998-2003 at about 171.4%. Totally 173 patients with an average age of 14.5 years were admitted to the university children hospital. There were significantly more boys than girls. The mean blood alcohol concentration of these patients was 1.77%. Some of the patients had severe symptoms. 62 were unconscious, 2 were in coma and at least 3 patients had to be ventilated. A difference between socioeconomic groups could be observed by comparing the different school types. 44.8% of the patients went to the middle school. Furthermore 17 patients of this study had mental disorders or psychosocial problems and were therefore in psychological or psychiatric treatment. In this study a significant influence of social classes or psychosocial problems on alcohol consumption such as binge-drinking leading to acute ethanol intoxication could not be found. Alarming is the increasing number of ethanol intoxicated patients, the young age, the high measured blood ethanol concentrations and the severe symptoms of these patients. This is the reason why early and intensive prevention strategies are required.

  7. Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital

    Science.gov (United States)

    Zaky, Hend Elham Mohamed; EL-Lateef Mohammad, Zienab Abd; EL-Labban, Abdou Saad Taha; Ahmed, Gahen

    2015-01-01

    Background: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of…

  8. Help seeking behavior and onset-to-alarm time in patients with acute stroke: sub-study of the preventive antibiotics in stroke study

    NARCIS (Netherlands)

    Zock, E.; Kerkhoff, H.; Kleyweg, R. P.; van Bavel-Ta, T. B. V.; Scott, S.; Kruyt, N. D.; Nederkoorn, P. J.; van de Beek, D.

    2016-01-01

    Patients with acute stroke often do not seek immediate medical help, which is assumed to be driven by lack of knowledge of stroke symptoms. We explored the process of help seeking behavior in patients with acute stroke, evaluating knowledge about stroke symptoms, socio-demographic and clinical

  9. Learned helplessness among families and surrogate decision-makers of patients admitted to medical, surgical, and trauma ICUs.

    Science.gov (United States)

    Sullivan, Donald R; Liu, Xinggang; Corwin, Douglas S; Verceles, Avelino C; McCurdy, Michael T; Pate, Drew A; Davis, Jennifer M; Netzer, Giora

    2012-12-01

    We sought to determine the prevalence of and clinical variables associated with learned helplessness, a psychologic state characterized by reduced motivation, difficulty in determining causality, and depression, in family members of patients admitted to ICUs. We conducted an observational survey study of a prospectively defined cohort of family members, spouses, and partners of patients admitted to surgical, medical, and trauma ICUs at a large academic medical center. Two validated instruments, the Learned Helplessness Scale and the Perceived Stress Scale, were used, and self-report of patient clinical characteristics and subject demographics were collected. Four hundred ninety-nine family members were assessed. Of these, 238 of 460 (51.7%) had responses consistent with a significant degree of learned helplessness. Among surrogate decision-makers, this proportion was 50% (92 of 184). Characteristics associated with significant learned helplessness included grade or high school education (OR, 3.27; 95% CI, 1.29-8.27; P = .01) and Perceived Stress Scale score > 18 (OR, 4.15; 95% CI, 2.65-6.50; P learned helplessness (OR, 0.56; 95% CI, 0.32-0.98; P = .05). The majority of family members of patients in the ICU experience significant learned helplessness. Risk factors for learned helplessness include lower educational levels, absence of an advance directive or DNR order, and higher stress levels among family members. Significant learned helplessness in family members may have negative implications in the collaborative decision-making process.

  10. [Frequency and in vitro susceptibility antiparasitic of Blastocystis hominis from patients admitted to the Hospital Regional Lambayeque, Peru].

    Science.gov (United States)

    Silva-Díaz, Heber; Flores-Esqueche, Lorena; Llatas-Cancino, Dunalia; Guevara Vásquez, Génesis; Silva-García, Teresa

    2016-01-01

    To describe the frequency and antiparasitic in vitro susceptibility of Blastocystis hominis in patients admitted to theHospital Regional Lambayeque, Peru. A cross-sectional study was conducted from January to August 2015 at 313 patients of all ages. B. hominis detection was performed on serial fecal samples by direct microscopic examination and microculture in modified Locke solution. The in vitro susceptibility testing against the drug metronidazole, nitazoxanide, trimethoprim-sulfamethoxazole and erythromycin was performed in 24 strains of B. hominis, which grew up (microculture method) in 10 double concentrations of each antimicrobial (from 256 ug/ml to 0.5 ug/mL) plus a control. 46.3% (145/313) of the sample had B. hominis, also the age between 12 to 17 years and 60 years was associated with higher frequency of parasites (OR: 2.93 and 2.62). The minimum inhibitory concentration (MIC) 90 of metronidazole and nitazoxanide was 3.19 ug/mL and 11.19 ug/ml, respectively, whereas the MIC 90 of trimethoprim-sulfamethoxazole and erythromycin were above 256 ug/mL. B. hominis occurs in high frequency in patients admitted to the Hospital Regional in Lambayeque, proving to be an important problem of public health in the region. Also B. hominis isolated from these patients were shown to be susceptible in vitro to low concentrations of metronidazole and nitazoxanide so they could be chosen for treatment of this parasite.

