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Tarvonen-Schröder S, Niemi T, Koivisto M. Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination. ADVANCES IN REHABILITATION SCIENCE AND PRACTICE 2023; 12:27536351231157966. [PMID: 37223636 PMCID: PMC10201155 DOI: 10.1177/27536351231157966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/25/2023] [Indexed: 05/25/2023]
Abstract
Background Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied. Aim The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation. Material and Methods On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression. Results 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized. Conclusion The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
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Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
| | - Tuuli Niemi
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
- Department of Expert Services, Turku
University Hospital, Turku, Finland
| | - Mari Koivisto
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
- Department of Biostatistics, University
of Turku, Turku, Finland
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2
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Stevens E, Clarke SG, Harrington J, Manthorpe J, Martin FC, Sackley C, McKevitt C, Marshall IJ, Wyatt D, Wolfe C. The provision of person-centred care for care home residents with stroke: An ethnographic study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5186-e5195. [PMID: 35869786 PMCID: PMC10084099 DOI: 10.1111/hsc.13936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Care home residents with stroke have higher levels of disability and poorer access to health services than those living in their own homes. We undertook observations and semi-structured interviews (n = 28 participants) with managers, staff, residents who had experienced a stroke and their relatives in four homes in London, England, in 2018/2019. Thematic analysis revealed that residents' needs regarding valued activity and stroke-specific care and rehabilitation were not always being met. This resulted from an interplay of factors: staff's lack of recognition of stroke and its effects; gaps in skills; time pressures; and the prioritisation of residents' safety. To improve residential care provision and residents' quality of life, care commissioners, regulators and providers may need to re-examine how care homes balance safety and limits on staff time against residents' valued activity, alongside improving access to specialist healthcare treatment and support.
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Affiliation(s)
- Eleanor Stevens
- School of Life Course & Population SciencesKing's College LondonLondonUK
| | - Stephanie G. Clarke
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
- University Hospitals BirminghamDepartment of PhysiotherapyBirminghamUK
| | - Jean Harrington
- School of Life Course & Population SciencesKing's College LondonLondonUK
| | - Jill Manthorpe
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Health & Social Care Workforce, King's College LondonLondonUK
| | - Finbarr C. Martin
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Catherine Sackley
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
| | - Christopher McKevitt
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Iain J. Marshall
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
| | - David Wyatt
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Charles Wolfe
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
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3
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Fisher RJ, Riley-Bennett F, Russell L, Lee C, Sturt R, Walker M, Sackley C. Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability. BMJ Open 2021; 11:e052593. [PMID: 34857570 PMCID: PMC8640659 DOI: 10.1136/bmjopen-2021-052593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/29/2021] [Indexed: 12/24/2022] Open
Abstract
In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge. OBJECTIVES To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus. SETTING Virtual nominal group technique (vNGT) across the UK. PARTICIPANTS Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience. METHODS Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique's five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements. RESULTS A combined total of 421 statements achieved positive consensus (>75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required. CONCLUSION The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.
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Affiliation(s)
| | | | - Lal Russell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Lee
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Ruth Sturt
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Cath Sackley
- School of Health Sciences, University of Nottingham, Nottingham, UK
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4
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Shek A, Jiang Z, Teo J, Au Yeung J, Bhalla A, Richardson MP, Mah Y. Machine learning-enabled multitrust audit of stroke comorbidities using natural language processing. Eur J Neurol 2021; 28:4090-4097. [PMID: 34407269 DOI: 10.1111/ene.15071] [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: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE With the increasing adoption of electronic records in the health system, machine learning-enabled techniques offer the opportunity for greater computer-assisted curation of these data for audit and research purposes. In this project, we evaluate the consistency of traditional curation methods used in routine clinical practice against a new machine learning-enabled tool, MedCAT, for the extraction of the stroke comorbidities recorded within the UK's Sentinel Stroke National Audit Programme (SSNAP) initiative. METHODS A total of 2327 stroke admission episodes from three different National Health Service (NHS) hospitals, between January 2019 and April 2020, were included in this evaluation. In addition, current clinical curation methods (SSNAP) and the machine learning-enabled method (MedCAT) were compared against a subsample of 200 admission episodes manually reviewed by our study team. Performance metrics of sensitivity, specificity, precision, negative predictive value, and F1 scores are reported. RESULTS The reporting of stroke comorbidities with current clinical curation methods is good for atrial fibrillation, hypertension, and diabetes mellitus, but poor for congestive cardiac failure. The machine learning-enabled method, MedCAT, achieved better performances across all four assessed comorbidities compared with current clinical methods, predominantly driven by higher sensitivity and F1 scores. CONCLUSIONS We have shown machine learning-enabled data collection can support existing clinical and service initiatives, with the potential to improve the quality and speed of data extraction from existing clinical repositories. The scalability and flexibility of these new machine-learning tools, therefore, present an opportunity to revolutionize audit and research methods.
