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Fountouki A, Tegos T, Ztriva E, Kaiafa G, Didangelos T, Theofanidis D, Savopoulos C. Hyperglycemic Patterns in Acute Stroke Patients. Cureus 2024; 16:e62039. [PMID: 38989392 PMCID: PMC11234241 DOI: 10.7759/cureus.62039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Background and objective Hyperglycemia following a stroke can independently aggravate the ischemic area. Ensuring adequate glucose management can help avoid complications and minimize mortality and disability in these patients. This study aimed to investigate hyperglycemic patterns in acute stroke patients. Materials and methods We conducted a non-interventional prospective observational study involving acute stroke patients by employing continuous glucose monitoring (CGM) for 72 hours after the onset of stroke symptoms. Admission glucose, patients' total mean glucose (TMG), and time in range (TIR) (70-140 mg/dl) were correlated with the hyperglycemic patterns elicited by the CGM system software. Data were analyzed using SPSS Statistics 26.0 (IBM Corp., Armonk, NY) with descriptive statistics, the Kruskal-Wallis test, and χ2 test. Results Our cohort comprised 105 diabetic and non-diabetic stroke patients. The hyperglycaemic patterns that we observed were as follows: (i) hyperglycemia from 23:00 to 10:00, (ii) 06.00 to 10.00, (iii) at night and after meals, iv) no pattern, v) unspecified patterns. Patients with nocturnal and morning hyperglycemia had admission glucose of 183 mg/dl, mean 72-hour glucose of 156 mg/dl, and TIR of 37%. Patients who did not develop a hyperglycemic pattern either had admission glucose of 131 mg/dl and TIR of 89% or had high admission glucose (197 mg/dl) and a short TIR (14%). Conventional pre-meal capillary glucose tests do not appear to detect these patients' hyperglycemic tendencies. Conclusions These results may indicate the necessity for more intensive measurements during the night or dawn in this patient population. Admission glucose could be considered a predictor of hyperglycemic patterns and contribute to the patient's care plan.
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Affiliation(s)
| | - Thomas Tegos
- 1st Department of Neurology, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, GRC
| | - Eleftheria Ztriva
- 1st Propaedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, GRC
| | - Georgia Kaiafa
- 1st Propaedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, GRC
| | - Triantafyllos Didangelos
- 1st Propaedeutic Department of Internal Medicine/Diabetic Care Unit, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, GRC
| | | | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, GRC
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Blázquez-González P, Mirón-González R, Lendínez-Mesa A, Luengo-González R, Mancebo-Salas N, Camacho-Arroyo MT, Martínez-Hortelano JA. Impact of virtual reality-based therapy on post-stroke depression: A systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2024; 21:194-201. [PMID: 38149683 DOI: 10.1111/wvn.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Post-stroke depression is the most common neuropsychiatric consequence and reduces rehabilitation effectiveness. However, the efficacy of virtual reality (VR) on mental health treatment for patients after a stroke is uncertain. AIMS The aim of this study was to evaluate the efficacy of VR as a co-adjuvant form of treatment to reduce depression in stroke patients admitted to neurorehabilitation units. METHODS We systematically searched medical databases including PubMed, CINAHL, PsycINFO, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to November 16, 2023. Clinical trials comparing the use of VR as an adjuvant form of treatment in stroke patients' rehabilitation with the usual treatment were included. Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses were performed according to type of stroke, VR characteristics, and the scale used to measure depression. Meta-regression analysis was performed for intervention duration and to determine the mean age of the participants. RESULTS Eight studies and 388 stroke patients were included. The VR interventions were associated with a lower risk of depression in patients (ES = -0.69; 95% CI [-1.05, -0.33]; I2 = 57.6%; p ≤ .02). The estimates were not affected by the type of stroke, the type of VR used, the blinding process, the type of scale used to detect depression, the duration of the intervention (weeks and minutes), and the total number of sessions. Meta-regression shows that younger samples (p = .00; 95% CI [0.01, 0.08) and longer interventions (p = < .05; 95% CI [-0.00, -0.00) lead to a greater reduction in depression. LINKING EVIDENCE TO ACTION This review provides an important basis for treating depression in patients after a stroke. Professionals working in stroke neurorehabilitation units should consider VR as a form of co-adjuvant treatment for depression in patients. SYSTEMATIC REVIEW REGISTRATION CRD42022303968.