  11. Chinese Medicine Patterns in Patients with Post-Stroke Dementia

    Directory of Open Access Journals (Sweden)

    Nou-Ying Tang

    2012-04-01

    Full Text Available A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP. Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I’Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. Results: 100 patients (99.0% were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, 腎精虧虛證, 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, 肝陽上亢證, 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, 氣血虧虛證, 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, 瘀血阻絡證, 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, 腑滯濁留證, 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, 火熱內盛證, and 39 participants (38.6% were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, 痰濁阻竅證; one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

  12. Chinese medicine patterns in patients with post-stroke dementia.

    Science.gov (United States)

    Tang, Nou-Ying; Liu, Chung-Hsiang; Liu, Hsu-Jan; Li, Tsai-Chung; Liu, Jui-Chen; Chen, Ping-Kun; Hsieh, Ching-Liang

    2012-04-01

    A stroke often results in post-stroke dementia, a rapid decline in memory and intelligence causing dysfunctions in daily life. The Chinese medicine doctor uses 4 examinations of inspection, listening, smelling, and feeling to determine the Chinese medicine pattern (CMP). Therefore, the purpose of the present study was to investigate the CMP in patients with post-stroke dementia. A total of 101 stroke patients were examined, consistent with the DSM IV diagnostic criteria of the American Psychiatric Association, as well as the National Institute of Neurological Disorders and Stroke-Association International pour Ia Recherche et I'Enseignement en Neurosciences vascular dementia diagnostic criteria of post-stroke dementia. 100 patients (99.0%) were KEDP (kidney essence deficiency pattern, shèn jīng kuī xū zhèng, ), 83 patients were AHLYP (ascendant hyperactivity of liver yang pattern, gān yáng shàng kàng zhèng, ), 83 patients were QBDP (qi-blood deficiency pattern, qì xuè kuī xū zhèng, ), 81 patients were SBOCP (static blood obstructing the collaterals pattern, yū xuè zǔ luò zhèng, ), 72 patients were BSTRP (bowels stagnation turbidity retention pattern, fǔ zhì zhuó liú zhèng, ), 50 patients were FHIEP (fire heat interior excess pattern, huǒ rè nèi sheng zhèng, ), and 39 participants (38.6%) were PTOOP (phlegm turbidity obstructing the orifices pattern, tán zhuó zǔ qiào zhèng, ); one to 31 patients have at least 2 CMPs simultaneously. In conclusion, the most CMP is KEDP CMP in the post-stroke dementia patients, and one patient may have one or at least 2 CMPs simultaneously.

  13. Brisk walking can promote functional recovery in chronic stroke patients.

    Science.gov (United States)

    Batcho, Charles Sèbiyo; Stoquart, Gaëtan; Thonnard, Jean-Louis

    2013-09-01

    To determine whether regular brisk walking can promote functional recovery in community-dwelling stroke patients. A total of 44 chronic stroke patients, recruited in Belgium and Benin, respectively European high-income and African low-income countries. This longitudinal, single-cohort, observational study with 1 intervention period and 4 time-points of assessments (2 baseline, 1 post-intervention and 1 follow-up) was structured in 3 periods: pre-intervention period (1 month), intervention period (3 months) and follow-up period (3 month). Intervention consisted of a 3 times/week group-based brisk walking programme. Primary outcome measures were ACTIVLIM-Stroke questionnaire and the 6-minute walk test (6MWT). Secondary outcome measures were the Stroke Impairment Assessment Set (SIAS), the Hospital Anxiety and Depression Scale (HADS), and the Berg Balance Scale (BBS). All outcome measures were stable during the pre-intervention period (p ≥ 0.16). They all improved significantly after intervention (p ≤ 0.01), except the HADS (p = 0.058). However, during the follow-up period, SIAS (p = 0.002) and BBS (p = 0.001) decreased, while ACTIVLIM-Stroke, 6MWT and HADS showed no significant change (p ≥ 0.13). This study suggests regular brisk walking as an effective approach to promote functional recovery in chronic stroke survivors. However, further studies are required before generalizing these results to the whole stroke population.

  14. Cognitive Profile of Elderly Patients with Mild Stroke

    Directory of Open Access Journals (Sweden)

    Arne Gramstad

    2011-11-01

    Full Text Available Background: A pattern characterizing cognitive deficits in mild stroke could help in differential diagnosis and rehabilitation planning. Methods: Fifty patients with mild stroke (modified Rankin scale ≤2 at discharge aged >60 years were given the Mini Mental State Examination (MMSE, the Hopkins Verbal Learning Test-Revised (HVLT-R and the Stroop test. Results: On HVLT-R, significant impairments were found in learning and recall, but not in delayed recall. The Stroop test revealed significant impairments in reading speed, but not in color-word interference. Using the MMSE, significant deficits were only found in the youngest age group. Conclusion: Elderly patients with mild stroke show deficits in verbal learning/recall and in reading speed, but not in the MMSE, delayed recall or color-word interference. The deficits are consistent with a mild-to-moderate brain dysfunction, with relative sparing of medial brain structures.