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Affiliation(s)
- Anthony Shek
- School of Neuroscience, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Zhilin Jiang
- King's College Hospital NHS Foundation Trust, London, UK
| | - James Teo
- School of Neuroscience, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | - Joshua Au Yeung
- Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Ajay Bhalla
- Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Mark P Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London & Maudsley NHS Foundation Trust, London, UK
| | - Yee Mah
- School of Neuroscience, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Green TL, McNair ND, Hinkle JL, Middleton S, Miller ET, Perrin S, Power M, Southerland AM, Summers DV. Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e179-e197. [PMID: 33691469 DOI: 10.1161/str.0000000000000357] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 2009, the American Heart Association/American Stroke Association published a comprehensive scientific statement detailing the nursing care of the patient with an acute ischemic stroke through all phases of hospitalization. The purpose of this statement is to provide an update to the 2009 document by summarizing and incorporating current best practice evidence relevant to the provision of nursing and interprofessional care to patients with ischemic stroke and their families during the acute (posthyperacute phase) inpatient admission phase of recovery. Many of the nursing care elements are informed by nurse-led research to embed best practices in the provision and standard of care for patients with stroke. The writing group comprised members of the Stroke Nursing Committee of the Council on Cardiovascular and Stroke Nursing and the Stroke Council. A literature review was undertaken to examine the best practices in the care of the patient with acute ischemic stroke. The drafts were circulated and reviewed by all committee members. This statement provides a summary of best practices based on available evidence to guide nurses caring for adult patients with acute ischemic stroke in the hospital posthyperacute/intensive care unit. In many instances, however, knowledge gaps exist, demonstrating the need for continued nurse-led research on care of the patient with acute ischemic stroke.
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6
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Zauszniewski JA, Herbell K, Lekhak N, Badr H. Differences among Caregivers on Coping Resources and Mental Health. Issues Ment Health Nurs 2021; 42:280-286. [PMID: 32822243 DOI: 10.1080/01612840.2020.1800876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Given the growing number of family members who provide care to adults with a disability or illness, this study examined differences in coping resources and mental health among family caregivers of persons with various health conditions. Within the context of Ensel and Lin's stress paradigm, 234 family caregivers participated in an online study by completing validated measures of resourcefulness, spiritual practices, caregiver burden, anxiety, and depression. Caregivers were categorized into nine groups according to their care recipient's condition. The groups differed significantly on burden and resourcefulness. Greatest burden and lowest resourcefulness were found in caregivers of persons with traumatic brain injury, stroke, and dementia. Caregivers across all groups were found to be at a similarly high risk for anxiety and depression. These results provide insights for tailoring interventions for caregivers, particularly those whose care recipients have traumatic brain injury, stroke, or dementia, who may benefit from resourcefulness training.
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Affiliation(s)
- Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kayla Herbell
- Nursing, The Ohio State University, Columbus, Ohio, USA
| | | | - Hanan Badr
- Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
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7
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Williams E, Jackson H, Wagland J, Martini A. Community Rehabilitation Outcomes for Different Stroke Diagnoses: An Observational Cohort Study. Arch Rehabil Res Clin Transl 2021; 2:100047. [PMID: 33543075 PMCID: PMC7853334 DOI: 10.1016/j.arrct.2020.100047] [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] [Indexed: 01/19/2023] Open
Abstract
Objective To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic). Design A 12-month follow-up observational retrospective cohort study. Setting Staged community-based brain injury rehabilitation. Participants Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months. Intervention Not applicable. Main Outcome Measures The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team. Results After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total (P<.001) and across Ability (P<.001) and Participation (P<.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech (P<.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication (P<.01) than the hemorrhagic right hemisphere group at admission. Conclusions There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.
