scholarly journals Impact of COVID-19 on the stroke rehabilitation pathway: multidisciplinary team reflections on a patient and carer journey from acute to community stroke services

2021 ◽  
Vol 14 (11) ◽  
pp. e245544
Author(s):  
Lauren Lucas ◽  
Sophie Gordon ◽  
Ruth Heyes
Keyword(s):  
Multidisciplinary Team ◽  
Stroke Rehabilitation ◽  
Management Strategies ◽  
Inpatient Rehabilitation ◽  
Left Middle Cerebral Artery ◽  
Language Therapy ◽  
Accident And Emergency ◽  
Stroke Team ◽  
Shared Goal ◽  
Potential Benefits

A 62-year old man attended accident and emergency in June 2020 with dense right sided weakness, aphasia and confusion. Investigations revealed a left middle cerebral artery infarct, and he was admitted under the stroke team for ongoing inpatient rehabilitation. He was discharged home in September 2020 and received community stroke rehabilitation from physiotherapy, nursing, occupational therapy and speech and language therapy. He is now working towards a graded discharge from the Community Stroke and Neuro Rehab Team, after achieving his rehabilitation goals. In this case, the multidisciplinary team adopted different ways of working to accommodate the patients’ priorities while also negotiating the COVID-19 pandemic. This included taking a transdisciplinary approach to rehabilitation and considering alternative supported self-management strategies. This case highlighted several learning points, particularly the potential benefits of shared goal setting for patients with communication difficulties and transdisciplinary approaches to community stroke rehabilitation.

scholarly journals Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received? An observational cohort study

2019 ◽  
Vol 33 (9) ◽  
pp. 1492-1502
Author(s):  
Verity Longley ◽  
Sarah Peters ◽  
Caroline Swarbrick ◽  
Sarah Rhodes ◽  
Audrey Bowen
Keyword(s):  
Cognitive Impairment ◽  
Occupational Therapy ◽  
Stroke Rehabilitation ◽  
Inpatient Rehabilitation ◽  
National Institutes Of Health ◽  
Language Therapy ◽  
Early Supported Discharge ◽  
Observational Cohort ◽  
Single Discipline ◽  
Therapy Sessions

Objective: To examine whether stroke survivors in inpatient rehabilitation with pre-existing cognitive impairment receive less therapy than those without. Design: Prospective observational cohort. Setting: Four UK inpatient stroke rehabilitation units. Participants: A total of 139 stroke patients receiving rehabilitation, able to give informed consent/had an individual available to act as personal consultee. In total, 33 participants were categorized with pre-existing cognitive impairment based on routine documentation by clinicians and 106 without. Measures: Number of inpatient therapy sessions received during the first eight weeks post-stroke, referral to early supported discharge, and length of stay. Results: On average, participants with pre-existing cognitive impairment received 40 total physiotherapy and occupational therapy sessions compared to 56 for those without (mean difference = 16.0, 95% confidence interval (CI) = 2.9, 29.2), which was not fully explained by adjusting for potential confounders (age, sex, National Institutes of Health Stroke Scale (NIHSS), and pre-stroke modified Rankin Scale (mRS)). While those with pre-existing cognitive impairment received nine fewer single-discipline physiotherapy sessions (95% CI = 3.7, 14.8), they received similar amounts of single-discipline occupational therapy, psychology, and speech and language therapy; two more non-patient-facing occupational therapy sessions (95% CI = –4.3, –0.6); and nine fewer patient-facing occupational therapy sessions (95% CI = 3.5, 14.9). There was no evidence to suggest they were discharged earlier, but of the 85 participants discharged within eight weeks, 8 (42%) with pre-existing cognitive impairment were referred to early supported discharge compared to 47 (75%) without. Conclusion: People in stroke rehabilitation with pre-existing cognitive impairments receive less therapy than those without, but it remains unknown whether this affects outcomes.

