scholarly journals A process evaluation of patient care needs using the Post- Stroke Checklist: a prospective study

2022 ◽  
Author(s):  
Bhasker Amatya ◽  
Alaeldin Elmalik ◽  
Su Yi Lee ◽  
Krystal Song ◽  
Mary Galea ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Care Needs ◽  
Post Discharge ◽  
Post Stroke ◽  
Consecutive Admission ◽  
The Mean ◽  
Observational Design ◽  
T1 And T2 ◽  
Improved Function ◽  
A Prospective Study

Objective: To assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of patients with stroke (PwS) in an inpatient rehabilitation setting. Methods: Prospective observational design with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. The post-stroke checklist was administered at hospital discharge (T1) and 3 months post-discharge (T2). Furthermore, validated questionnaires assessed function and participation, including the Clinical Functioning Information Tool (ClinFIT) on admission (T0), T1 and T2. Results: Participants’ mean age was 67.7 years (standard deviation; SD) 14.6), 58% of participants were female, and the mean length of inpatient stay was 32.7 days (SD 22.4). At T1, 80% and at T2 only 60% of participants reported ≥1 stroke-related problem (mean 5.3 (SD 3.3) and 3.6 (SD 2.8), respectively). Half of participants were referred to physiotherapy/occupational therapy, and 36% to specialist clinics following discharge. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living, and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed improved function at T1 and T2 (Extension Index, ClinFIT set), from T0 to T1 and T0 to T2 (p<0.001, with large effect sizes). Conclusion: The mPSC is feasible to implement in an inpatient rehabilitation setting and community. It can identify relevant stroke-related problems, and hence facilitate targeted intervention.

Abstract 3861: The Effect of Stroke Survivor and Caregiver Family Function and Mutuality on Post Stroke Depression

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Kyler M Godwin ◽  
Paul Swank ◽  
Sharon K Ostwald
Keyword(s):  
Structural Model ◽  
Inpatient Rehabilitation ◽  
Stroke Survivor ◽  
Mediating Effect ◽  
Stroke Survivors ◽  
Post Discharge ◽  
Family Function ◽  
Her Family ◽  
Post Stroke ◽  
Post Stroke Depression

Background: Post-stroke depression is common among both stroke survivors and their caregivers. This secondary data analysis explored the effect that stroke survivor and caregiver family function and mutuality, a measure of the perceived positive aspects of the caregiving relationship, had on the depression of spousal dyads over the first 12 months post discharge from inpatient rehabilitation. Methods: Longitudinal meditational analysis was employed to examine the mediating effect of mutuality on the dyads’ perception of family function and caregiver and stroke survivor depression over time. The model was estimated in MPlus version 6.1 using bootstrap estimation with 1000 draws. The final structural model had good model fit to the data with a chi square ( df= 16; N = 132) of 17.55, p =.35, a comparative fit index (CFI) of 0.996, and root mean square error of approximation (RMSEA) of 0.027 (CI = 0-.087). Results: This study included 159 stroke survivors and their spousal caregivers who were an average (standard deviation) age of 66.4 (9.1) and 62.5 (10.5) years, respectively. The majority of stroke survivors were predominately male and non-Hispanic white, although almost 40% of the sample was represented by ethnic minorities. Mutuality was not found to mediate the relationship between caregivers’ and stroke survivors’ perception of family function at baseline and their own or their partners’ depression at 12 months as hypothesized. However, caregivers who perceived healthier family functioning at baseline and stroke survivors who had higher perceived mutuality at 12 months had lower depression at one year post discharge from inpatient rehabilitation (-.117, p=.048; -1.007, p=.034, respectively). Additionally, caregiver mutuality at 6 months, but not at baseline or 12 months, was found to be inversely related to caregiver depression at 12 months (-1.06, p=.04). Conclusions: This study highlights the importance of focusing on the relational aspects of stroke. A stroke does not only happen to the stroke survivor. It affects his or her family, and it oftentimes changes the life of both the stroke survivor and their spousal caregiver. Health professionals should encourage couples who have experienced a stroke to focus on the positive aspects of the caregiving relationship to mitigate post-stroke depression.

scholarly journals A Prospective Study Identifying a Change in Energy and Protein Intake of Older Adults during Inpatient Rehabilitation

