43Computed Tomography Angiography in Acute Stroke Patients in St. Vincent’s University Hospital- A Vessel for Change?

Abstract Background Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients. Methods The FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. The study was designed as a cross-sectional hospital-based registry. Results We investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage. Oropharyngeal dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6–17] vs. 7 [4–12], p = .013; median mRS 5 [IQR 4–5] vs. 4 [IQR 3–5], p = .012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p = .107). FEES examinations revealed that only 30.9% of the patients had an oral diet appropriate for their swallowing abilities. A change of oral diet was associated with a better outcome at discharge (mRS; p = .006), less need of mechanical ventilation (p = .028), shorter period of hospitalisation (p = .044), and lower rates of pneumonia (p = .007) and mortality (p = .011). Conclusion Due to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre. FEES in acute stroke patients helps to adjust the oral diet for the vast majority of stroke patients (69.1%) based on their swallowing abilities, potentially avoiding severe complications.

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41Getting the Right Flow: Quality Improvement Project of Carotid Doppler Ultrasound Service in Acute Stroke Patients at University Hospital Limerick

Age and Ageing ◽

10.1093/ageing/afy140.29 ◽

2018 ◽

Vol 47 (suppl_5) ◽

pp. v13-v60

Author(s):

Michelle Brennan ◽

Margaret O’Connor ◽

John McManus ◽

Tony Moloney ◽

Nora Cunningham

Keyword(s):

Quality Improvement ◽

Acute Stroke ◽

Doppler Ultrasound ◽

Quality Improvement Project ◽

University Hospital ◽

Stroke Patients ◽

Improvement Project ◽

Flow Quality ◽

The Right ◽

Carotid Doppler

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Abstract T P205: Efficacy and Safety of Telemedicine in Acute Stroke Care in a Metropolitan Area: Final Results of the Madrid Telestroke Project

Stroke ◽

10.1161/str.46.suppl_1.tp205 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Patricia Martinez Sanchez ◽

María Alonso de Leciñana ◽

Ambrosio Miralles ◽

Nuria Huertas Gonzalez ◽

Blanca Fuentes ◽

...

Keyword(s):

Acute Stroke ◽

Metropolitan Area ◽

Community Hospital ◽

Intravenous Thrombolysis ◽

University Hospital ◽

Stroke Patients ◽

Acute Stroke Care ◽

Phone Calls ◽

Number Of Patients ◽

Stroke Center

Introduction: our primary objective was to analyze the efficacy of a Telestroke system in terms of an increase in the number of patients treated with intravenous thrombolysis (IVT) and a shorter door-to-needle time, in the metropolitan area of Madrid, Spain. Our secondary objective was to analyze the safety of Telestroke in terms of mortality and symptomatic hemorrhagic transformation (SHT). Methods: prospective observational cohort study: 1) cohort exposed to Telestroke: acute ischemic stroke patients attended at Infanta Sofia University Hospital (community hospital) connected by Telestroke with the Stroke Center at La Paz University Hospital; 2) Non-exposed cohort: acute stroke patients who are attended at Severo Ochoa University Hospital (community hospital) connected by phone with the Stroke Center at Ramon y Cajal University Hospital. The number of patient attended, number of IVT, times (min), 3-months outcome (mRS), the number of unnecessary transfers and safety parameters (mortality and SHT by ECAS III criteria) were recorded. We analyzed the first 34 months of the Telestroke (March 2011-december 2013). Results: in the Telestroke cohort the system was activated in 59 patients, being stroke code in 42 cases. In the non-exposed cohort 45 phone calls were made, being stroke code in 42 cases. In the Telestroke cohort, IVT were administrated in 61.9% (26/42) of patients whereas in the non-exposed only 28.6% (12/42) received this treatment (P=0,002). The door-to-needle time was shorter in Telestroke cohort than in the non-exposed cohort (mean [SD]) (86.9 [41.7] vs. 149.7 [68.2], P=0.001). The 3-month outcomes were better in the Telestroke cohort (mRS 0-3: 92.9% vs. 73.8%, P=0.038). Mortality (4,8% vs. 4.8%) and SHT (0% vs. 4.8%) were similar in both groups (P = NS). In addition, there were fewer unnecessary secondary transfers in the Telestroke cohort (4.3% vs. 20%, P=0.027). Conclusion: the implementation of a Telestroke system in a metropolitan area is effective and safe, increasing the number of IV thrombolysis and reducing the door-to-needle times. Furthermore, the Telestroke reduces the number of unnecessary secondary transfers.