  15. Language-specific dysgraphia in Korean stroke patients.

    Science.gov (United States)

    Yoon, Ji Hye; Suh, Mee Kyung; Kim, HyangHee

    2010-12-01

    We investigated how changes in the writing of 14 Korean stroke patients reflect the unique features of the Korean writing system. The Korean writing system, Han-geul, has both linguistic and visuospatial/constructive characteristics. In the visuospatial construction of a syllable, the component consonant(s) and vowel(s) must be arranged from top-to-bottom and/or left-to-right within the form of a square. This syllabic organization, unique to Korean writing, may distinguish dysgraphia in Korean patients from the disorder in other languages, and reveal the effects of stroke on visuospatial/constructive abilities. We compared 2 groups of patients affected by stroke, 1 group with left hemisphere (LH) lesions and the other with right hemisphere (RH) lesions. We instructed them to write from a dictation of 90 monosyllabic stimuli, each presented with a real word cue. Patients had to repeat a target syllable and a word cue, and then to write the target syllable only. Patients with LH and RH lesions produced qualitatively different error patterns. While the LH lesion group produced primarily linguistic errors, visuospatial/constructive errors predominated in the group with RH lesions. With regard to language-specific features, these Korean patients with RH lesions produced diverse visuospatial/constructive errors not commonly observed in dysgraphia of the English language. Language-specific writing errors by Korean stroke patients reflect the unique characteristics of Korean writing, which include the arrangement of strokes and graphemes within a square syllabic form by dimensional and spatial rules. These findings support the notion that the Korean writing system possesses a language-specific nature with both linguistic and visuospatial/constructive processes. Distinctive patterns of dysgraphia in the Korean language also suggest interactivity between linguistic and visuospatial/constructive levels of processing. This study is noteworthy for its systematic description of

  16. Brain perfusion-CT in acute stroke patients

    International Nuclear Information System (INIS)

    Andreev, T.; Totsev, N.; Tzvetanov, P.

    2013-01-01

    Since 1979 when Grodfrey Hounsfield and Allan Corman introduced the computed tomography new generations of CT were developed that improved the special resolution and time of acquisition. The role of neuro-imaging in the evaluation of acute stroke has changed dramatically in the past decade. Previously, neuro-imaging was used in this set-ting to provide anatomic imaging that indicated the presence or absence of acute cerebral ischemia and excluded lesions that produce symptoms or signs mimicking those of stroke, such as hemorrhage and neoplasms. More recently, the introduction of thrombolysis has changed the goals of neuro-imaging from providing solely anatomic information to providing physiologic information that could help to determine which patients might benefit from therapy. In particular, significant emphasis has been placed on the delineation of the ischemic penumbra, also called tissue at risk. Modem CT survey, consisting of three indissociable elements; noncontrast CT (NCT) of course, perfusion-CT (PCT) and CT-angiography (CTA), fulfill all the requirements for hyperacute stroke imaging. CTA can define the occlusion site, depict arterial dissection, grade collateral blood flow, and characterize atherosclerotic disease, whereas PCT accurately defines the infarct core and the ischemic penumbra. CT offers a number of practical advantages over other cerebral perfusion imaging methods, including its wide availability. Using PCT and CTA to define new individualized strategies for acute reperfusion will allow more acute stroke patients to benefit from thrombolytic therapy. Key words: Stroke. Penumbra. Computed Tomography. Perfusion-CT. CT Angiography. Outcome

  17. The effect of stimulant and sedative use on treatment outcome of patients admitted to methadone maintenance treatment.

    Science.gov (United States)

    DeMaria, P A; Sterling, R; Weinstein, S P

    2000-01-01

    While methadone maintenance treatment (MMT) has been demonstrated to be an effective treatment for opiate dependence, its impact on the treatment outcome of other illicit drug abuse is not as clear. Using the initial urine drug screen (UDS) and follow-up UDS at 1, 6, 12, and 24 months, 167 patients consecutively admitted to MMT were evaluated for opiate, sedative (predominantly benzodiazepine), and stimulant (predominantly cocaine) use. Retention for the opiate only group was 97.32 days longer on average than for patients using opiates along with stimulants, sedatives, or both stimulants and sedatives. Patients abusing opiates only had the greatest decrease in drug use; however, MMT was also associated with decreases in cocaine and sedative use over the 24 month follow-up period. There was no evidence that patients "switched" their drugs of abuse with time in treatment. The negative impact of non-opiate drug use on outcome in MMT and its implications for treatment planning are discussed.