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 453 ◽  
Author(s):  
Jorja Collins ◽  
Judi Porter ◽  
Helen Truby ◽  
Catherine Huggins
Keyword(s):  
Protein Intake ◽  
Associated Factors ◽  
Daily Intake ◽  
Inpatient Rehabilitation ◽  
Point Scale ◽  
Plate Waste ◽  
Hospital Malnutrition ◽  
Daily Energy ◽  
The Mean ◽  
A Prospective Study

Understanding older patients’ dietary intake patterns may improve the timing of strategies to address hospital malnutrition. The aims of this study were to explore longitudinally the change in daily energy (kJ/day) and protein (g/day) intake, and associated factors. Data were derived using a 5-point scale to visually estimate plate waste, and known nutrient composition data. Analyses determined the change in intake between admission and day 14, and admission, day 14 and day 28, respectively. Data were available for 39 participants between admission and day 14 (median (interquartile range) age 82 (78–87) years; 54% male) and 12 participants between admission, day 14 and day 28 (median (IQR) age 79 (69–84) years; 58% male). From admission to day 14 there was a significant increase in the mean (SD) daily intake of energy (6177 (1879) kJ/day vs. 7213 (1903), p < 0.001) and protein (63.7 (23) g/day vs. 76.4 (23.0) g/day, p = 0.003) but no change from admission to day 14 to day 28. There was a significant inverse relationship between amount consumed at admission and change in intake. Variability in elderly patients’ intake over time has implications for the timing of nutritional care and data collection in research studies.

scholarly journals Cohort profile: A prospective study of clinical and epidemiological characteristics of COVID-19 patients post-discharge in Tehran, Iran (Tele-COVID-19) (Preprint)

2020 ◽  
Author(s):  
Laya Jalilian Khave ◽  
Mohammad Vahidi ◽  
Dorsa Shirini ◽  
Ghazal Sanadgol ◽  
Farzad Ashrafi ◽  
...  
Keyword(s):  
Healthcare Delivery ◽  
Teaching Hospitals ◽  
Post Discharge ◽  
Discharge Data ◽  
The Mean ◽  
Hospital To Home ◽  
A Prospective Study ◽  
Epidemiological Characteristics ◽  
Severe Shortage

BACKGROUND Coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020. Given the severe shortage of hospital beds leading to early discharges and insufficient patient education regarding home care routines and isolation protocols, close follow-up with patients and their immediate relatives is an integral part of care transition from hospital to home among COVID-19 patients. OBJECTIVE We designed the Tele-COVID-19 prospective cohort to follow-up COVID-19 patients in Tehran, Iran in order to help improve healthcare delivery and recording of patients’ clinical profile post-discharge. METHODS All adult patients admitted to COVID-19 wards of teaching hospitals of Tehran, Iran are eligible to participate. In the baseline wave, patients were recruited from four major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups led by volunteer medical students were made on days 1, 2, 3, 5, 7, 10, and 14 post-discharge. Data was collected on a range of socio-demographic, epidemiological, and clinical characteristics using a standard questionnaire. RESULTS Out of 950 confirmed COVID-19 patients who were approached, 823 consented and were enrolled in the cohort (response rate = 86.6%). A total of 449 (54.5%) participants were male and the mean (SD) age of participants was 50.1 (12.6). CONCLUSIONS Tele-COVID-19 will provide the patients with sufficient education on homecare and isolation as well as medical advice on care and proper use of drugs. In addition, by preventing unnecessary hospital returns and diagnosis of household transmissions at the earliest stages, this cohort would help disease management in resource restricted settings.

Osteotomy for Correction of Premature Growth Plate Closure in 24 Dogs

1994 ◽  
Vol 07 (03) ◽  
pp. 129-135 ◽  
Author(s):  
C.W. Miller ◽  
P.W. Morgan
Keyword(s):  
Corrective Osteotomy ◽  
Functional Results ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Angular Deformity ◽  
Dynamic Correction ◽  
Age At Surgery ◽  
Limb Deformities ◽  
The Mean ◽  
A Prospective Study

