scholarly journals EXPRESS: Longer term patient management following stroke A systematic review

2021 ◽  
pp. 174749302110169
Author(s):  
Christian Boehme ◽  
Thomas Töll ◽  
Wilfried Lang ◽  
Michael Knoflach ◽  
Stefan Kiechl
Keyword(s):  
Hospital Care ◽  
Recurrent Events ◽  
Patient Management ◽  
Action Plan ◽  
Vascular Events ◽  
Sustainable Solutions ◽  
Post Stroke ◽  
Stroke Team ◽  
Patient Reported

<b>Background</b> Tremendous progress in acute stroke therapy has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits and recurrent vascular events. <b>Aims</b> This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs. <b>Summary of review</b> A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregivers’ central role in post-stroke patient management is broadly neglected in research. <b>Conclusions</b> Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018-2030.

Aspirin and recurrent venous thromboembolism

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 99-104 ◽  
Author(s):  
P Prandoni ◽  
F Noventa ◽  
M Milan
Keyword(s):  
Venous Thromboembolism ◽  
Recurrent Events ◽  
Vitamin K Antagonists ◽  
Initial Period ◽  
Conclusive Evidence ◽  
First Episode ◽  
Vascular Events ◽  
Double Blind ◽  
Recurrent Vte

While there is conclusive evidence that aspirin plays a role in reducing the risk of clinically relevant venous thromboembolism (VTE) arising in a number of surgical and non-surgical situations at risk, little is known of the potential of aspirin for the long/term prevention of recurrent VTE. In two recent multicentre, double-blind studies (WARFASA and ASPIRE), the efficacy and safety of a low dose of aspirin (100 mg per day) were assessed in patients with unprovoked VTE who had completed an initial period of conventional treatment with vitamin K antagonists. The two studies used identical aspirin regimens and had similar enrolment criteria and outcome measures. When data from these two trials were pooled, there was a 32% reduction in the rate of recurrence of VTE (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.51–0.90) and a 34% reduction in the rate of major vascular events (HR, 0.66; 95% CI, 0.51–0.86). Moreover, these benefits were achieved with a low risk of bleeding. As patients with previous symptomatic atherosclerosis were not enrolled in these two studies, whether these results apply also to this category of patients is uncertain. We recently had the opportunity to review the clinical charts of 1919 consecutive patients presented with a first episode of VTE, which was either unprovoked or triggered by transient risk factors, and were followed up for an average period of four years after discontinuing anticoagulation. The rate of recurrent VTE in the 256 patients with a history of symptomatic atherosclerosis who had been given 80–160 mg of aspirin once daily (17.2%) did not differ from that (19.9%) observed in those without atherosclerosis who were left without any antithrombotic treatments. The implication of this observation is that whenever patients with symptomatic atherosclerosis are deemed to require long-term protection against recurrent VTE, they are unlikely to benefit from (resuming) aspirin. Conversely, aspirin in low doses offers an appealing, safe and highly cost-effective option for the long-term prevention of recurrent events in patients with unprovoked VTE who are free from symptomatic atherosclerotic lesions.

scholarly journals Long-term patient-reported outcome measures after injury: National Trauma Research Action Plan (NTRAP) scoping review protocol

2020 ◽  
Vol 5 (1) ◽  
pp. e000512
Author(s):  
Juan Pablo Herrera-Escobar ◽  
Manuel A Castillo-Angeles ◽  
Samia Y Osman ◽  
Claudia P Orlas ◽  
Mahin B Janjua ◽  
...  
Keyword(s):  
Scoping Review ◽  
Patient Reported Outcomes ◽  
Action Plan ◽  
Current Evidence ◽  
Trauma Research ◽  
National Trauma ◽  
Patient Reported ◽  
Research Action ◽  
Outcome Metrics

BackgroundA significant proportion of patients who survive traumatic injury continue to suffer impaired functional status and increased mortality long after discharge. However, despite the need to improve long-term outcomes, trauma registries in the USA do not collect data on outcomes or care processes after discharge. One of the main barriers is the lack of consensus regarding the optimal outcome metrics.ObjectivesTo describe the methodology of a scoping review evaluating current evidence on the available measures for tracking functional and patient-reported outcomes after injury. The aim of the review was to identify and summarize measures that are being used to track long-term functional recovery and patient-reported outcomes among adults after injury.MethodsA systematic search of PubMed and Embase will be performed using the search terms for the population (adult trauma patients), type of outcomes (long-term physical, mental, cognitive, and quality of life), and measures available to track them. Studies identified will be reviewed and assessed for relevance by at least two reviewers. Data will be extracted and summarized using descriptive statistics and a narrative synthesis of the results. This protocol is being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.DisseminationThis scoping review will provide information regarding the currently available metrics for tracking functional and patient-reported outcomes after injury. The review will be presented to a multi-disciplinary stakeholder group that will evaluate these outcome metrics using an online Delphi approach to achieve consensus as part of the development of the National Trauma Research Action Plan (NTRAP). The results of this review will be presented at relevant national surgical conferences and published in peer-reviewed scientific journals.

scholarly journals Stroke Induces Prolonged Changes in Lipid Metabolism, the Liver and Body Composition in Mice