  18. Resistant hypertension, patient characteristics, and risk of stroke.

    Directory of Open Access Journals (Sweden)

    Chen-Ying Hung

    Full Text Available Little is known about the prognosis of resistant hypertension (RH in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes.Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6% patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years. Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events] in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years. There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09-1.26; p<0.001. Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08-1.27; p<0.001, especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20-1.48; p<0.001, but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95-1.19; p = 0.312 or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99-1.39; p = 0.070 were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients.Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and elderly patients than in male or young

  19. Resistant Hypertension, Patient Characteristics, and Risk of Stroke

    Science.gov (United States)

    Hung, Chen-Ying; Wang, Kuo-Yang; Wu, Tsu-Juey; Hsieh, Yu-Cheng; Huang, Jin-Long; Loh, El-Wui; Lin, Ching-Heng

    2014-01-01

    Background Little is known about the prognosis of resistant hypertension (RH) in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes. Methods and Results Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6%) patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years). Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events]) in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years). There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years) patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09–1.26; p<0.001). Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08–1.27; p<0.001), especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20–1.48; p<0.001), but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95–1.19; p = 0.312) or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99–1.39; p = 0.070) were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients. Conclusions Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and

  20. How is nursing care for stroke patients organised? Nurses' views on best praactices

    DEFF Research Database (Denmark)

    Lind, Jette; Struwe, Jytte Holm; Baernholdt, Marianne

    2013-01-01

    In the developed world, stroke is the third leading cause of death (DSFA 2009) In Denmark there are 12400 new patients every year and 30000 - 40000 people living with long-term after stroke. This group consists mainly of people aged 80 years and older. When these patients have a stroke their biol......In the developed world, stroke is the third leading cause of death (DSFA 2009) In Denmark there are 12400 new patients every year and 30000 - 40000 people living with long-term after stroke. This group consists mainly of people aged 80 years and older. When these patients have a stroke...

  1. [Predictors of the therapeutic discharge in patients with dual pathology admitted to a therapeutic community with a psychiatric unit].

    Science.gov (United States)

    Madoz-Gúrpide, Agustín; García Vicent, Vicente; Luque Fuentes, Encarnación; Ochoa Mangado, Enriqueta

    2013-01-01

    This study aims to analyze the variables on which depends therapeutic discharge, in patients with a severe dual diagnosis admitted to a professional therapeutic community where their pathology is treated. 325 patients admitted between June 2000 and June 2009 to the therapeutic community. This is a retrospective, cross-sectional study with no control group, based on the detailed analysis of the information collected in a model of semi-structured clinical interview designed in the therapeutic community. The 29.5% of the individuals included in the sample were therapeutically discharged. Of all the variables introduced in this analysis the most significant ones were gender, age at the beginning of treatment, education level, opiate dependence, polidrug abuse, and the presence of psychotic disorders and borderline personality disorder. In our study, gender determines the type of discharge, being therapeutic discharge more frequent among women. A higher educational also increases a better prognosis with a higher rate of therapeutic discharge among individuals with higher education level. A later age at the beginning of the treatment reduces the likelihood of therapeutic discharge. Likewise, polidrug abuse, diagnosis of psychotic disorders and borderline personality disorder are associated to a lower rate of therapeutic discharge. Recognizing these characteristics will allow the early identification of those patients more at risk of dropping treatment hastily, while trying to prevent it by increasing the therapeutic intensity.

  2. Comparison of cardiovascular risk factors and survival in patients with ischemic or hemorrhagic stroke.

    Science.gov (United States)

    Henriksson, Karin M; Farahmand, Bahman; Åsberg, Signild; Edvardsson, Nils; Terént, Andreas

    2012-06-01

    Differences in risk factor profiles between patients with ischemic and hemorrhagic stroke may have an impact on subsequent mortality. To explore cardiovascular disease risk factors, including the CHADS(2) score, with survival after ischemic or hemorrhagic stroke. Between 2001 and 2005, 87 111 (83%) ischemic stroke, 12 497 (12%) hemorrhagic stroke, and 5435 (5%) patients with unspecified stroke were identified in the Swedish Stroke Register. Data on gender, age, and cardiovascular disease risk factors were linked to the Swedish Hospital Discharge and Cause of Death Registers. Adjusted odds and hazard ratios and 95% confidence interval were calculated using logistic and Cox proportional hazard regression models. Hemorrhagic stroke patients were younger than ischemic stroke patients. All cardiovascular disease risk factors studied, alone or combined in the CHADS(2) score, were associated with higher odds ratios for ischemic stroke vs. hemorrhagic stroke. Higher CHADS(2) scores and all studied risk factors except hypertension were associated with higher odds ratio for death by ischemic stroke than hemorrhagic stroke. Ischemic stroke was associated with lower early mortality (within 30 days) vs. hemorrhagic stroke (hazard ratio = 0·28, confidence interval 0·27 to 0·29). Patients with hemorrhagic stroke had a higher risk of dying within the first 30 days after stroke, but the risk of death was similar in the two groups after one-month. Hypertension was the only cardiovascular disease risk factor associated with an increased mortality rate for hemorrhagic stroke as compared to ischemic stroke. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

  3. Who is sleeping in our beds? Factors predicting the ED boarding of admitted patients for more than 2 hours.

    Science.gov (United States)