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Affiliation(s)
- Patricia Blázquez-González
- Department of Nursing, Red Cross Nursing School, Madrid, Spain
- Biomechanics and Bioengineering Applied to Health, Doctoral School, University of Alcalá, Madrid, Spain
| | - Rubén Mirón-González
- Nursing and Physiotherapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
| | | | - Raquel Luengo-González
- Nursing and Physiotherapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Group for Research in Nursing Care, Gregorio Marañón, Health Research Institute (IiSGM), Madrid, Spain
| | - Noelia Mancebo-Salas
- General Directorate of Social Services with the Ministry of Family, Youth, and Social Policy of the Community of Madrid, Madrid, Spain
| | | | - José Alberto Martínez-Hortelano
- Nursing and Physiotherapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Health and Social Research Centre, University of Castilla-La Mancha, Cuenca, Spain
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Ma W, Li S, Wang X, Chang Z, Ma J. The impact of refined nursing intervention on neurological function recovery and prognosis improvement in patients undergoing intracranial aneurysm intervention. Int J Neurosci 2024:1-7. [PMID: 38517685 DOI: 10.1080/00207454.2024.2333478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND This study aims to explore the application of refined nursing intervention in patients undergoing unruptured intracranial aneurysm intervention, evaluating its impact on neurological function recovery and prognosis improvement. METHODS Patients diagnosed with intracranial aneurysms and undergoing treatment at our hospital from February 2022 to June 2023 were included in this study. After applying complete inclusion and exclusion criteria to ensure sample representativeness, a total of 92 patients were enrolled. Using a randomization method, patients were divided into an observation group and a control group. The control group received routine nursing care, while the observation group received refined nursing intervention. Nursing effects were compared between the two groups, and statistical analysis was conducted using appropriate methods, with content analysis summarizing the results. RESULTS The observation group, post-intervention, exhibited significantly improved Neurological Function Deficit (NFD) scores compared to the control group (p = 0.023). Additionally, the observation group showed higher proportions of Grade V patients in the Glasgow Outcome Scale (GOS) post-intervention (p = 0.031). Moreover, Fugl Meyer Assessment (FMA) scores for motor function were notably higher in the observation group than the control group (p = 0.003). The observation group also reported lower headache intensity and fewer adverse outcomes than the control group (p = 0.018, 0.038). CONCLUSION Refined nursing intervention in patients undergoing intracranial aneurysm intervention demonstrates better outcomes in terms of neurological function recovery and prognosis improvement. It reduces uncertainty in nursing practices, effectively enhancing nursing outcomes, and warrants clinical application and promotion.
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Affiliation(s)
- Wenfang Ma
- Department of Interventional Therapy, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan, China
| | - Shixing Li
- Department of Interventional Therapy, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan, China
| | - Xiuhua Wang
- Department of Interventional Therapy, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan, China
| | - Zukuan Chang
- Department of Interventional Therapy, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan, China
| | - Jing Ma
- Department of Neurointerventional, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan, China
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Hyvärinen S, Jarva E, Mikkonen K, Karsikas E, Koivunen K, Kääriäinen M, Meriläinen M, Jounila-Ilola P, Tuomikoski A, Oikarinen A. Healthcare professionals' experience regarding competencies in specialized and primary stroke units: A qualitative study. JOURNAL OF VASCULAR NURSING 2024; 42:26-34. [PMID: 38555175 DOI: 10.1016/j.jvn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 04/02/2024]
Abstract
AIM To describe healthcare professionals' experience of needed competence in patient stroke care within specialist and primary healthcare. BACKGROUND Healthcare professionals who provide stroke care need multifaceted, multi-professional skills; ongoing training is important for competent stroke care. DESIGN A descriptive qualitative study. METHODS Six focus group interviews with semi-structured interviews were conducted in October and November 2020. Healthcare professionals (n = 25) working in stroke care units in both specialist and primary healthcare settings were interviewed. The interviews were recorded, transcribed and analyzed inductively by content analysis. The study was conducted, and results were reported according to the Consolidated Criteria for Reporting Qualitative Research. RESULTS Five main categories were identified: clinical competence; multiprofessional networking competence; competence in interaction skills; emotional and psychoeducational support competence; and self-management and development competence. CONCLUSION Competence in stroke care includes both in-depth and wide-ranging professional competences that require ongoing development. Utilizing various education models and collaborative learning approaches can help meet the requirements for developing competence in stroke care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Satu Hyvärinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI- 90014 University of Oulu, Oulu, Finland.
| | - Erika Jarva
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI- 90014 University of Oulu, Oulu, Finland.
| | - Kristina Mikkonen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Eevi Karsikas
- Oulu University Hospital, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | | | - Maria Kääriäinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Merja Meriläinen
- Oulu University Hospital, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | | | | | - Anne Oikarinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI- 90014 University of Oulu, Oulu, Finland.
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Blázquez-González P, Mirón-González R, Lendínez-Mesa A, Luengo-González R, Mancebo-Salas N, Camacho-Arroyo MT, Muriel-García A, García-Sastre MM. Efficacy of the use of video games on mood, anxiety and depression in stroke patients: preliminary findings of a randomised controlled trial. J Neurol 2024; 271:1224-1234. [PMID: 38197947 PMCID: PMC10896939 DOI: 10.1007/s00415-023-12043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In the different published studies, there is no consensus on the efficacy of virtual reality as an adjuvant treatment of mood states. AIM The aim of this study is to evaluate the impact of no immersive virtual reality with the Nintendo Switch device in rehabilitation treatment on mood, anxiety and depression in stroke patients admitted to neurorehabilitation units. METHODS Fifty-eight patients admitted to neurorehabilitation units underwent a 1:3 multicentre randomised clinical trial. The intervention group consisted of 17 patients and the control group of 41 patients. The intervention group performed 6 virtual reality sessions together with the conventional treatment, and the control group performed only the conventional rehabilitation sessions. Primary and secondary clinical outcomes were measured before and six weeks after the intervention. RESULTS Comparing the intervention group and control group, the anxiety levels of the intervention group decreased compared to the results observed in the control group (p = 0.01), as did the dependence of the intervention group (0.015). On the other hand, the results obtained after the intervention by the control group for anxiety (0.479) and depression (0.292) were not statistically significant. CONCLUSION Rehabilitation VR used as an adjuvant treatment to conventional treatment has a beneficial impact on the neurological status and state of anxiety of stroke patients admitted to neurorehabilitation units. TRIAL REGISTRATION Registered in the https://clinicaltrials.gov/ repository (NTC NCT05143385). Protocol registration date 7 October 2021, retrospectively registered.