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Affiliation(s)
- Elly Williams
- Brightwater Care Group, Research Centre, Perth, Australia
| | - Hayley Jackson
- Brightwater Care Group, Research Centre, Perth, Australia.,University of Western Australia, Faculty of Science, School of Psychological Science, Perth, Australia
| | - Janet Wagland
- Brightwater Care Group, Research Centre, Perth, Australia
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Chen L, Xiao LD, Chamberlain D. An integrative review: Challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. J Adv Nurs 2020; 76:2253-2265. [PMID: 32511778 DOI: 10.1111/jan.14446] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. BACKGROUND Due to shortened hospital stays, stroke survivors and caregivers must take responsibility for complex care on discharge from hospital to home. Gaps exist in the literature that synthesizes studies on hospital to home transition care. DESIGN A systematic integrated review. DATA SOURCES Six databases were searched systematically between 18 June 2018 - 31 October 2018 including Medline, CINAHL, Web of Science, ProQuest, Scopus and Science Direct. The search did not have a date limit. REVIEW METHODS Studies that met the selection criteria were critically reviewed. Data were extracted from the studies for analyses. A convergent qualitative synthesis approach using inductive thematic synthesis was applied to the review. RESULTS The analysis of 23 studies identified three major findings. First, health and social care systems influence transition care by either enabling stroke survivors and caregivers to manage transition care via well-coordinated services or preventing them from accessing services. Second, health professionals' partnership with stroke survivors and caregivers largely decides tailored support for them. Successful partnerships and engagements with stroke survivors and caregivers depend on organizational resources. Third, survivors and caregivers are at different levels of readiness to cope with challenges. Individualized support for them to develop resilience is highly regarded. CONCLUSION Stroke survivors and caregivers encounter enormous challenges in self-management of hospital to home transition care. Further research is required to address their expectations of support during transition care. IMPACT There is a lack of synthesis of studies on factors affecting hospital to home transition care for stroke survivors. Health and social care system designs, health professionals' commitment to individualized care and the self-management capability of stroke survivors and their caregivers have a profound influence on the transition care experiences.
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Affiliation(s)
- Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lily D Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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9
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A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1396705. [PMID: 32090066 PMCID: PMC7008289 DOI: 10.1155/2020/1396705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022]
Abstract
Objective This study aimed to explore the risk factors of urinary tract infection (UTI) in patients with intracranial cerebral hemorrhage (ICH). Design This is a retrospective study, and a total of 77 patients with ICH consecutively admitted to the First Affiliated Hospital of USTC (Anhui Provincial Hospital, Hefei, China) during the period of August 2015 to August 2017 were included. The patients were divided into an UTI group (24 cases) and a non-UTI group (53 cases); patients with UTI were diagnosed according to clinical manifestations, recent urinary routines, and urine culture results. The following information in these two groups was recorded: age, sex, course of disease, side of paralysis, location and type of cerebral hemorrhage, disturbance of consciousness or not, the Brunnstrom stage of paralysed lower limbs, number of basic diseases, whether there were complications (tracheotomy, retention catheterization, pulmonary infection, pressure sore, deep venous thrombosis, etc.), whether rehabilitation interventions were conducted, blood routine, biochemistry index, DIC complete set, urine routine, and urine culture data. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors of UTI in patients with ICH. Results Univariate analysis showed that age, side of paralysis, disturbance of consciousness, the Brunnstrom stage of lower limbs, tracheotomies, retention catheterization, pulmonary infection, leukocyte count, neutrophil proportion, sodium, uric acid, D-dimer, and fibrinogen may be related to UTI in patients with ICH (P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), Conclusions Increased age and high D-dimer are independent risk factors for UTI in patients with ICH, while right-sided paralysis is a protective factor for UTI in patients with ICH.
