Stroke-unit care for stroke patients in China: the results from Bigdata Observatory platform for Stroke of China

2021 ◽  
Author(s):  
Wen-Jun Tu ◽  
Feng Yan ◽  
Bao-Hua Chao ◽  
Xun-Ming Ji ◽  
Longde Wang
Keyword(s):  
Stroke Unit ◽  
Stroke Patients ◽  
Stroke Unit Care

Abstract T P259: What Should Really be Happening to Our Stroke Patients Post-Acute Care?: A System Best Practice Model for Inpatient Rehab

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shelley Sharp ◽  
Elizabeth Linkewich ◽  
Jacqueline Willems ◽  
Nicola Tahair ◽  
Charissa Levy ◽  
...  
Keyword(s):  
Acute Care ◽  
Stroke Unit ◽  
Best Practice ◽  
Patient Flow ◽  
System Capacity ◽  
Stroke Patients ◽  
Practice Model ◽  
Term Care ◽  
Stroke Unit Care ◽  
The Right

Background: A regional Stroke Report Card identified poor performance on system efficiency, effectiveness, and integration of stroke best practice. This engaged regional funders and 17 organizations (11 acute, 6 rehab) to collaborate in stroke system planning. The focus included stroke unit care and access to timely and appropriate rehabilitation, including increased access for severe stroke. Changes in acute care, including pre-hospital, have facilitated access to stroke unit care in the city. A model of patient flow from acute care was needed to understand other system capacity needs. Purpose: To use best practice and benchmarks to delineate post-acute patient flow and facilitate alignment of resources for inpatient rehabilitation. Methods: Administrative data from national reporting and local rehab referral system databases were used to review current system usage from acute care. A model of proportional distribution of cases from acute, specifically to inpatient rehab, was established using provincial benchmarks, evidence informed targets, and organization market share of total inpatient rehab system capacity. Iterative discussions were required to confirm the organizations’ commitment to stroke best practice. New volume and case mix changes were applied to determine capacity and resource planning needs across organizations. Results: The best practice model, approved by all stakeholders, proposes 40% of stroke patients discharged alive from acute care should access inpatient, 13% outpatient rehabilitation and 6% to Complex Continuing Care and Long Term Care. Current practice is 26%, <5% and 13% respectively. A projected volume increase of 278 patients is distributed across 5/6 rehab providers. This results in a total proportional system shift from 20% (n=160) to 41.5% (n =446) of severe patients receiving access to high intensity rehab. A reduction in the overall proportion of moderate and mild stroke patients from 65% (519) to 49.5% (n=534) and 15% (n=119) to 9% (n=96) respectively. Conclusion: Significant investment/redistribution of resources within the system is required to support patient flow and provide care in the right place at the right time. System funder support is critical to create a quality of care (best practice) system.

Stroke Rehabilitation 2007: What Should it Be?

2007 ◽  
Vol 2 (3) ◽  
pp. 191-200 ◽  
Author(s):  
Helen M. Dewey ◽  
Lisa J. Sherry ◽  
Janice M. Collier
Keyword(s):  
Stroke Unit ◽  
Stroke Rehabilitation ◽  
Number Needed To Treat ◽  
Stroke Patients ◽  
High Quality ◽  
High Quality Research ◽  
Stroke Units ◽  
Proven Efficacy ◽  
Stroke Unit Care ◽  
Medical Wards

Background There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. Summary of review There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include ( 1 ) a functional approach targeted at specific activities e.g. walking, activities of daily living, ( 2 ) frequent and intense practice, and ( 3 ) commencement in the first days or weeks after stroke. Conclusion The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.

scholarly journals The Stroke Unit Story: Where Have We Been and Where Are We Going?