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Affiliation(s)
- Patricia Blázquez-González
- Department of Nursing, Red Cross University, Madrid, Spain
- Biomechanics and Bioengineering Applied to Health, Doctoral School, University of Alcalá, Madrid, Spain
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
| | - Rubén Mirón-González
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
| | - Alejandro Lendínez-Mesa
- Departamento de EnfermeríaServicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Luengo-González
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain.
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain.
- Group for Research in Nursing Care, Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.
| | - Noelia Mancebo-Salas
- General Directorate of Social Services With the Ministry of Family, Youth and Social Policy of the, Community of Madrid, Madrid, Spain
| | | | - Alfonso Muriel-García
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Montserrat García-Sastre
- Group for Research in Community Care and Social Determinants of Health, University of Alcalá, Madrid, Spain
- Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
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Zhou F, Tao X, Wang L, Shen B, Fang H. Effects of "two-heart" nursing mode on the psychological state and quality of life of stroke patients. BMC Neurol 2023; 23:397. [PMID: 37923983 PMCID: PMC10625222 DOI: 10.1186/s12883-023-03439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Evidence-based nursing (EBN) intervention is a nursing approach that uses credible scientific research findings as evidence, in conjunction with patient needs, to provide personalized nursing care tailored to the specific needs of patients. EBN has been widely applied in clinical practice and has achieved remarkable results. However, there are limited studies evaluating the efficacy of EBN on cognitive impairment, psychological disorders, and quality of life in stroke patients. This study aims to explore the clinical effects of the EBN, which we call "two-heart" nursing mode on cognitive function, limb function, mental state, and quality of life of stroke patients. METHODS A total of 92 stroke patients were divided into two groups: the traditional group (n = 46) and the two-heart group (n = 46). The traditional group received conventional nursing care, while the two-heart group received the double-heart nursing mode in addition to conventional nursing care. The cognitive function, limb function, living ability, mental state, quality of life, and nursing satisfaction of both groups were compared. RESULTS The cognitive function in the two-heart group (26.81 ± 3.15 points) was better than the traditional group (23.61 ± 3.74 points; P = 001); limb function in the two-heart group (86.16 ± 6.73 points) was improved compared to the traditional group (79.57 ± 5.19 points; P = 0.002), and the living ability of patients in the two-heart group (68.53 ± 5.87 points) was superior to the traditional group (60.79 ± 5.96 points; P = 0.003). Similarly, the quality of life of patients in the two-heart group (81.13 ± 6.69 points) was higher than the traditional group (70.78 ± 6.63 points; P = 0.003), and the mental state of patients in the two-heart group (43.61 ± 4.13 points, 43.19 ± 4.16 points) was better than that in the traditional group (50.59 ± 3.76 points, 51.49 ± 4.43 points; P = 0.003). However, the nursing satisfaction score in the two-heart group (97.83%) was slightly higher than the traditional group (95.65%; P = 0.068). CONCLUSIONS The two-heart nursing mode can improve cognitive function, limb function, and mental state, as well as enhance the quality of life of stroke patients. This approach is worthy of clinical promotion and application.
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Affiliation(s)
- Feifei Zhou
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, 210029, Nanjing, Jiangsu, China
| | - Xumei Tao
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, 210029, Nanjing, Jiangsu, China
| | - Liping Wang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, 210029, Nanjing, Jiangsu, China
| | - Bo Shen
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, 210029, Nanjing, Jiangsu, China
| | - Honglian Fang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, 210029, Nanjing, Jiangsu, China.