2019 ◽  
Vol 11 (4) ◽  
pp. 837-850 ◽  
Author(s):  
Michael J. Haley ◽  
Claire S. White ◽  
Daisy Roberts ◽  
Kelly O’Toole ◽  
Catriona J. Cunningham ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Composition ◽  
Global Changes ◽  
Depression And Anxiety ◽  
Vascular Events ◽  
Post Stroke ◽  
Increased Risk ◽  
Co Morbidity ◽  
Long Term Changes

AbstractDuring recovery, stroke patients are at risk of developing long-term complications that impact quality of life, including changes in body weight and composition, depression and anxiety, as well as an increased risk of subsequent vascular events. The aetiologies and time-course of these post-stroke complications have not been extensively studied and are poorly understood. Therefore, we assessed long-term changes in body composition, metabolic markers and behaviour after middle cerebral artery occlusion in mice. These outcomes were also studied in the context of obesity, a common stroke co-morbidity proposed to protect against post-stroke weight loss in patients. We found that stroke induced long-term changes in body composition, characterised by a sustained loss of fat mass with a recovery of lean weight loss. These global changes in response to stroke were accompanied by an altered lipid profile (increased plasma free fatty acids and triglycerides) and increased adipokine release at 60 days. After stroke, the liver also showed histological changes indicative of liver damage and a decrease in plasma alanine aminotransferase (ALT) was observed. Stroke induced depression and anxiety-like behaviours in mice, illustrated by deficits in exploration, nest building and burrowing behaviours. When initial infarct volumes were matched between mice with and without comorbid obesity, these outcomes were not drastically altered. Overall, we found that stroke induced long-term changes in depressive/anxiety-like behaviours, and changes in plasma lipids, adipokines and the liver that may impact negatively on future vascular health.

Clinical Study of Gud-Amalaka Yoga in Garbhini Mutrakrichra w.s.r to Urinary Tract Infections during Pregnancy

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Sandeep Kumar Rajan ◽  
Rajnish Gautam ◽  
Pankaj Mishra
Keyword(s):  
Pregnant Woman ◽  
Urinary Tract ◽  
The Body ◽  
Premature Delivery ◽  
Healthy Baby ◽  
Patient Reported ◽  
Long Term Result ◽  
Tract Infections ◽  
Prompt Attention

Healthy mother and healthy baby are foremost aim of antenatal care. Progressive anatomical and physiological changes during pregnancy are not only confined to the genital organs however within other systems of the body too, some may be felt as discomfort by a pregnant woman. A pregnant woman having pain or burning micturition, fever with chills, nausea, vomiting and cloudy urine having bad smell can be diagnosed as having Urinary Tract Infection (UTI). UTI is most common bacterial infection encountered during Pregnancy and troublesome to the woman suffering from it. Pyelonephritis, premature delivery and other risk such as PROM, IUGR etc. can be the long term result of UTI hence prompt attention is requisite. In the present study Gud-Amalaka Yoga has been tried in 15 patients for evaluation of its clinical efficacy and adverse / side effects if any. It was observed that Gud-Amalaka Yoga showed better results (25% patients were moderately improved, 75% patients were mildly improved). None of the patient reported any adverse effect during or after the treatment.

The impact of ageing on hospital care and long-term care—the example of Germany

Health Policy ◽  
2004 ◽  
Vol 67 (1) ◽  
pp. 57-74 ◽  
Author(s):  
Erika Schulz ◽  
Reiner Leidl ◽  
Hans-Helmut König
Keyword(s):  
Hospital Care ◽  
Long Term Care ◽  
Term Care ◽  
The Impact

scholarly journals Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ingrid Johansen Skogestad ◽  
Marit Kirkevold ◽  
Petra Larsson ◽  
Christine Råheim Borge ◽  
Bent Indredavik ◽  
...  
Keyword(s):  
Future Development ◽  
Health Professionals ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Post Stroke ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

scholarly journals Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

2021 ◽  
Vol 10 (9) ◽  
pp. 2009
Author(s):  
Joaquín Fernández ◽  
Manuel Rodríguez-Vallejo ◽  
Javier Martinez ◽  
Noemi Burguera ◽  
David P. Piñero
Keyword(s):  
Intraocular Lens ◽  
Patient Reported Outcomes ◽  
Phone Call ◽  
Distortion Analysis ◽  
Patient Reported ◽  
Visual Function Questionnaire ◽  
Secondary Objective ◽  
Defocus Curve ◽  
The Mean

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m−1 and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

scholarly journals Long-Term Efficacy of Extracorporeal Shock Wave Therapy on Lower Limb Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 10 (1) ◽  
pp. 86
Author(s):  
Emanuela Elena Mihai ◽  
Luminita Dumitru ◽  
Ilie Valentin Mihai ◽  
Mihai Berteanu
Keyword(s):  
Systematic Review ◽  
Lower Limb ◽  
Meta Analysis ◽  
Extracorporeal Shock Wave Therapy ◽  
Shock Wave Therapy ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Term Efficacy ◽  
Extracorporeal Shock Wave

The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults. A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events. A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD) = 0.53; 95% confidence interval (95% CI): (0.07–0.99); Modified Tardieu Scale (MTS): SMD = 0.56; 95% CI: (0.01–1.12); Visual Analogue Scale (VAS): SMD = 0.35; 95% CI: (−0.21–0.91); PROM: SMD = 0.69; 95% CI: (0.20–1.19). ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.

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