SummaryTwenty-four dogs (27 limbs) were evaluated after surgery for correction of forelimb angular limb deformities. Partial ulnar ostectomies or definitive corrective osteotomies were performed depending upon the age of the dog. According to owner assessment nine of fourteen limbs were considered functionally good, or excellent, after partial ulnar ostectomies. Younger dogs appeared to have better functional results after dynamic correction with the mean age at surgery of dogs with good to excellent results being 6.5 months contrasted to the mean age at surgery of dogs with fair to poor results being 9.75 months. Ten of fourteen limbs were considered functionally good or excellent after definitive corrective osteotomy. One dog had definitive osteotomy after partial ulnar ostectomy in order to further correct a residual angular deformity. However, 58% of the limbs with radiographic follow-up had signs of degenerative joint disease (DJD). There were not significant differences between neither degree of angulation remaining after surgery and the functional result nor the degree of angulation remaining after surgery and the development of DJD. A prospective study is warranted to more objectively assess the efficacy of surgical correction of angular limb deformities in dogs.Twenty-four dogs were evaluated after surgery for correction of forelimb angular limb deformities. The results are described.

scholarly journals Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation

2021 ◽  
Author(s):  
Gurumayum Sonachand Sharma ◽  
Anupam Gupta ◽  
Meeka Khanna ◽  
Naveen Bangarpet Prakash
Keyword(s):  
Outcome Measures ◽  
Functional Outcomes ◽  
Rating Scale ◽  
Tertiary Care ◽  
Depression Scale ◽  
Inpatient Rehabilitation ◽  
University Hospital ◽  
Post Stroke ◽  
Significant Difference ◽  
Post Stroke Depression

Abstract Objective The aim of the study is to observe the effect of post-stroke depression on functional outcomes during inpatient rehabilitation. Patients and Methods The design involved is prospective observational study. The location involved is Neurological Rehabilitation unit in a tertiary care university hospital. The study period ranges from October 2019 to April 2020. The participants involved are the patients with first ever stroke, male and female with age ≥18 years and duration less than 1 year. All participants were assessed at admission and after 14 sessions of inpatient rehabilitation by depression subscale of Hospital Anxiety and Depression Scale (HADS-D) and Hamilton Depression Rating Scale (HDRS). The stroke outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS), and Modified Rankin Scale (MRS). Results There are a total of 30 participants (18 males) with median stroke duration of 90 days. The median age of the patients was 58 years. Sixteen patients had ischemic and 14 had hemorrhagic stroke. Out of these, 57% (n = 17) had symptoms of depression (HADS-D >7). Participants in both groups (with and without depression) showed improvement in all the functional outcome measures (BI, SSS, MRS) at the time of discharge as compared with admission scores. The changes in the outcome measures were statistically significant within groups (p < 0.05) but not significant between the groups (p > 0.05). Conclusion The post-stroke depression is common among stroke survivors of less than 1 year duration. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program.

scholarly journals Structure and processes of emergency observation units with a geriatric focus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pieter Heeren ◽  
Annabelle Hendrikx ◽  
Janne Ceyssens ◽  
Els Devriendt ◽  
Mieke Deschodt ◽  
...  
Keyword(s):  
Scoping Review ◽  
Emergency Care ◽  
Older Patients ◽  
Clinical Care ◽  
Care Needs ◽  
Post Discharge ◽  
Care Services ◽  
Observation Units ◽  
Primary Care Services ◽  
Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

scholarly journals Analysis of Sagittal Thoracic Inlet Measures in Relation to Anterior Access to the Cervicothoracic Junction

2021 ◽  
pp. 219256822110057
Author(s):  
Joseph F. Baker
Keyword(s):  
Vertebral Body ◽  
Cervicothoracic Junction ◽  
Thoracic Inlet ◽  
Mean Values ◽  
Anterior Access ◽  
Projection Angle ◽  
The Mean ◽  
T1 And T2 ◽  
Trauma Ct ◽  
Inlet Angle