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Wang J, Zhang Y, Chen Y, Li M, Jin J. Nurse-Led Motor Function Rehabilitation Program for Acute Ischemic Stroke: A Randomized Pilot Study. J Nurs Res 2022; 30:e249. [PMID: 36445316 DOI: 10.1097/jnr.0000000000000529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Rehabilitation care for patients with stroke in the acute stage must be strengthened. However, the evidence on how to strengthen this care is insufficient. PURPOSE This article was designed to evaluate the feasibility and effectiveness of implementing a nurse-led motor function rehabilitation program on patients with acute ischemic stroke. METHODS From January to October 2018, patients with initial acute ischemic stroke were assigned to one of two groups using a pilot randomized controlled trial design, with one group receiving a nurse-led motor function intervention program developed based on Orem's theory (7 consecutive days, twice daily for 30 minutes, experimental group) and the other receiving usual care (control group). The effectiveness measures included changes in the Motor Assessment Scale, the modified Barthel Index, and the National Institutes of Health Stroke Scale. The feasibility measures included patient retention rate, incidence of adverse events, and acceptance of nurses and patients. RESULTS We assigned 104 patients (male: 55.7%; age: 62.8 ± 13.2 years) to receive either a nurse-led motor function rehabilitation program or usual care. Eighty-eight patients were evaluated after 7 days (87% retention rate), including 43 (83% retention rate) in the experimental group. Patients accepted the intervention well, and no severe adverse events were reported. Nurses had good fidelity and showed high acceptance. The experimental group showed significantly higher postintervention Motor Assessment Scale and modified Barthel Index scores than the control group (p < .001), whereas postintervention National Institutes of Health Stroke Scale scores did not differ significantly between the two groups. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The nurse-led rehabilitation program used in this study was shown to be feasible and effective in improving motor function in patients with acute ischemic stroke. Further study is recommended to determine related clinical recommendations.
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Affiliation(s)
- Jianmiao Wang
- BSN, Doctoral Candidate, Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, PRC
| | - Yuping Zhang
- MSN, RN, Supervisor, Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, PRC
| | - Yuanyuan Chen
- MSN, RN, Nurse Supervisor, Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, PRC
| | - Mei Li
- MSN, RN, Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, PRC
| | - Jingfen Jin
- MHA, RN, Professor and Executive President, Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou; Changxing Branch Hospital of SAHZU, Huzhou, PRC
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Deep Reinforcement Learning-Based iTrain Serious Game for Caregivers Dealing with Post-Stroke Patients. INFORMATION 2022. [DOI: 10.3390/info13120564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
This paper describes a serious game based on a knowledge transfer model using deep reinforcement learning, with an aim to improve the caretakers’ knowledge and abilities in post-stroke care. The iTrain game was designed to improve caregiver knowledge and abilities by providing non-traditional training to formal and informal caregivers who deal with stroke survivors. The methodologies utilized professional medical experiences and real-life evidence data gathered during the duration of the iTrain project to create the scenarios for the game’s deep reinforcement caregiver behavior improvement model, as well as the design of game mechanics, game images and game characters, and gameplay implementation. Furthermore, the results of the game’s direct impact on caregivers (n = 25) and stroke survivors (n = 21) in Lithuania using the Geriatric Depression Scale (GDS) and user experience questionnaire (UEQ) are presented. Both surveys had favorable outcomes, showing the effectiveness of the approach. The GDS scale (score 10) revealed a low number of 28% of individuals depressed, and the UEQ received a very favorable grade of +0.8.
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Xu S, Yu Y, Liu H, Qiu W, Tang Y, Liu Y. Application of Nursing Outcome-Oriented Integrated Zero-Defect Nursing Combined with Respiratory Function Training in Long-Term Bedridden Patients Undergoing Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4425680. [PMID: 36212954 PMCID: PMC9546674 DOI: 10.1155/2022/4425680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the application effect of nursing outcome-oriented integrated zero-defect nursing combined with respiratory function training in long-term bedridden patients with stroke. Methods A total of 120 long-term bedridden patients with stroke were randomly divided into three groups: groups A, B, and C. Group A was given nursing outcome-oriented integrated zero-defect nursing combined with respiratory function training, group B was given nursing outcome-oriented integrated zero-defect nursing, and group C was given routine nursing. Rosenbek aspiration degree classification criteria were used to evaluate the incidence of aspiration; blood oxygen saturation, arterial oxygen partial pressure, and respiratory pressure were compared before and after the intervention. The swallowing function was evaluated by a water swallowing test (WST). The quality of life was assessed using the Generic Quality of Life Inventory-74 (GQOLI-74). Results After treatment, the Rosenbek aspiration degree of groups A and B were better than those of group C (P < 0.05); the improvement degree of respiratory function indexes in group A was better than those in B and C, and the blood oxygen saturation and arterial blood oxygen partial pressure in group B were better than those in C (P < 0.05). The incidence of complications in groups A and B was lower than that in C, and complications in group A were lower than that in B (P < 0.05). After treatment, the scores of psychological function, social function, and material life status of the three groups were increased, and each score of groups A and B was higher than that of C, and each score of group A was higher than that of B (P < 0.05). Conclusion Nursing outcome-oriented integrated zero-defect nursing combined with respiratory function training can effectively improve aspiration, respiratory function, swallowing function, complication rate, and quality of life in long-term bedridden patients with stroke.