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Clery A, Bhalla A, Bisquera A, Skolarus LE, Marshall I, McKevitt C, Rudd A, Sackley C, Martin FC, Manthorpe J, Wolfe C, Wang Y. Long-Term Trends in Stroke Survivors Discharged to Care Homes: The South London Stroke Register. Stroke 2020; 51:179-185. [PMID: 31690255 PMCID: PMC6924949 DOI: 10.1161/strokeaha.119.026618] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023]
Abstract
Background and Purpose- Care homes provide care to many stroke survivors, yet little is known about changes in care home use over time. We aim to determine trends in discharge to care homes, to explore the characteristics of stroke survivors over time (1995-2018), and to identify the associations between these characteristics and discharge to care homes poststroke. Methods- Using data from the South London Stroke Register between 1995 and 2018, we estimated the proportions discharged to care homes and their characteristics over time, assessed by tests for trends. Multivariable logistic regression models were built to assess the associations between their characteristics and discharge destination. Results- Of 4172 stroke survivors, 484 (12%) were discharged to care homes. This proportion has decreased from 24% in 1995 to 2000 to 5% in 2013 to 2018. The mean age of those discharged to care homes has increased over time, from 73 to 75 (P<0.001). Among stroke survivors discharged to a care home, the proportion with a prestroke Barthel Index <15 has also increased over time from 7% to 21% (P=0.027), while the proportion with a 7-day poststroke Barthel Index <15 remains largely unchanged over time (93% in 1995-2000, 90% in 2013-2018). The characteristics most strongly associated with discharge to care homes were (odds ratio [95% CI]) age (1.05 [1.04-1.07] per year), stroke subtype (hemorrhagic; 0.64 [0.43-0.95]), stroke severity (Glasgow Coma Scale score, <13; 1.67 [1.19-2.35]), failed swallow test at admission (1.65 [1.20-2.25]), 7-day poststroke Barthel Index <15 (3.58 [2.20-6.03]), and a longer hospital stay (1.02 [1.02-1.03] per day). Conclusions- Over >20 years, there has been an 80% reduction in the proportion of stroke survivors discharged to care homes, influenced by changes in the demographics, disability, and stroke care in the underlying stroke population. In those moving to care homes, the level of poststroke disability remains high, requiring continued attention and investment.
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Affiliation(s)
- Amanda Clery
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
| | - Ajay Bhalla
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (A. Bhalla, A.R.)
| | - Alessandra Bisquera
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
| | - Lesli E. Skolarus
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
- Department of Neurology, University of Michigan, Ann Arbor (L.E.S.)
| | - Iain Marshall
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
| | - Christopher McKevitt
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
| | - Anthony Rudd
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (A. Bhalla, A.R.)
| | - Catherine Sackley
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
| | - Finbarr C. Martin
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
| | - Jill Manthorpe
- National Institute for Health Research Policy Research Unit in Health and Social Care Workforce, King’s College London, London, United Kingdom (J.M.)
| | - Charles Wolfe
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (C.W., Y.W.)
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London, United Kingdom (C.W., Y.W.)
| | - Yanzhong Wang
- From the Department of Population Health Sciences, School of Population Health and Environmental Sciences (A.C., A. Bhalla, A.B., L.E.S., I.M., C.M., A.R., C.S., F.C.M., C.W., Y.W.), King’s College London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (C.W., Y.W.)
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London, United Kingdom (C.W., Y.W.)
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Smith C, Almallouhi E, Feng W. Urinary tract infection after stroke: A narrative review. J Neurol Sci 2019; 403:146-152. [DOI: 10.1016/j.jns.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
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Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke. Can J Neurol Sci 2019; 46:209-215. [DOI: 10.1017/cjn.2018.386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT:Background: We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. Methods: A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built. Results: Univariate predictors of discharge to LTC: advanced age, decreasing admission and discharge functional independence measure (FIM) scores, increasing change in FIM score from admission to discharge, dependency, residence outside of home before the stroke, absence of a caregiver, urinary and bowel incontinence, low Berg balance score at admission and discharge, low Montreal Cognitive Assessment scores, smoking, chronic heart failure, and an inability to transfer. Multivariable logistic regression: five factors remained significant predictors with LTC disposition: advanced age, bowel incontinence, residence outside of the home prior to stroke, right hemisphere site of the stroke, and absence of a caregiver. Conclusions: Several easily measured variables were significantly associated with discharge to LTC versus home following stroke rehabilitation.
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