scholarly journals Combined Clinical and Home Rehabilitation: Case Report of an Integrated Knowledge-to-Action Study in a Dutch Rehabilitation Stroke Unit

2015 ◽  
Vol 95 (4) ◽  
pp. 558-567 ◽  
Author(s):  
Christa S. Nanninga ◽  
Klaas Postema ◽  
Marleen C. Schönherr ◽  
Sacha van Twillert ◽  
Ant T. Lettinga
Keyword(s):  
Case Report ◽  
Stroke Unit ◽  
Practical Knowledge ◽  
Transfer Problem ◽  
Stroke Care ◽  
Application Process ◽  
Research Knowledge ◽  
Knowledge To Action ◽  
Straightforward Application ◽  
Early Supported Discharge

Background and Purpose There is growing awareness that the poor uptake of evidence in health care is not a knowledge-transfer problem but rather one of knowledge production. This issue calls for re-examination of the evidence produced and assumptions that underpin existing knowledge-to-action (KTA) activities. Accordingly, it has been advocated that KTA studies should treat research knowledge and local practical knowledge with analytical impartiality. The purpose of this case report is to illustrate the complexities in an evidence-informed improvement process of organized stroke care in a local rehabilitation setting. Case Description A participatory action approach was used to co-create knowledge and engage local therapists in a 2-way knowledge translation and multidirectional learning process. Evidence regarding rehabilitation stroke units was applied in a straightforward manner, as the setting met the criteria articulated in stroke unit reviews. Evidence on early supported discharge (ESD) could not be directly applied because of differences in target group and implementation environment between the local and reviewed settings. Early supported discharge was tailored to the needs of patients severely affected by stroke admitted to the local rehabilitation stroke unit by combining clinical and home rehabilitation (CCHR). Outcomes Local therapists welcomed CCHR because it helped them make their task-specific training truly context specific. Key barriers to implementation were travel time, logistical problems, partitioning walls between financing streams, and legislative procedures. Discussion Improving local settings with available evidence is not a straightforward application process but rather a matter of searching, logical reasoning, and creatively working with heterogeneous knowledge sources in partnership with different stakeholders. Multiple organizational levels need to be addressed rather than focusing on therapists as sole site of change.

Abstract 3030: Meta-analysis of Cost Effectiveness of Different Stroke Unit Subtypes

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Minal Jain ◽  
Anunaya Jain ◽  
Abhijit R Kanthala ◽  
Babak S Jahromi
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Systems Of Care ◽  
Surrogate Marker ◽  
Cost Effective ◽  
Stroke Care ◽  
Developed Countries ◽  
Direct Care ◽  
Early Supported Discharge ◽  
Acute Rehabilitation

Aim: To perform a systematic review and metanalysis, comparing outcome and cost of stroke care in a stroke unit (SU) versus conventional care (CC). Secondary aim was to compare cost effectiveness of different SU subtypes. Methods: Pubmed search was performed for “Stroke Unit” among all English language articles from 01/01/1996 to 01/01/2011. Only articles from developed countries, reporting the length of stay (LOS) and/or cost and outcomes for ischemic stroke were included. Studies wherein data was collected before 01/01/1996, articles only on rehabilitation units, and all systematic reviews were excluded. LOS was taken as a surrogate marker of stroke care cost in studies wherein direct care costs were not reported. Non-QALY outcomes were converted to QALYs using reported logistic regressions. Ratios less than $50,000/QALY were considered cost effective while greater than $100,000 /QALY were considered non-cost effective. All cost were reported in 2010 US$. Result: A total of 5,537 articles in Pubmed were studied, of which 19 studies met the inclusion criteria. LOS for patients managed at SU ranged from 9.2-32.3 days versus 8-35.3 days for CC units and average incremental QALYs between them were 0.09. The average incremental cost/QALY was $41,204.37. The average cost/QALY for different types of SU were $19,428.64 for Acute only SU (A SU), $44,228.81 for Acute+Rehabilitation SU (A+R SU), $29,145.93 for Acute+Rehabilitation+Early Supported Discharge (A+R+ESD) SU and $20,460.56 for SU with Continuous monitoring (SU CM). In comparison to an A SU, SU CM and A+R+ESD SU were cost effective alternatives (ICER SU CM estimated at $25,120.89, ICER A+R+ESD SU estimated at $24,574.59). Conclusion: Stroke Units are cost effective when compared to the conventional systems of care. Acute + rehab SU with early supported discharge appears to be the most cost effective model amongst different subtypes of SU.