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Affiliation(s)
- Shaona Xu
- Department of Neurosurgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Yanan Yu
- Department of Neurosurgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Hongling Liu
- Department of Surgery of Thyroid Gland and Breast, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Weiwei Qiu
- Department of Neurology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Yu Tang
- College of Basic Medicine, Binzhou Medical University, Yantai, Shandong 264000, China
| | - Ying Liu
- Department of Neurosurgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
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Hisaka Y, Ito H, Yasuhara Y, Takase K, Tanioka T, Locsin R. Nurses' Awareness and Actual Nursing Practice Situation of Stroke Care in Acute Stroke Units: A Japanese Cross-Sectional Web-Based Questionnaire Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312800. [PMID: 34886526 PMCID: PMC8657563 DOI: 10.3390/ijerph182312800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
The awareness of care provided by stroke care unit (SCU) nurses in Japan to patients with an acute cerebrovascular accident (CVA) and the characteristic differences in their actual nursing practice were evaluated. A cross-sectional web-based questionnaire survey was administered to 1040 SCU nurses. Data collection and reporting procedures followed the STROBE Statement Checklist for cross-sectional studies. Exploratory factor analysis, using 52 observation items, identified eight factors with a factor loading > 0.4. For all factors, the actual practice was significantly lower than the awareness of the importance of nursing care for patients with acute CVA. Awareness and actual practice of recognition of patients' physical changes (RPPCs) were high. The actual practice of RPPCs and preventing the worsening of acute stroke and related symptoms varied, depending on years of experience in acute phase stroke care. RPPCs in actual practice had a significantly higher score among certified nurses or certified nurse specialists. Their awareness of the importance of collaborating with therapists was low. On-the-job training can improve nurses' competence and prevent worsening conditions in patients with CVA. An emphasis on enhancing practice experience toward patients with acute CVA and facilitating the deployment of certified nurses in SCUs can improve nursing care practice.
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Affiliation(s)
- Yukari Hisaka
- Department of Adult Nursing, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan;
- Graduate School of Health Sciences, Tokushima University, Tokushima 770-8509, Japan
| | - Hirokazu Ito
- Institute of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan; (H.I.); (Y.Y.); (R.L.)
| | - Yuko Yasuhara
- Institute of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan; (H.I.); (Y.Y.); (R.L.)
| | - Kensaku Takase
- Department of Rehabilitation, Anan Medical Center, Tokushima 774-0045, Japan;
| | - Tetsuya Tanioka
- Institute of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan; (H.I.); (Y.Y.); (R.L.)
- Correspondence: ; Tel.: + 81-88-633-9021
| | - Rozzano Locsin
- Institute of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan; (H.I.); (Y.Y.); (R.L.)
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Yan B, Zhang H, Liu J. Application of Quantitative CT Imaging in Rehabilitation Nursing of Cerebral Apoplexy Patients. Pak J Med Sci 2021; 37:1574-1579. [PMID: 34712285 PMCID: PMC8520363 DOI: 10.12669/pjms.37.6-wit.4840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: Electronic computed tomography (CT) is an important imaging method for the diagnosis of cerebral infarction. This paper explores the preventive effects of quantitative CT imaging and early rehabilitation nursing on patients with cerebral apoplexy and shoulder-hand syndrome. Methods: Sixty cerebral apoplexy patients treated were included as control group and given routine care from September 2018 to May 2020. Sixty cerebral apoplexy patients were included as observation group, and early rehabilitation nursing intervention was given based on control group. The incidence of shoulder-hand syndrome and upper limb function were compared between the two groups, to explore the effectiveness of the CT examination in promoting the physical function restoration. Results: The incidence of shoulder-hand syndrome in observation group after three months of intervention was lower than that in control group, and the severity was less than that in control group (P<0.05); The Ashworth score of muscle tension in observation group after three months of intervention was lower than that in control group, and the simplified FMA score of the upper limbs was higher than that in control group. Conclusion: Early rehabilitation nursing intervention after CT examination can prevent the occurrence of cerebral apoplexy and shoulder-hand syndrome and improve upper limb function, which is worthy of promotion.
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Affiliation(s)
- Bing Yan
- Bing Yan, Bachelor's Degree, Department of Nursing, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Huanhuan Zhang
- Huanhuan Zhang, Master of Degree, Department of Nursing, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Jie Liu
- Jie Liu, Master of Degree, Department of Nursing, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
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12
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Image Features of Magnetic Resonance Angiography under Deep Learning in Exploring the Effect of Comprehensive Rehabilitation Nursing on the Neurological Function Recovery of Patients with Acute Stroke. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:1197728. [PMID: 34602911 PMCID: PMC8449730 DOI: 10.1155/2021/1197728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
This study was to explore the effects of imaging characteristics of magnetic resonance angiography (MRA) based on deep learning on the comprehensive rehabilitation nursing on the neurological recovery of patients with acute stroke. In this study, 84 patients with acute stroke who were treated in hospital were selected as the research objects, and they were rolled into a control group (routine care) and an experimental group (comprehensive rehabilitation care). The dense dilated block-convolution neural network (DD-CNN) algorithm under deep learning for cerebrovascular was adopted to assess the effect of comprehensive rehabilitation care on the neurological recovery of patients with acute stroke. The results showed that the Berg scale scores, Fugl-Meyer scores, and Functional Independence Measure (FIM) scores of the experimental group of patients after 6 weeks and 12 weeks of comprehensive rehabilitation nursing were greatly different from those before treatment, showing statistical differences (P < 0.05). Compared with conventional magnetic resonance imaging (MRI) images, MRA images based on CNN algorithm, Dense Net algorithm, and DD-CNN algorithm can more clearly show the patient's cerebral artery occlusion. The average dice similarity coefficient (DSC) values of CNN algorithm, Dense Net algorithm, and DD-CNN algorithm were determined to be 84.3%, 95.7%, and 97.8%, respectively; the average sensitivity (Sen) values of the three algorithms were 76.1%, 95.4%, and 96.8%, respectively; and the average accuracy (Acc) values were 87.9%, 96.3%, and 97.9%, respectively. Thus, there were statistically obvious differences among the three algorithms in terms of average values of DSC, Sen, and Acc (P < 0.05). The MRA images processed by the DD-CNN algorithm showed that the degree of neurological recovery of the experimental group was observably greater than that of the control group, and the difference was statistically obvious (P < 0.05). In short, the image features of MRA based on the deep learning DD-CNN algorithm showed good application value in studying the effect of comprehensive rehabilitation nursing on the neurological recovery of patients with acute stroke, and it was worthy of promotion.