Study Design: Retrospective radiographic study. Objective: The aim of this study was to define the association between thoracic inlet measures in relation to anterior access to the cervicothoracic junction. Methods: Trauma CT scans in patients >16 years were analyzed. The projection angle (PA), defined as the angle subtended by a line along the superior endplate of the vertebral body and the line from the anterosuperior corner of the vertebral body to the manubrium, was measured at C7, T1 and T2; angles were positive if the projection was above the manubrium. Thoracic inlet angle (TIA), thoracic inlet distance (TID) and pelvic incidence (PI) were measured. Results: 65 scans were assessed (33 males; mean age 47.7 years (s.d. 8.7)). The mean TIA 79.9° (s.d. 13.4°; range 52.6° – 112.2°), mean TID 66.1 mm (s.d. 6.6 mm) and mean PI was 50.5° (s.d. 10.2°). Mean values for the projection angles at C7, T1 and T2 were 24.2°, 7.6° and −8.3° respectively. PA were positive in 95% at C7, 73% at T1 and 30% at T2. PA at each level correlated significantly with age (mean r=−0.371; P = .015) and TIA (mean r=−0.916; P < .001) but neither TID nor PI. TIA correlated with age (r = 0.328; P = .008). Conclusions: The projection angles of the CTJ vertebrae are influenced by thoracic inlet angle and a lesser degree age. Understanding sagittal spinal parameters in the CTJ can aid in planning surgical strategy and approach.

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

2019 ◽  
pp. jramc-2018-001132
Author(s):  
Pierre Perrier ◽  
J Leyral ◽  
O Thabouillot ◽  
D Papeix ◽  
G Comat ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Examination ◽  
Point Of Care ◽  
Military Medicine ◽  
Final Diagnosis ◽  
Absolute Difference ◽  
Point Of Care Ultrasound ◽  
Medical Emergencies ◽  
The Mean ◽  
A Prospective Study

IntroductionTo evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies.MethodsA prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a ‘clinicaldiagnostic probability’ (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an ‘ultrasounddiagnostic probability’ (UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy).ResultsForty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0–5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%).ConclusionPOCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.

scholarly journals Biological and clinical impact of hemangioblastoma-associated peritumoral cysts in von Hippel-Lindau disease

2016 ◽  
Vol 124 (4) ◽  
pp. 971-976 ◽  
Author(s):  
Kristin Huntoon ◽  
Tianxia Wu ◽  
J. Bradley Elder ◽  
John A. Butman ◽  
Emily Y. Chew ◽  
...  
Keyword(s):  
Clinical Impact ◽  
Anatomical Location ◽  
Von Hippel Lindau ◽  
Study Enrollment ◽  
Common Location ◽  
Younger Age ◽  
The Mean ◽  
A Prospective Study ◽  
Vhl Disease

OBJECT Peritumoral cysts are frequently associated with CNS hemangioblastomas and often underlie neurological morbidity and mortality. To determine their natural history and clinical impact, the authors prospectively analyzed hemangioblastoma-associated peritumoral cysts in patients with von Hippel-Lindau (VHL) disease. METHODS Patients with VHL disease who had 2 or more years of follow-up and who were enrolled in a prospective study at the National Institutes of Health were included. Serial prospectively acquired laboratory, genetic, imaging, and clinical data were analyzed. RESULTS One hundred thirty-two patients (of 225 in the VHL study with at least 2 years of follow-up) had peritumoral cysts that were followed for more than 2 years (total of 292 CNS peritumoral cysts). The mean age at study entrance was 37.4 ± 13.1 years ([mean ± SD], median 37.9, range 12.3–65.1 years). The mean follow-up was 7.0 ± 1.7 years (median 7.3, range 2.1–9.0 years). Over the study period, 121 of the 292 peritumoral cysts (41.4%) became symptomatic. Development of new cysts was associated with a larger number cysts at study enrollment (p = 0.002) and younger age (p < 0.0001). Cyst growth rate was associated with anatomical location (cerebellum cysts grew faster than spine and brainstem cysts; p = 0.0002 and p = 0.0008), younger age (< 35 years of age; p = 0.0006), and development of new neurological symptoms (p < 0.0001). Cyst size at symptom production depended on anatomical location (p < 0.0001; largest to smallest were found, successively, in the cerebellum, spinal cord, and brainstem). The most common location for peritumoral cysts was the cerebellum (184 cysts [63%]; p < 0.0001). CONCLUSIONS Peritumoral cysts frequently underlie symptom formation that requires surgical intervention in patients with VHL disease. Development of new cysts was associated with a larger number of cysts at study enrollment and younger age. Total peritumoral cyst burden was associated with germline partial deletion of the VHL gene.

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