scholarly journals Incorporating Self-Management in Prosthetic Rehabilitation: Case Report of an Integrated Knowledge-to-Action Process

2015 ◽  
Vol 95 (4) ◽  
pp. 640-647 ◽  
Author(s):  
Sacha van Twillert ◽  
Klaas Postema ◽  
Jan H.B. Geertzen ◽  
Ant T. Lettinga
Keyword(s):  
Knowledge Translation ◽  
Practical Knowledge ◽  
Self Management ◽  
Specific Training ◽  
Prosthetic Rehabilitation ◽  
Research Knowledge ◽  
Translation Process ◽  
Knowledge To Action ◽  
Context Specific ◽  
And Task

Background In improvement of clinical practice, unidirectional approaches of translating evidence into clinical practice have been pinpointed as main obstacles. The concept of engaged scholarship has been introduced to guide knowledge-to-action (KTA) processes, in which research knowledge and practical knowledge derived from therapists, patients, and organizational structures mutually inform each other. Accordingly, KTA experts should engage end-users earlier in knowledge translation and work in concert with them on both knowledge creation and knowledge implementation. Purpose The purposes of this case report are: (1) to provide an illustrative example of an evidence-informed improvement process in prosthetic rehabilitation in a local setting and (2) to articulate the bidirectional translation work incorporated into an integrated KTA process. Case Description A KTA expert translated research knowledge on self-management and task- and context-specific training into a functional prosthetic training program for patients with a lower limb amputation. Therapists contributed as co-creators to the translation process with practical knowledge of the specificities of the target group and local organizational context. The KTA expert moved the co-created knowledge into action in iterative and interactive steps with local therapists, patients, and managers. Outcome This bidirectional KTA translation process led to shared ownership of the functional prosthetic training program, in which self-management and task- and context-specific training principles and practices were integrated. Discussion Bidirectional knowledge translation builds on explicating and integrating the different knowledge practices of researchers, therapists, and their patients. Knowledge-to-action experts and end-users have their own roles and activities in such knowledge translation processes. Appreciating these different roles in genuine partnerships and acknowledging the distinct but equally valued knowledge practices can help in effectively translating evidence into action.

Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 116-123
Author(s):  
Mathew Cherian ◽  
Pankaj Mehta ◽  
Shriram Varadharajan ◽  
Santosh Poyyamozhi ◽  
Elango Swamiappan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Retrospective Review ◽  
Stroke Unit ◽  
Care Pathway ◽  
Clinical Care ◽  
Stroke Care ◽  
First Year ◽  
Proof Of Concept ◽  
Mobile Stroke Unit ◽  
Clinical Care Pathway

Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.

scholarly journals Stroke Unit Care Combined With Early Supported Discharge

Stroke ◽  
2003 ◽  
Vol 34 (11) ◽  
pp. 2687-2691 ◽  
Author(s):  
Hild Fjærtoft ◽  
Bent Indredavik ◽  
Stian Lydersen
Keyword(s):  
Stroke Unit ◽  
Early Supported Discharge ◽  
Stroke Unit Care

scholarly journals Stroke Care During the First and the Second Waves of the COVID-19 Pandemic in a Community Hospital

2021 ◽  
Vol 12 ◽  
Author(s):  
Piotr Sobolewski ◽  
Wiktor Szczuchniak ◽  
Danuta Grzesiak-Witek ◽  
Jacek Wilczyński ◽  
Karol Paciura ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Stroke Unit ◽  
Community Hospital ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Staff Members ◽  
Second Wave

Objective: The coronavirus disease 2019 (COVID-19) infection may alter a stroke course; thus, we compared stroke course during subsequent pandemic waves in a stroke unit (SU) from a hospital located in a rural area.Methods: A retrospective study included all patients consecutively admitted to the SU between March 15 and May 31, 2020 (“first wave”), and between September 15 and November 30, 2020 (“second wave”). We compared demographic and clinical data, treatments, and outcomes of patients between the first and the second waves of the pandemic and between subjects with and without COVID-19.Results: During the “first wave,” 1.4% of 71 patients were hospitalized due to stroke/TIA, and 41.8% of 91 during the “second wave” were infected with SARS-CoV-2 (p < 0.001). During the “second wave,” more SU staff members were infected with COVID-19 than during the “first wave” (45.6 vs. 8.7%, p < 0.001). Nevertheless, more patients underwent intravenous thrombolysis (26.4 vs. 9.9%, p < 0.008) and endovascular thrombectomy (5.3 vs. 0.0%, p < 0.001) during the second than the first wave. Large vessel occlusion (LVO) (OR 8.74; 95% CI 1.60–47.82; p = 0.012) and higher 30-day mortality (OR 6.01; 95% CI 1.04–34.78; p = 0.045) were associated with patients infected with COVID-19. No differences regarding proportions between ischemic and hemorrhagic strokes and TIAs between both waves or subgroups with and without COVID-19 existed.Conclusion: Despite the greater COVID-19 infection rate among both SU patients and staff during the “second wave” of the pandemic, a higher percentage of reperfusion procedures has been performed then. COVID-19 infection was associated with a higher rate of the LVO and 30-day mortality.

