Diagnosis and Management of Asthma

A regional sample of members of the American Association of Occupational Health Nurses (AAOHN) from Maryland, Delaware, Virginia, and the District of Columbia was surveyed prior to the publication of the Expert Panel Report on Guidelines for the Diagnosis and Management of Asthma (time 1). The guidelines were disseminated directly to AAOHN members through an article in the AAOHN Journal and an annual convention plenary session presentation at which copies of the Report were distributed. They were disseminated indirectly through medical journals and government documents. A follow up survey of AAOHN members familiarity with and use of the Expert Panel Report was conducted 1 year later (time 2). Of the total eligible sample of 570 persons, 325 (57.0%) responded at time 1. Of these, 232 (71.4%) responded at time 2. One year after publication, 31 (13.4%) of the nurses participating in the time 2 survey were aware of the Report, 16 (6.9%) reported having an available copy of the Report, 31 (13.4%) were familiar with the recommendations in the Report, 17 (7.3%) referred to the guidelines, and 34 (14.7%) based care on the guidelines. Multiple direct dissemination strategies of consensus guidelines to improve practice will be necessary if nurses' awareness and use are to be enhanced.

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Abstract T P42: Patients With a Clinical Diagnosis of Non-disabling Stroke, and a Normal MRI are Clinically Indistinguishable From Patients With a MRI Lesion at 1 Year Post Stroke

Stroke ◽

10.1161/str.45.suppl_1.tp42 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Stephen Makin ◽

Martin Dennis ◽

Joanna M Wardlaw

Keyword(s):

Cognitive Impairment ◽

Cognitive Assessment ◽

Expert Panel ◽

Recurrent Stroke ◽

Final Diagnosis ◽

Cognitively Impaired ◽

Post Stroke ◽

Mild Stroke ◽

One Year

Background: Up to one third of patients with a clinically apparent mild stroke and no other apparent cause of their symptoms have a normal MRI. We examined disability, recurrent stroke, and cognitive impairment at one year compared to patient with an MRI-DWI lesion. Methods: We recruited consecutive patients with a non-disabling ischaemic stroke, and performed clinical assessment and MRI (with DWI) . An expert panel reviewed all cases, we included patients with a final diagnosis of stroke and excluded patients with another diagnosis. At one year post stroke we recorded modified Rankin scale (mRs), stroke and TIA recurrence, Addenbrookes Cognitive Assessment Revised (ACE-R) and the Beck Depression index (BDI) and performed another MRI. Non-attenders were assessed by telephone or post. We defined cognitive impairment as ACE-R of <88, and depression as a BDI of >9. Results: Almost one third (75/264) (median NIHSS=2) of patients had a no relevant lesion on MRI DWI. There was no difference in age, sex, symptoms, or risk factors in patients with and without a lesion, 197 had MRI at 1 year (all had clinical follow-up). Of 75 with no lesion, 41% were mRs ≥2, 13% had recurrent stroke or TIA, 36% were cognitively impaired and 46% had depression. This was not significantly different from the patients with a lesion. Of the 197 who had a follow-up MRI 50 patients with no initial lesion had follow-up MRI and one had a new lesion, (versus 20/147 patients with a lesion) (p=0.016). Conclusions: Patients with a clinical stroke and no other obvious cause for their symptoms are clinically indistinguishable from patients with the same NIHSS who have a lesion on DWI-MRI, in terms of recurrence, disability, or cognitive impairment. Suggesting that these patients have had a stroke that does not appear on MRI. The presence of an initial lesion increases the liklihood of a lesion on 1 year MRI, however without a difference in clinical stroke this is of doubtful significance.

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