2021 ◽  
pp. 1-8
Author(s):  
Peter Langhorne
Keyword(s):  
Collaborative Research ◽  
Stroke Unit ◽  
Final Section ◽  
Evidence Base ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Units ◽  
History Of ◽  
Stroke Unit Care ◽  
Stroke Type

<b><i>Background:</i></b> The concept of stroke unit care has been discussed for over 50 years, but it is only in the last 25 years that clear evidence of its effectiveness has emerged to inform these discussions. <b><i>Summary:</i></b> This review outlines the history of the concept of stroke units to improve recovery after stroke and their evaluation in clinical trials. It describes the first systematic review of stroke unit trials published in 1993, the establishment of a collaborative research group (the Stroke Unit Trialists’ Collaboration), the subsequent analyses and updates of the evidence base, and the efforts to implement stroke unit care in routine settings. The final section considers some of the remaining challenges in this area of research and clinical practice. <b><i>Key Messages:</i></b> Good quality evidence confirms that stroke patients who are looked after in a stroke unit are more likely to survive and be independent and living at home 1 year after their stroke. The apparent benefits are independent of patient age, sex, stroke type, or initial stroke severity. The benefits are most obvious in units based in a discrete ward (stroke ward). The current challenges include integrating effective stroke units with more recent systems to deliver hyper-acute stroke interventions and implementing stroke units in lower resource regions.

scholarly journals Beneficial Effects of Stroke-Unit Care in Stroke Patients with Atrial Fibrillation

2013 ◽  
Vol 54 (2) ◽  
pp. 301 ◽  
Author(s):  
Hye-Yeon Choi ◽  
Joo Hyun Seo ◽  
Jae Hoon Yang ◽  
Young Dae Kim ◽  
Yo Han Jung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Unit ◽  
Stroke Patients ◽  
Beneficial Effects ◽  
Stroke Unit Care

Stroke units: research in practice

2015 ◽  
Author(s):  
Lalit Kalra
Keyword(s):  
Stroke Unit ◽  
Stroke Care ◽  
Evidence Base ◽  
Multidisciplinary Teams ◽  
Stroke Patients ◽  
Stroke Units ◽  
Key Points ◽  
Stroke Unit Care ◽  
Rehabilitation Needs ◽  
Therapy Sessions

Key points• Stroke units are the cornerstone of quality stroke care.• The benefits of stroke unit care are supported by a very strong evidence base• In 2007 the National Stroke Strategy mandated that all stroke patients should have prompt access to stroke unit care.• Despite policy and guidelines, only 62% stroke patients were treated on specialist stroke units in 2010.• Patients spend long periods of inactivity on stroke units; multidisciplinary teams need to encourage rehabilitation activities outside therapy sessions.• Rehabilitation needs to be family- and carer-oriented to prepare patients for life after discharge.

scholarly journals Stroke-unit care for acute stroke patients: an observational follow-up study

The Lancet ◽  
2007 ◽  
Vol 369 (9558) ◽  
pp. 299-305 ◽  
Author(s):  
Livia Candelise ◽  
Monica Gattinoni ◽  
Anna Bersano ◽  
Giuseppe Micieli ◽  
Roberto Sterzi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Stroke Patients ◽  
Follow Up Study ◽  
Stroke Unit Care

scholarly journals Actigraphic Measurement of the Upper Limbs for the Prediction of Ischemic Stroke Prognosis: An Observational Study

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2479
Author(s):  
Giuseppe Reale ◽  
Silvia Giovannini ◽  
Chiara Iacovelli ◽  
Stefano Filippo Castiglia ◽  
Pietro Picerno ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Stroke Unit ◽  
Prognostic Model ◽  
Recovery Process ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Movement Asymmetry

Background: It is often challenging to formulate a reliable prognosis for patients with acute ischemic stroke. The most accepted prognostic factors may not be sufficient to predict the recovery process. In this view, describing the evolution of motor deficits over time via sensors might be useful for strengthening the prognostic model. Our aim was to assess whether an actigraphic-based parameter (Asymmetry Rate Index for the 24 h period (AR2_24 h)) obtained in the acute stroke phase could be a predictor of a 90 d prognosis. Methods: In this observational study, we recorded and analyzed the 24 h upper limb movement asymmetry of 20 consecutive patients with acute ischemic stroke during their stay in a stroke unit. We recorded the motor activity of both arms using two programmable actigraphic systems positioned on patients’ wrists. We clinically evaluated the stroke patients by NIHSS in the acute phase and then assessed them across 90 days using the modified Rankin Scale (mRS). Results: We found that the AR2_24 h parameter positively correlates with the 90 d mRS (r = 0.69, p < 0.001). Moreover, we found that an AR2_24 h > 32% predicts a poorer outcome (90 d mRS > 2), with sensitivity = 100% and specificity = 89%. Conclusions: Sensor-based parameters might provide useful information for predicting ischemic stroke prognosis in the acute phase.

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