Sarasota Bay: Protection of a Natural Resource

1993 ◽  
Vol 28 (3-5) ◽  
pp. 91-99
Author(s):  
R. A. Wagner ◽  
M. G. Heyl
Keyword(s):  
Wastewater Treatment ◽  
Best Management Practices ◽  
Management Practices ◽  
Treatment Plan ◽  
Management Strategies ◽  
Treatment Plant ◽  
Modeling Tools ◽  
Best Management ◽  
Sarasota Bay ◽  
Potential Benefits

As part of the Sarasota Bay National Estuary Program (NEP) evaluation of environmental problems, modeling tools were used to estimate pollution loadings from diverse sources, including surface runoff, baseflow, wastewater treatment plant discbarges, septic tanks, and direct deposition of rainfall on the bay surface. After assessing the relative impacts of the pollution sources, alternative management strategies were identified and analyzed. These strategies focused primarily on future development, and included structural and nonstructural best management practices (BMPs), as well as a regional wastewater treatment plan. Loading reductions, along with planning-level cost data and estimates of feasibility and other potential benefits, were used to identify the most promising alternatives.

scholarly journals The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative

2021 ◽  
pp. 175114372098870
Author(s):  
Zudin Puthucheary ◽  
Craig Brown ◽  
Evelyn Corner ◽  
Sarah Wallace ◽  
Julie Highfield ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Inpatient Rehabilitation ◽  
Service Evaluation ◽  
Language Therapy ◽  
Initial Development ◽  
Related Data ◽  
Acute Hospitals ◽  
Rehabilitation Needs ◽  
Post Intensive Care Syndrome

Background Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation needs of severely affected COVID-19 survivors has become clear. Such tools offer the opportunity to improve rehabilitation for all critical illness survivors through provision of a personalised Rehabilitation Prescription (RP). The initial development and secondary refinement of such an assessment and data tools is described in the linked paper. We report here the clinical and workforce data that was generated as a result. Methods Prospective service evaluation of 26 acute hospitals in England using the Post-ICU Presentation Screen (PICUPS) tool and the RP. The PICUPS tool comprised items in domains of a) Medical and essential care, b) Breathing and nutrition; c) Physical movement and d) Communication, cognition and behaviour. Results No difference was seen in total PICUPS scores between patients with or without COVID-19 (77 (IQR 60-92) vs. 84 (IQR 68-97); Mann-Whitney z = −1.46, p = 0.144. A network analysis demonstrated that requirements for physiotherapy, occupational therapy, speech and language therapy, dietetics and clinical psychology were closely related and unaffected by COVID-19 infection status. A greater proportion of COVID-19 patients were referred for inpatient rehabilitation (13% vs. 7%) and community-based rehabilitation (36% vs.15%). The RP informed by the PICUPS tool generally specified a greater need for multi-professional input when compared to rehabilitation plans instituted. Conclusions The PICUPS tool is feasible to implement as a screening mechanism for post-intensive care syndrome. No differences are seen in the rehabilitation needs of patients with and without COVID-19 infection. The RP could be the vehicle that drives the professional interventions across the transitions from acute to community care. No single discipline dominates the rehabilitation requirements of these patients, reinforcing the need for a personalised RP for critical illness survivors.