scholarly journals Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lena Rafsten ◽  
Anna Danielsson ◽  
Asa Nordin ◽  
Ann Björkdahl ◽  
Asa Lundgren-Nilsson ◽  
...  
Keyword(s):  
Multidisciplinary Team ◽  
Controlled Trial ◽  
Stroke Care ◽  
Secondary Outcome ◽  
Outpatient Rehabilitation ◽  
Control Group ◽  
Stroke Patients ◽  
Post Stroke ◽  
Early Supported Discharge ◽  
Significant Difference

Abstract Background and purpose Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. Methods A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS). Results No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. Conclusions The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. Trial registration Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

scholarly journals The role of cardiologists on the stroke unit

2020 ◽  
Vol 22 (Supplement_M) ◽  
pp. M3-M12
Author(s):  
Wolfram Doehner ◽  
David Manuel Leistner ◽  
Heinrich J Audebert ◽  
Jan F Scheitz
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Stroke Care ◽  
Cardiovascular Complications ◽  
Large Artery ◽  
Stroke Management ◽  
Acute Stroke Care ◽  
Daily Work ◽  
Cardiovascular Comorbidity ◽  
Treatment And Prevention

Abstract Cardiologists need a better understanding of stroke and of cardiac implications in modern stroke management. Stroke is a leading disease in terms of mortality and disability in our society. Up to half of ischaemic strokes are directly related to cardiac and large artery diseases and cardiovascular risk factors are involved in most other strokes. Moreover, in an acute stroke direct central brain signals and a consecutive autonomic/vegetative imbalance may account for severe and life-threatening cardiovascular complications. The strong cerebro-cardiac link in acute stroke has recently been addressed as the stroke-heart syndrome that requires careful cardiovascular monitoring and immediate therapeutic measures. The regular involvement of cardiologic expertise in daily work on a stroke unit is therefore of high importance and a cornerstone of up-to-date comprehensive stroke care concepts. The main targets of the cardiologists’ contribution to acute stroke care can be categorized in three main areas (i) diagnostics workup of stroke aetiology, (ii) treatment and prevention of complications, and (iii) secondary prevention and sub-acute workup of cardiovascular comorbidity. All three aspects are by themselves highly relevant to support optimal acute management and to improve the short-term and long-term outcomes of patients. In this article, an overview is provided on these main targets of cardiologists’ contribution to acute stroke management.

scholarly journals Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018143 ◽  
Author(s):  
Michael Allen ◽  
Kerry Pearn ◽  
Emma Villeneuve ◽  
Thomas Monks ◽  
Ken Stein ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Travel Time ◽  
Stroke Unit ◽  
Stroke Care ◽  
Hyperacute Stroke ◽  
Geographical Access ◽  
Unit Model ◽  
Stroke Services ◽  
Time Critical ◽  
Institutional Size

ObjectivesThe policy of centralising hyperacute stroke units (HASUs) in England aims to provide stroke care in units that are both large enough to sustain expertise (>600 admissions/year) and dispersed enough to rapidly deliver time-critical treatments (<30 min maximum travel time). Currently, just over half (56%) of patients with stroke access care in such a unit. We sought to model national configurations of HASUs that would optimise both institutional size and geographical access to stroke care, to maximise the population benefit from the centralisation of stroke care.DesignModelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.Setting127 acute stroke services in England, serving a population of 54 million people.Participants238 887 emergency admissions with acute stroke over a 3-year period (2013–2015).InterventionModelled reconfigurations of HASUs optimised for institutional size and geographical access.Main outcome measureTravel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.ResultsSolutions were identified with 75–85 HASUs with annual stroke admissions in the range of 600–2000, which achieve up to 82% of patients attending a stroke unit within 30 min estimated travel time (with at least 95% and 98% of the patients being within 45 and 60 min travel time, respectively).ConclusionsThe reconfiguration of hyperacute stroke services in England could lead to all patients being treated in a HASU with between 600 and 2000 admissions per year. However, the proportion of patients within 30 min of a HASU would fall from over 90% to 80%–82%.

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