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Mohammadi E, Hassandoost F, Mozhdehipanah H. Evaluation of the "partnership care model" on quality of life and activity of daily living in stroke patients: A randomized clinical trial. Jpn J Nurs Sci 2021; 19:e12448. [PMID: 34448546 DOI: 10.1111/jjns.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stroke is a widespread chronic disease which remains a serious problem for public health and is the cause of major disability and death in adults. Despite valuable efforts, these patients still need new care programs for recovery and rehabilitation. AIM The aim of this study is to determine the effect of the partnership care model (PCM) on quality of life (QOL) and activities of daily living (ADL) in stroke participants. METHOD The study is a randomized clinical trial carried out in an educational and therapeutic center in 2019. Sixty-seven participants (allocated randomly in intervention and control groups) with cerebrovascular accident who had hospitalization histories were selected. Data collection instruments were the Stroke-Specific QOL scale and Lawton questionnaires. The care plan was developed and implemented for the intervention group after evaluating and recording basic information including demographic variables, care needs, and problems identified in the first PCM-based stage. Ethics approval was obtained from the University / Regional Research Ethics Committee (IR.NIMAD.REC.1397.236). RESULTS The results show that the mean scores of the QOL significantly increased after the intervention in the intervention group (before = 130.80; 3 months = 172.19; 6 months = 205.29) compared to the control group (before = 150; 3 months = 144.86; 6 months = 160.66). Also, the mean scores of the ADL significantly increased after the intervention in the intervention group (before = 1.96; 3 months = 3.64; 6 months = 4.87) compared to the control group (p < .05). The effect size is equal to 0.501 and 0.245 for QOL and ADL, respectively. CONCLUSION The findings show that the care program based on a PCM recovered the QOL and ADL of stroke participants more than other interventions.
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Affiliation(s)
- Eesa Mohammadi
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Fateme Hassandoost
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Hossein Mozhdehipanah
- Clinical Research Development Unit, Bouali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
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Liu Y, Qu M, Wang N, Wang L. Effects of an evidence-based nursing intervention on neurological function and serum inflammatory cytokines in patients with acute cerebral infarction: A randomized controlled trial. Restor Neurol Neurosci 2021; 39:129-137. [PMID: 33935121 DOI: 10.3233/rnn-201080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Acute cerebral infarction is a clinically common and critical disease which seriously endangers the life and safety of elderly patients. Evidence-based nursing is an effective way of nursing and has great significance in improving the neurological function and quality of life of patients. In China, evidence-based nursing has been highlighted and highly developed in recent decades. OBJECTIVES This research aimed to investigate the effect of evidence-based nursing on the recovery of neurological function and serum inflammatory cytokines in patients with acute cerebral infarction. METHODS A total of 116 patients with acute cerebral infarction were randomly divided into two groups: the control group patients (n = 58) received conventional nursing, while the intervention group patients (n = 58) received evidence-based nursing intervention. National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA) and activities of daily living (ADL) scores, as well as serum TNF-α and IL-6 levels were evaluated and compared between the two groups. RESULTS NIHSS scores in the intervention group were significantly lower than the control group. FMA and ADL scores in the intervention group were significantly higher than the control group. TNF-α and IL-6 levels in the serum of the intervention group were significantly lower than the control group. CONCLUSIONS In conclusion, evidence-based nursing has a positive effect on the treatment of patients with acute cerebral infarction, which decreases the level of serum inflammatory cytokines and contributes to the recovery of neurological function, motor function and activities of daily living.