    Hodgins, Marilyn J; Moore, Nicole; Legere, Laura

    2011-05-01

    Although the provision of inpatient care is not typically associated with emergency nursing, it is the new reality in many departments. Given the number of admitted patients boarded in the emergency department for part or all of their hospital stay, it is important to know who these patients are. The purpose of this analysis was to determine whether the occurrence of ED boarding could be predicted by factors specific to the type and timing of the ED visit or whether patient characteristics also affected these decisions. A retrospective review of administrative data for a 1-year period was conducted. Chi-square and logistic regression analyses were used to determine whether the likelihood of being boarded for more than 2 hours could be predicted by factors specific to the type of visit (ie, triage level and admission type) and timing of the visit (ie, time of day and day of week) or whether patient characteristics (ie, sex and age group) also played a role. Slightly more than half of patients remained in the emergency department for more than 2 hours following receipt of an admission order. Results suggest the likelihood of boarding was highest for those who were medical admissions and admitted on a weekday or during the night shift. Even after accounting for these factors, patient characteristics improved the ability to predict ED boarding. Female patients and those 65 years of age or older were more likely to be boarded. Findings suggest that in addition to their usual responsibilities, emergency nurses are providing care to a group of inpatients who tend to have high medical and nursing care needs. Copyright © 2011 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  4. Discharge Disposition After Stroke in Patients With Liver Disease.

    Science.gov (United States)

    Parikh, Neal S; Merkler, Alexander E; Schneider, Yecheskel; Navi, Babak B; Kamel, Hooman

    2017-02-01

    Liver disease is associated with both hemorrhagic and thrombotic processes, including an elevated risk of intracranial hemorrhage. We sought to assess the relationship between liver disease and outcomes after stroke, as measured by discharge disposition. Using administrative claims data, we identified a cohort of patients hospitalized with stroke in California, Florida, and New York from 2005 to 2013. The predictor variable was liver disease. All diagnoses were defined using validated diagnosis codes. Ordinal logistic regression was used to analyze the association between liver disease and worsening discharge disposition: home, nursing/rehabilitation facility, or death. Secondarily, multiple logistic regression was used to analyze the association between liver disease and in-hospital mortality. Models were adjusted for demographics, vascular risk factors, and comorbidities. We identified 121 428 patients with intracerebral hemorrhage and 703 918 with ischemic stroke. Liver disease was documented in 13 584 patients (1.7%). Liver disease was associated with worse discharge disposition after both intracerebral hemorrhage (global odds ratio, 1.28; 95% confidence interval, 1.19-1.38) and ischemic stroke (odds ratio, 1.23; 95% confidence interval, 1.17-1.29). Similarly, liver disease was associated with in-hospital death after both intracerebral hemorrhage (odds ratio, 1.33; 95% confidence interval, 1.23-1.44) and ischemic stroke (odds ratio, 1.60; 95% confidence interval, 1.51-1.71). Liver disease was associated with worse hospital discharge disposition and in-hospital mortality after stroke, suggesting worse functional outcomes. © 2016 American Heart Association, Inc.

  5. Towards evidence-based physiotherapy for patients with stroke

    NARCIS (Netherlands)

    van Peppen, R.P.S.

    2008-01-01

    The first aim of the thesis was to collect and review systematically, and to appraise critically the available evidence stemming from physiotherapy and physiotherapy-related studies in patients with stroke. It can be concluded that the application of physiotherapy improves performance to execute

  6. Long-term outcome in children of patients after stroke

    NARCIS (Netherlands)

    van de Port, Ingrid G. L.; Visser-Meily, Anne M. A.; Post, Marcel W. M.; Lindeman, Eline

    2007-01-01

    Objective: To investigate the long-term effects on children of parental stroke, with respect to care-giving tasks, children's behavioural problems and stress, and to study the relationship between stress and child, patient and partner characteristics. Subjects: A total of 44 children (age range

  7. Emotional reactions in patients after frontal lobe stroke.

    Science.gov (United States)

    Stojanović, Zlatan; Stojanović, Sanja Vukadinović

    2015-09-01

    Emotional reactions have been documented after tumor lesions and the other damages of the brain. The aim of this paper was to examine the correlation between frontal lobe lesions and emotional reactions in patients with stroke. The research included 118 patients after stroke. Lesion localization was defined on computed axial tomography records, whereas the area and perimeter of lesion were measured by AutoCAD 2004 software. Examinations by means of the Hamilton Rating Scale for Anxiety and Depression (HRSA and HRSD) were carried out 11-40 days after stroke. Statistic data were processed by simple linear/nonlinear regression, Cox's and the generalized linear model. A higher frequency of emotional reactions, i.e. anxiety, was determined in women after stroke (p = 0.024). A negative correlation between the lesion size and the intensity of anxiety manifestations was determined (Spearman's r = -0.297; p = 0.001). Anxiety was more frequent in patients with frontal lobe lesions in the dominant hemisphere (interaction: frontal lesion * hand dominant hemisphere, p = 0.017). Also, HRSD score values showed the tendency for lesser decline in case of greater frontal lobe lesions in relation to lesions of other regions of prosencephalon (interaction: frontal lesion * lesion area, p = 0.001). The results of this study indicate the correlation between evolutionary younger structures of the central nervous system and emotional reactions of man. Therefore, it is necessary to undertake proper early psychopharmacotherapy in the vulnerable group of patients.