scholarly journals Subacute postoperative atrial fibrillation after heart surgery: incidence and predictive factors in cardiac rehabilitation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
V Rizza ◽  
F Maranta ◽  
L Cianfanelli ◽  
R Grippo ◽  
C Meloni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Heart Surgery ◽  
Troponin T ◽  
Management Strategies ◽  
Inpatient Rehabilitation ◽  
Postoperative Atrial Fibrillation ◽  
Funding Sources ◽  
Valvular Surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. It may occur between the second and fourth postoperative days as acute POAF, or within 30 days as subacute POAF (sPOAF). The incidence varies from 15% to 60%, with the highest rates observed in patients undergoing valvular surgery. POAF is associated with longer hospital stay and higher thromboembolic risk, which consistently increase patients’ morbidity and mortality. Identification of high-risk categories may allow optimization of in-hospital prevention and treatment, possibly improving clinical outcomes. Aim of the study. The aim of this study was to assess the incidence of sPOAF and to identify possible predictors in patients performing Cardiovascular Rehabilitation (CR) after Cardiac Surgery (CS). Methods. A single-centre retrospective study was performed on 383 post-cardiac surgery patients hospitalised in our CR Unit for inpatient rehabilitation. The entire population was on sinus rhythm at the admission in CR and continuous monitoring with 12-lead ECG telemetry was performed during the hospital stay. We calculated the incidence of sPOAF and then evaluated the predictive value of the following variables: anamnestic data, type of cardiac intervention, clinical course in both CS and CR Unit, laboratory parameters including baseline neutrophil-to-lymphocyte ratio (NLR). Results. Median age was 65 years (63% male). sPOAF was documented in 122 cases (31.9%). Patients developing sPOAF were older [median age 69 (63-76) vs. 61 (51-70); p < 0.001)], more frequently underwent complex surgical procedures (50% vs. 36%; p = 0.009) and were known for previous episodes of atrial fibrillation (27.9% vs. 11.2%; p < 0.001). On the first day after surgery (T1), sPOAF group showed higher values of glycemia [median 155 (126.5–186.8) vs. 129 (106.5–164); p < 0.001] and troponin T [median 721.5 (470.1–1084.3) vs. 488 (301.6-776.2); p < 0.001]. The multivariate analysis identified advanced age (OR 1.04, 95% CI 1.01-1.08; p = 0.023), acute POAF in the Cardiac Surgery Unit (OR 3.51, 95% CI 1.62-7.59; p = 0.001), baseline NLR (OR 1.46, 95% CI 1.10-1.93; p = 0.008) and T1-troponin > 552 ng/L (OR 4.16 95% CI 1.50-11.53; p = 0.006) as independent risk predictors of sPOAF during the CR period. Conclusions. sPOAF is common after cardiac surgery occurring in 31.9% of patients during CR. Age, acute POAF, baseline NLR and elevated troponin T on the first postoperative day were shown predictors of increased sPOAF risk. Recognition of new predictors of POAF could be helpful to better stratify patients, improving management strategies and outcomes.

Zarządzanie wiekiem jako strategia wzrostu konkurencyjności przedsiębiorstw w dobie globalizacji

2011 ◽  
Vol 7 ◽  
pp. 73-81
Author(s):  
Paweł Czapliński
Keyword(s):  
Competitive Advantage ◽  
Management Strategies ◽  
Cultural Conditions ◽  
Age Diversity ◽  
Potential Benefits ◽  
A Company

This article is an attempt to characterise the age management strategies in companies in the context of demographic, economic and cultural conditions. As it is suggested by the conducted research, the majority of Polish companies currently do not use the age management strategies, which is primarily caused by their failure to realise the potential benefits as the fact of possessing rich age diversity in a company is one of the methods to accomplish the competitive advantage.

Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

2001 ◽  
Vol 10 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Jan Coleman Gross ◽  
Stacey W. Goodrich ◽  
Mary E. Kain ◽  
Elizabeth A. Faulkner
Keyword(s):  
Nursing Care ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Two Factors ◽  
Staffing Needs ◽  
Care Index ◽  
Strong Inverse Relationship

The purpose of this study was to evaluate the feasibility of using the Functional Independence Measure (FIM) to predict staffing needs of stroke patients in an acute inpatient rehabilitation program. The Patient Care Index (PCI) was concurrently administered with the FIM on all stroke admissions to a stroke rehabilitation unit over a 3-month period. One hundred fourteen patients 18 years of age or older admitted to the unit with a medical diagnosis of stroke were included in the sample. Total FIM score had a strong inverse relationship to the level of care indicated by the PCI at Days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = —.76 to —.87). Total FIM score and the need for staff supervision for safety were the two factors predictive of the level of nursing care. The FIM has potential to guide nurse-staffing decisions.