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Affiliation(s)
- Yaping Liu
- Department of Neurology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Mingwei Qu
- Department of Neurology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Nan Wang
- Party Office, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Limin Wang
- Department of Neurology, Cangzhou Central Hospital, Cangzhou, Hebei, China
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15
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Jarva E, Mikkonen K, Tuomikoski AM, Kääriäinen M, Meriläinen M, Karsikas E, Koivunen K, Jounila-Ilola P, Oikarinen A. Healthcare professionals' competence in stroke care pathways: A mixed-methods systematic review. J Clin Nurs 2021; 30:1206-1235. [PMID: 33350004 DOI: 10.1111/jocn.15612] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The challenges of caring for stroke patients are growing due to population ageing and improved survival rates. Healthcare professionals' competence development in stroke care is a necessity to ensure high-quality patient care. OBJECTIVES To identify and describe the competence areas of healthcare professionals working in the stroke patient care pathway and factors influencing these competences. DESIGN A mixed-methods systematic review. METHODS The review was conducted according to the JBI guidelines and registered in the PROSPERO database (CRD42020204062). PRISMA checklist guided the review process. Relevant original studies were identified by searching four databases-CINAHL (EBSCO), PubMed, Scopus and Medic. After researcher consensus was reached, 32 studies were selected for inclusion and subjected to content analysis and data tabulation. RESULTS Competence in care processes, clinical competence, competence in using self-management strategies, interaction skills, skills in acknowledging family and competence in integrating the available evidence base into patient care were identified as key competence areas. Organisation of services, specialisation in stroke care, continuous development and education, family and carer and training in oral care and cognitive rehabilitation were identified as factors that influence healthcare professionals' competence. CONCLUSIONS Diverse clinical and interaction competencies are needed throughout the stroke care pathway, and various factors affect healthcare professionals' competence. Further research on healthcare professionals' stroke care competence will be needed to respond to changing healthcare demand. RELEVANCE TO CLINICAL PRACTICE We recommend organisational support and formulation of stroke care patient guidelines in line with healthcare competence requirements. Focus should be added for nursing professions in developing interactive communication competence since nurses spend the majority of the time providing individual patient care. Also, organisations should integrate continuing training in specialised stroke care for healthcare professionals' competence development.
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Affiliation(s)
- Erika Jarva
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Kristina Mikkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Oulu University of Applied Sciences, Oulu, Finland.,The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Meriläinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | | | | | | | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
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16
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Yang Y, Mu A, Wang Y. Early path nursing improves neurological function recovery in patients with intracerebral hemorrhage: Protocol for a randomized controlled trial. Medicine (Baltimore) 2021; 100:e24020. [PMID: 33429767 PMCID: PMC7793312 DOI: 10.1097/md.0000000000024020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To explore the influence of the early path nursing on life quality and the neurological function recovery in the intracerebral hemorrhage (ICH) patients. METHODS The experiment was implemented from January 2018 to October 2020 at the First Affiliated Hospital of Soochow University. The experiment was granted through the Research Ethics Committee of the First Affiliated Hospital of Soochow University (2017033). In this experiment, the criteria for inclusion includes: hemorrhagic stroke diagnosed via the MRI or head CT; over 18 years of age; patients with motor dysfunction; The Glasgow Coma Scale > 12. The patients with these symptoms will be excluded: severe cognitive impairment; ischemic stroke; onset time > 3 days; and severe complications. The scale used for the evaluation the neurological function is the American Stroke Scale. This scale contains a total of eleven items, that is, the movements of upper and lower limb, the consciousness level, gaze, visual field, etc. Other outcomes include patient satisfaction and complications. RESULTS Evaluation the neurological function and quality of life will be shown in Table 1. CONCLUSION The early path nursing can promote the neurological function recovery in the ICH patients. TRIAL REGISTRATION NUMBER researchregistry6327.
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Wang J, Chen Y, Zhang Y, Li M, Jin J. Rehabilitation nursing for motor functional recovery of acute ischaemic stroke: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e037391. [PMID: 32978194 PMCID: PMC7520831 DOI: 10.1136/bmjopen-2020-037391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Stroke is the second-leading cause of death and disability in the world, and patients with stroke often suffer from functional impairments and need rehabilitation. Notably, there is much evidence that rehabilitation can lead to better mortality and morbidity outcomes. The evidence for the effectiveness of rehabilitation nursing, however, is limited. Thus, this study seeks to explore whether rehabilitation nursing is not inferior to usual rehabilitation for motor functional recovery in patients with acute ischaemic stroke. METHODS AND ANALYSIS We will conduct an assessor-blinded parallel randomised controlled trial of patients who meet the inclusion criteria after stratification by weighted corticospinal tract lesion load. The experimental group will receive rehabilitation nursing by trained and qualified nurses (seven consecutive days, two sessions per day, 30 min each session). The control group will receive usual rehabilitation provided by therapists (seven consecutive days, two sessions per day, 30 min each session). The primary outcome measures are the Motor Assessment Scale, the Fugl-Meyer Assessment and the Action Research Arm Test. The secondary outcome measures are the modified Rankin Scale, the modified Barthel Index and the National Institute of Health Stroke Scale. Primary and secondary outcome assessment will be performed before and after the intervention, and secondary outcome be assessed at 4 and 12 weeks follow-up. We will recruit 224 patients within a period of 12-18 months from a hospital in southeastern China. ETHICS AND DISSEMINATION The study was approved by the Human Research Ethics Committee from the corresponding author's hospital (approval Number is Ethical Review Study No. 2018 - 112). Peer-reviewed journals and presentations at national and international conferences will be used to disseminate the results. TRIAL REGISTRATION NUMBER NCT03702452.