  8. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    DEFF Research Database (Denmark)

    Andreasen, Jane; Lund, Hans; Aadahl, Mette

    2015-01-01

    INTRODUCTION: Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences...... of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. METHODS: The qualitative methodological approach was interpretive description. Data were...... gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. RESULTS: Four main categories were identified: "The system," "Keeping a social life," "Being...

  9. Multiple Sclerosis (M.S.: Epidemiologic Research in 187 Patients Who Admitted in University Cnters of Tehran in 1998

    Directory of Open Access Journals (Sweden)

    Homeira Sajjadi

    2001-01-01

    Full Text Available Objective: Multiple Sclerosis (M.S. is a chronic disease which most commonly involves females. Prevalence of disease begins from adolescent, gradually increases until 35 years old and then decreases. Its geographical distribution is non homogen and prevalence changes from 5/100000 to 250/100000. Iran is a low incident region with prevalence of 5/100000 or at least 3000 patients. Materials & Methods: This research has been done on 187 patients who admitted in Tehran university centers in 1998. Results: Results show that 63.3% of patients were female and most of them were married. The average age at beginning was 28y. Conclusion: Manifestation of disease were: Extremity weakness (44.2%, vision cloudiness and diplopia (33.7% and sensory disturbances (32.2%.

  10. The risk of ischaemic stroke in primary antiphospholipid syndrome patients

    DEFF Research Database (Denmark)

    Radin, M; Schreiber, K; Cecchi, I

    2018-01-01

    BACKGROUND AND PURPOSE: The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic...... thrombosis and were receiving vitamin K antagonist (VKA), with international normalized ratio target 2-3; one patient had a history of a previous arterial event receiving treatment with VKA target international normalized ratio 2-3 plus low dose aspirin; and one patient had a history of previous pregnancy...... morbidity receiving only low dose aspirin. Time in the therapeutic range for patients receiving VKA was 77.7% (SD 6.6%). Hypercholesterolaemia was significantly higher in patients with confirmed stroke compared to those without (P

  11. Cognitive Investigation Study of Patients Admitted for Cosmetic Surgery: Information, Expectations, and Consent for Treatment

    Directory of Open Access Journals (Sweden)

    Mauro Barone

    2015-01-01

    Full Text Available BackgroundIn all branches of medicine, it is the surgeon's responsibility to provide the patient with accurate information before surgery. This is especially important in cosmetic surgery because the surgeon must focus on the aesthetic results desired by the patient.MethodsAn experimental protocol was developed based on an original questionnaire given to 72 patients. The nature of the responses, the patients' motivation and expectations, the degree of patient awareness regarding the planned operation, and the patients' perceptions of the purpose of the required consent for cosmetic surgery were all analyzed using Fisher's exact test.ResultsCandidates for abdominal wall surgery had significantly more preoperative psychological problems than their counterparts did (P=0.035. A significantly different percentage of patients under 40 years of age compared to those over 40 years of age searched for additional sources of information prior to the operation (P=0.046. Only 30% of patients with a lower educational background stated that the preoperative information had been adequate, whereas 92% of subjects with secondary schooling or a postsecondary degree felt that the information was sufficient (P=0.001. A statistically significant difference was also present between patients according to their educational background regarding expected improvements in their quality of life postoperatively (P=0.008.ConclusionsThis study suggests that patients require more attention in presurgical consultations and that clear communication should be prioritized to ensure that the surgeon understands the patient's expectations.

  12. HFE mutations and hemochromatosis in Danish patients admitted for HFE genotyping

    DEFF Research Database (Denmark)

    Koefoed, P; Dalhoff, K; Dissing, J

    2002-01-01

    Analysis of the common C282Y and H63D mutations in the HFE gene is widely used to diagnose hereditary hemochromatosis (HH). The aim of this study was to evaluate the efficiency with which different hospitals and general practitioners select patients for HH genotype and to determine the distribution...... of HFE mutations in such patients. Nine hundred unrelated patients from Danish hospitals and general practitioners (group A) and 69 consecutive patients from a specialized liver unit (group B) were examined for HFE substitutions using multiplex real-time polymerase chain reaction. In group A we found 13...... in the H63D homozygotes or S65C heterozygotes. Moreover, 7 wild-type patients, 2 C282Y heterozygote patients and one H63D heterozygote patient fulfilled the criteria for HH. The significant enrichment of HH among associated genotype samples submitted for HFE testing indicates that the clinical selection...