Abstract WP165: Mexican Americans Receive Less Intensive Stroke Rehabilitation Than non Hispanic Whites

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lewis B Morgenstern ◽  
Emma Sais ◽  
Michael Fuentes ◽  
Nneka Ifejika ◽  
Xiaqing Jiang ◽  
...  
Keyword(s):  
Mexican Americans ◽  
Stroke Rehabilitation ◽  
Inpatient Rehabilitation ◽  
Population Based ◽  
Cognitive Outcomes ◽  
Rehabilitation Services ◽  
Population Based Study ◽  
Corpus Christi ◽  
Home Based ◽  
Chi Squared

Background: Mexican Americans (MAs) have worse neurologic, functional and cognitive outcomes after stroke than non Hispanic whites (NHWs). Stroke rehabilitation is important for outcome. In a population-based study, we sought to determine if allocation of stroke rehabilitation services differed by ethnicity. Methods: Consecutive stroke patients were identified for a three month time period as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for three months following stroke to determine self-reported rehabilitation services. Descriptive statistics were used to describe the study population. Ethnic comparisons of rehabilitation services were made using chi-squared or Fisher’s exact tests. Results: Seventy-two subjects (50 MA, 22 NHW) were followed. Mean age, NHW-69 (sd-13), MA-66 (sd-11) years, sex (NHW 55% male, MA 50% male) and median presenting NIHSS (NHW-2.5, MA-3.0) did not differ significantly. There were no ethnic differences in the proportion of patients who were discharged home without rehabilitation services (p=0.9). Among those who received rehabilitation (n=48), the figure shows the distribution of the first place for services. NHWs were more likely to be discharged to inpatient rehabilitation (73%) compared with MAs (30%), p=0.016. MAs (51%) were much more likely to be receive home rehabilitation services compared with NHWs (0%) (p=0.0017). Conclusions: In this population-based study, MAs were more likely to receive home-based rehabilitation while NHWs more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.

scholarly journals What Makes Stroke Rehabilitation Patients Complex? Clinician Perspectives and the Role of Discharge Pressure

2016 ◽  
Vol 6 (2) ◽  
pp. 35-41 ◽  
Author(s):  
Michelle L.A. Nelson ◽  
Elizabeth Hanna ◽  
Stephen Hall ◽  
Michael Calvert
Keyword(s):  
Stroke Rehabilitation ◽  
Personal Characteristics ◽  
Inpatient Rehabilitation ◽  
Community Services ◽  
Social Determinant ◽  
Structural Element ◽  
Wide Range ◽  
Patient Complexity ◽  
Definition Of ◽  
Discharge Pressure

Background Approximately 80% of people who survive a stroke have on average five other conditions and a wide range of psychosocial issues. Attention to biopsychosocial issues has led to the identification of ‘complex patients’. No single definition of ‘patient complexity’ exists; therefore, applied health researchers seek to understand ‘patient complexity’ as it relates to a specific clinical context. Objective To understand how ‘patient complexity’ is conceptualized by clinicians, and to position the findings within the existing literature on patient complexity. Methods A qualitative descriptive approach was utilized. Twenty-three stroke rehabilitation clinicians participated in four focus groups. Results Five elements of patient complexity were identified: medical/functional issues, social determinant factors, social/family support, personal characteristics, and health system factors. Using biopsychosocial factors to identify complexity results in all patients being complex; operationalization of the definition led to the identification of systemic elements. A disconnect between acute, inpatient rehabilitation and community services was identified as a trigger for increased complexity. Conclusions Patient complexity is not a dichotomous state. If applying existing complexity definitions, all patients are complex. This study extends the understanding by suggesting a structural element of complexity from manageable to less manageable complexity based on ability to discharge.

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