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Affiliation(s)
- Jianmiao Wang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuanyuan Chen
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mei Li
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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18
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Liu H, Zhu D, Song B, Jin J, Liu Y, Wen X, Cheng S, Nicholas S, Wu X. Cost-effectiveness of an intervention to improve the quality of nursing care among immobile patients with stroke in China: A multicenter study. Int J Nurs Stud 2020; 110:103703. [PMID: 32738722 DOI: 10.1016/j.ijnurstu.2020.103703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND While a nursing intervention program for immobile patients with stroke can improve clinic outcomes, less is known about the cost-effectiveness of these interventions. OBJECTIVES The goal of this study was to evaluate the cost-effectiveness of the intervention program for immobile patients with stroke in China. DESIGN A cost-effectiveness analysis alongside a pre-test/post-test (before and after) study was undertaken from a health care perspective. SETTINGS Participants were recruited from 25 hospitals among six provinces or municipal cities in eastern (Guangdong province, Zhejiang province, and Beijing municipal city), western (Sichuan province), and central (Henan province and Hubei province) China. PARTICIPANTS A total of 7,653 immobile stroke patients were included in our sample. Patients in routine care settings were recruited from November 2015 to June 2016, and the recruitment of the intervention group patients was from November 2016 to July 2017. METHODS To adjust for potential bias from confounding variables, the 1:1 propensity score matching yielded matched pairs of 2,966 patients in the routine care group and 2,966 patients in the intervention group, with no significant differences in sociodemographic or clinical characteristics between two groups. All patients were followed-up 3 months after enrolment in the study. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the intervention program measured using the EuroQol five-dimensional questionnaire (EQ-5D) instrument and the cost-effectiveness of the intervention measured by the incremental cost-effectiveness ratio with a time horizon of 3 months. RESULTS Compared to routine care, the intervention program decreased the total costs of stroke patients by CN¥4,600 (95% confidence interval [CI]: [-7050, -2151]), while increasing quality-adjusted life year 0.009 (95% CI: [0.005, 0.013]). The incremental cost-effectiveness ratios over 3 months was CN¥-517,011 per quality-adjusted life year (95% CI: [-1,111,442, -203,912]). Subgroup analysis reveals that both the health-related quality of life and cost effectiveness improved significantly for ischemic patients and tertiary hospitals patients while for hemorrhagic patients and non-tertiary hospital patients only the health-related quality of life improved significantly. CONCLUSIONS Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an intervention program provided significant cost saving, but mainly in ischemic patients and tertiary hospital patients. Wider adoption of such programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China.
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou 450003, China.
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou 310009, China.
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, No.1277 Jiefangdadao, Jianghan District, Wuhan 430060, China.
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, No.32 West Second Section First Ring Road, Chengdu 610072, China.
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Second Road, Yuexiu District, Guangzhou 200032, China.
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh Sydney NSW 2015, Australia; School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, Tianjin 300074, China; Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, Guangzhou 510420, China; Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia.
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
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Liu H, Zhu D, Cao J, Jiao J, Song B, Jin J, Liu Y, Wen X, Cheng S, Nicholas S, Wu X. The effects of a standardized nursing intervention model on immobile patients with stroke: a multicenter study in China. Eur J Cardiovasc Nurs 2019; 18:753-763. [PMID: 31480908 DOI: 10.1177/1474515119872850] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke. AIMS To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke. METHODS A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals. RESULTS In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals. CONCLUSIONS A structured and systematic SNIM benefited immobile stroke patients' clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.
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Affiliation(s)
- Hongpeng Liu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingfen Jin
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Stephen Nicholas
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, Guangzhou, China.,School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, Tianjin, China.,TOP Education Institute 1 Central Avenue Australian Technology Park, Eveleigh Sydney, Australia.,Newcastle Business School, University of Newcastle, University Drive, Newcastle, Australia
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
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Alamri MS, Waked IS, Amin FM, Al-Quliti KW, Manzar MD. Effectiveness of an early mobility protocol for stroke patients in Intensive Care Unit. ACTA ACUST UNITED AC 2019; 24:81-88. [PMID: 31056538 PMCID: PMC8015460 DOI: 10.17712/nsj.2019.2.20180004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives: To evaluate the effectiveness of an early mobility protocol for stroke patients in the intensive care unit. Methods: Participants were patients with first or recurrent stroke (n=60, age=49.02±6.36 years, body mass index=32.95±5.67 kg/m2) admitted to the intensive care stroke unit in general hospitals, Riyadh during October and December 2016. Single group pretest-posttest design involving an early mobility protocol was started within first 24 hours admission. Pre and post measurements of muscle strength, pulmonary function and quality of life were carried out. Results: There were significant improvements in muscle strength of upper and lower extremities´ muscles after treatment (p<0.05), pulmonary functions including Forced Vital Capacity, Forced Expiratory Volume 1 (p<0.05) and quality of life, namely, Barthel Index and modified Rankin Scale (p<0.01). Conclusion: This study demonstrates that initiating an early mobility protocol is safe and effective for intensive care unit stroke patients and supports introducing the current protocol as a standard protocol in neurogenic Intensive Care Units.
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Affiliation(s)
- Majed S Alamri
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Kingdom of Saudi Arabia. E-mail:
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