  13. Evaluation of patients with stroke monitored by home care programs

    Directory of Open Access Journals (Sweden)

    Ana Railka de Souza Oliveira

    2013-10-01

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  14. Evaluation of patients with stroke monitored by home care programs

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    Ana Railka de Souza Oliveira

    Full Text Available The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%, elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8% and instrumental (80.3 % activities of daily living, and a low cognitive level (95.1%. Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

  15. [Efficacy of agreements within the Enchede Stroke Service to refer patients with a stroke from the stroke unit in the hospital to a nursing home for short-term rehabilitation

    NARCIS (Netherlands)

    Nijmeijer, N.M.; Stegge, B.M. aan de; Zuidema, S.U.; Sips, H.J.W.; Brouwers, P.J.

    2005-01-01

    OBJECTIVE: To assess the efficacy of agreements within the Enschede Stroke Service to refer patients with a stroke from the stroke unit in the hospital to a nursing home for short-term rehabilitation. DESIGN: Prospective, partly retrospective. METHOD: All patients who were referred from the stroke

  16. Feasibility and preliminary effects of an intervention targeting schema development for caregivers of newly admitted hospice patients.

    Science.gov (United States)

    Lindstrom, Kathryn B; Mazurek Melnyk, Bernadette

    2013-06-01

    The transition to hospice care is a stressful experience for caregivers, who report high anxiety, unpreparedness, and lack of confidence. These sequelae are likely explained by the lack of an accurate cognitive schema, not knowing what to expect or how to help their loved one. Few interventions exist for this population and most do not measure preparedness, confidence, and anxiety using a schema building a conceptual framework for a new experience. The purpose of this study was to test the feasibility and preliminary effects of an intervention program, Education and Skill building Intervention for Caregivers of Hospice patients (ESI-CH), using an innovative conceptual design that targets cognitive schema development and basic skill building for caregivers of loved ones newly admitted to hospice services. A pre-experimental one-group pre- and post-test study design was used. Eighteen caregivers caring for loved ones in their homes were recruited and twelve completed the pilot study. Depression, anxiety, activity restriction, preparedness, and beliefs/confidence were measured. Caregivers reported increased preparedness, more helpful beliefs, and more confidence about their ability to care for their loved one. Preliminary trends suggested decreased anxiety levels for the intervention group. Caregivers who completed the intervention program rated the program very good or excellent, thought the information was helpful and timely, and would recommend it to friends. Results show promise that the ESI-CH program may assist as an evidence-based program to support caregivers in their role as a caregiver to a newly admitted hospice patient.

  17. Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS: a protocol for a randomised controlled trial

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    Leistner Stefanie

    2013-01-01

    Full Text Available Abstract Background Patients with recent stroke or TIA are at high risk for new vascular events. Several evidence based strategies in secondary prevention of stroke are available but frequently underused. Support programs with multifactorial risk factor modifications after stroke or TIA have not been investigated in large-scale prospective controlled trials so far. INSPiRE-TMS is a prospective, multi-center, randomized open intervention trial for intensified secondary prevention after minor stroke and TIA. Methods/design Patients with acute TIA or minor stroke admitted to the participating stroke centers are screened and recruited during in-hospital stay. Patients are randomised in a 1:1 ratio to intervention (support program and control (usual care arms. Inclusion of 2.082 patients is planned. The support program includes cardiovascular risk factor measurement and feedback, monitoring of medication adherence, coaching in lifestyle modifications, and active involvement of relatives. Standardized motivational interviewing is used to assess and enhance patients’ motivation. Primary objective is a reduction of new major vascular events defined as nonfatal stroke and myocardial infarction or vascular death. Recruitment time is planned for 3.5 years, follow up time is at least 2 years for every patient resulting in a total study time of 5 years (first patient in to last patient out. Discussion Given the high risk for vascular re-events in acute stroke and the available effective strategies in secondary prevention, the INSPIRE-TMS support program has the potential to lead to a relevant reduction of recurrent events and a prolongation of the event-free survival time. The trial will provide the basis for the decision whether an intensified secondary prevention program after stroke should be implemented into regular care. A cost-effectiveness evaluation will be performed. Trial registration clinicaltrials.gov: 01586702

  18. Association between the volume of inpatient rehabilitation therapy and the risk of all-cause and cardiovascular mortality in patients with ischemic stroke.

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    Hu, Gwo-Chi; Hsu, Chia-Yu; Yu, Hui-Kung; Chen, Jiann-Perng; Chang, Yu-Ju; Chien, Kuo-Liong

    2014-02-01

    To investigate the relationship between the volume of inpatient rehabilitation therapy and mortality among patients with acute ischemic stroke, as well as to assess whether the association varies with respect to stroke severity. A retrospective study with a cohort of consecutive patients who had acute ischemic stroke between January 1, 2008, and June 30, 2009. Referral medical center. Adults with acute ischemic stroke (N=1277) who were admitted to a tertiary hospital. Not applicable. Stroke-related mortality. During the median follow-up period of 12.3 months (ranging from January 1, 2008, to December 31, 2009), 163 deaths occurred. Greater volume of rehabilitation therapy was associated with a reduced risk of all-cause and cardiovascular mortality (P for trend rehabilitation volume was associated with a 55% lower risk of all-cause mortality (hazard ratio [HR]=.45; 95% confidence interval [CI], .30-.65) and a 50% lower risk of cardiovascular mortality (HR=.50; 95% CI, .31-.82). The association did not vary with respect to stroke severity (P for interaction = .45 and .73 for all-cause and cardiovascular mortality, respectively). The volume of inpatient rehabilitation therapy and mortality were significantly inversely related in the patients with ischemic stroke. Thus, further programs aimed at promoting greater use of rehabilitation services are warranted. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  19. Urinary Retention Associated with Stroke.