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Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients.A cross-sectional hospital-based registry study.

10.21203/rs.2.9300/v2 ◽

2019 ◽

Author(s):

Tobias Braun ◽

Martin Juenemann ◽

Maxime Viard ◽

Marco Meyer ◽

Iris Reuter ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Stroke ◽

Standard Procedure ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Silent Aspiration ◽

Cross Sectional ◽

The Impact ◽

Oral Diet

Abstract Background Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients. Methods The FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. Results We investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage. Pharyngeal-phase dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6-17] vs. 7 [4-12], p=.013; median mRS 5 [IQR 4-5] vs. 4 [IQR 3-5], p=.012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p=.107). FEES examinations revealed that only 30.9% of the patients had an adequate oral diet. A change of oral diet was associated with a better outcome at discharge (mRS; p=.006), less need of mechanical ventilation (p=.028), shorter period of hospitalisation (p=.044), and lower rates of pneumonia (p=.007) and mortality (p=.011). Conclusion Due to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre. FEES in acute stroke patients helps to adequately adjust the oral diet for the vast majority of stroke patients (69.1%), potentially avoiding severe complications. Trial registration The study was not registered

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Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients.A cross-sectional hospital-based registry study.

10.21203/rs.2.9300/v3 ◽

2019 ◽

Author(s):

Tobias Braun ◽

Martin Juenemann ◽

Maxime Viard ◽

Marco Meyer ◽

Iris Reuter ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Stroke ◽

Standard Procedure ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Silent Aspiration ◽

Cross Sectional ◽

The Impact ◽

Oral Diet

Abstract Background Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients. Methods The FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. Results We investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage. Pharyngeal-phase dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6-17] vs. 7 [4-12], p=.013; median mRS 5 [IQR 4-5] vs. 4 [IQR 3-5], p=.012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p=.107). FEES examinations revealed that only 30.9% of the patients had an adequate oral diet. A change of oral diet was associated with a better outcome at discharge (mRS; p=.006), less need of mechanical ventilation (p=.028), shorter period of hospitalisation (p=.044), and lower rates of pneumonia (p=.007) and mortality (p=.011). Conclusion Due to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre. FEES in acute stroke patients helps to adequately adjust the oral diet for the vast majority of stroke patients (69.1%), potentially avoiding severe complications. Trial registration The study was not registered

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Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients.A cross-sectional hospital-based registry study.

10.21203/rs.2.9300/v1 ◽

2019 ◽

Author(s):

Tobias Braun ◽

Martin Juenemann ◽

Maxime Viard ◽

Marco Meyer ◽

Iris Reuter ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Stroke ◽

Standard Procedure ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Silent Aspiration ◽

Cross Sectional ◽

The Impact ◽

Oral Diet

Abstract Background Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines the outcome; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients. Methods The FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. Results We investigated 152 patients (173 FEES). The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage. Dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6-17] vs. 7 [4-12], p=.013; median mRS 5 [IQR 4-5] vs. 4 [IQR 3-5], p=.012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p=.107). FEES examinations revealed that only 30.9% of the patients had an adequate oral diet. A change of oral diet was associated with a better outcome at discharge (mRS; p=.006), less need of mechanical ventilation (p=.028), shorter period of hospitalisation (p=.044), and lower rates of pneumonia (p=.007) and mortality (p=.011). Discussion Due to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre. FEES in acute stroke patients helps to adequately adjust the oral diet for the vast majority of stroke patients (69.1%), potentially avoiding severe complications.

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The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽

10.1024/1012-5302.12.1.21 ◽

1999 ◽

Vol 12 (1) ◽

pp. 21-27

Author(s):

Marit Kirkevold

Keyword(s):

Acute Stroke ◽

Theoretical Perspective ◽

Stroke Patients ◽

Role Of Nursing ◽

Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

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