    Science.gov (United States)

    Umemura, Takeru; Ohta, Hirotsugu; Yokota, Akira; Yarimizu, Shiroh; Nishizawa, Shigeru

    Patients often exhibit urinary retention following a stroke. Various neuropathological and animal studies have implicated the medulla oblongata, pons, limbic system, frontal lobe as areas responsible for micturition control, although the exact area responsible for urinary retention after stroke is not clear. The purpose of this study was to identify the stroke area responsible for urinary retention by localizing the areas where strokes occur. We assessed 110 patients with cerebral infarction and 27 patients with cerebral hemorrhage (78 men, 59 women; mean age, 73.0 years) who had been admitted to our hospital between October, 2012 and September, 2013. We used computed tomography (CT) and magnetic resonance imaging (MRI) to investigate the stroke location, and evaluated whether post-stroke urinary retention occurred. Twelve (8.8%) of the 137 patients (7 men, 5 women; mean age, 78.8 years) exhibited urinary retention after a stroke. Stroke occurred in the right/left dominant hemisphere in 7 patients; nondominant hemisphere in 1; cerebellum in 3; and brainstem in 1. Strokes in the dominant hemisphere were associated with urinary retention (P = 0.0314), particularly in the area of the insula (P < 0.01). We concluded that stroke affecting the insula of the dominant hemisphere tends to cause urinary retention.

  20. Risk Factors and Etiology of Young Ischemic Stroke Patients in Estonia

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    Siim Schneider

    2017-01-01

    Full Text Available Objectives. Reports on young patients with ischemic stroke from Eastern Europe have been scarce. This study aimed to assess risk factors and etiology of first-ever and recurrent stroke among young Estonian patients. Methods. We performed a retrospective study of consecutive ischemic stroke patients aged 18–54 years who were treated in our two hospitals from 2003 to 2012. Results. We identified 741 patients with first-ever stroke and 96 patients with recurrent stroke. Among first-time patients, men predominated in all age groups. The prevalence of well-documented risk factors in first-time stroke patients was 83% and in the recurrent group 91%. The most frequent risk factors were hypertension (53%, dyslipidemia (46%, and smoking (35%. Recurrent stroke patients had fewer less well-documented risk factors compared to first-time stroke patients (19.8 versus 30.0%, P=0.036. Atrial fibrillation was the most common cause of cardioembolic strokes (48% and large-artery atherosclerosis (LAA was the cause in 8% among those aged <35 years. Compared to first-time strokes, recurrent ones were more frequently caused by LAA (14.3 versus 24.0%, P=0.01 and less often by other definite etiology (8.5 versus 1.0%, P=0.01. Conclusions. The prevalence of vascular risk factors among Estonian young stroke patients is high. Premature atherosclerosis is a cause in a substantial part of very young stroke patients.

  1. Development and validation of a patient-reported outcome measure for stroke patients.

    Science.gov (United States)

    Luo, Yanhong; Yang, Jie; Zhang, Yanbo

    2015-05-08

    Family support and patient satisfaction with treatment are crucial for aiding in the recovery from stroke. However, current validated stroke-specific questionnaires may not adequately capture the impact of these two variables on patients undergoing clinical trials of new drugs. Therefore, the aim of this study was to develop and evaluate a new stroke patient-reported outcome measure (Stroke-PROM) instrument for capturing more comprehensive effects of stroke on patients participating in clinical trials of new drugs. A conceptual framework and a pool of items for the preliminary Stroke-PROM were generated by consulting the relevant literature and other questionnaires created in China and other countries, and interviewing 20 patients and 4 experts to ensure that all germane parameters were included. During the first item-selection phase, classical test theory and item response theory were applied to an initial scale completed by 133 patients with stroke. During the item-revaluation phase, classical test theory and item response theory were used again, this time with 475 patients with stroke and 104 healthy participants. During the scale assessment phase, confirmatory factor analysis was applied to the final scale of the Stroke-PROM using the same study population as in the second item-selection phase. Reliability, validity, responsiveness and feasibility of the final scale were tested. The final scale of Stroke-PROM contained 46 items describing four domains (physiology, psychology, society and treatment). These four domains were subdivided into 10 subdomains. Cronbach's α coefficients for the four domains ranged from 0.861 to 0.908. Confirmat