The knowledge nurses need to educate patients about stroke

Ensuring that patients and clients receive the information they need and/or want, in a form that is comprehensible, is a major part of the nurse's role. This role has expanded in recent years, and many wards and units have prepared information booklets that answer some of the more frequently asked questions about particular conditions. However, many of these cannot be used outside a small area, because the information contained is too specific. This article launches a new series presenting up-to-date material that complements existing information booklets and packs or which may be used to start them. An example is given, using cerebrovascular accident, to demonstrate the format.     

社区康复护理干预对脑卒中患者生活质量的影响

目的 探讨社区康复护理干预对脑卒中患者生活质量的影响.方法 选择120例曾在本院门诊就诊或住过院的脑卒中患者,随机分成康复组和对照组,对康复组通过评估、制定康复计划,予以心理护理、肢体功能锻炼、日常生活能力训练配合理疗,对照组不予任何康复护理干预,实施前后及2组间的Barthel指数进行比较.结果 康复组和对照组分组时、2个月末和6个月时进行Barthel指数评定比较差异具有统计学意义(P<0.001).结论 针对性的社区康复护理干预,能降低脑卒中患者致残率和复发率,减少后遗症,提高生活质量,减轻家庭和社会负担.     

Crisis intervention: program evaluation

Crisis intervention is based upon crisis theory and is defined as a short-term active mode of therapy that focuses on solving the client's immediate problem and reestablishing psychological equilibrium. The crisis intervention program was the first phase in the development of a broader mental health program with advancement decisions being based upon evaluation results of this initial phase. An evaluation methodology using the Stufflebeam Goal-Stakeholder Model (1980) was designed and implemented. A satisfaction survey was conducted to develop a database relative to the program's process. The Mental Health Category Measure, and the Crisis Call Outcome Rating Scale were used to capture outcome data. Analysis of the qualitative and quantitative data indicate that stakeholders are satisfied with the program. outcome data demonstrates that the program produces the intended outcomes. Triangulation, a method of comparing the qualitative and quantitative findings revealed consistency, and thus provides confidence in the accuracy of the findings.     

Problems with borderline patients in a crisis intervention unit: a case history

This article describes some characteristics, advantages, and disadvantages of crisis intervention in patients with borderline personality disorder. The theoretical issues are illustrated by a case study of a patient with the disorder. Therapeutic proceedings are analyzed, with special focus on the treatment plan, goal-setting, and termination of therapy. The positive effects of the treatment and the patient's unexpected loss of compliance are discussed. Some suggestions are made about dealing with such patients in the light of mistakes made by the crisis therapist, which produced feelings of inadequacy and incompetence in her, stemming from unresolved transference-countertransference problems.     

Initial experience with a multi-station objective structured teaching skills evaluation

PURPOSE: To explore the applicability of using an objective structured evaluation to assess community preceptors' teaching performances. METHOD: The authors developed and, in 1996, administered an objective structured teaching evaluation (OSTE) at the University of California, Irvine, College of Medicine. They compared assessments of teaching skills made by faculty observers and standardized students, and examined instrument reliability, realism, and utility. RESULTS: Reliabilities of the OSTE varied with individual stations but, in several instances, approached acceptable standards. Faculty observers' and standardized students' evaluations of preceptors' performances were similar. Participants' feedback indicated that the greatest OSTE-related benefit was derived by the faculty observers. CONCLUSIONS: An OSTE that reflects realistic teaching situations can be successfully developed. Objective structured evaluation can be successfully applied to assessing faculty teaching performance. However, it may be no more discriminating than are student evaluations. An OSTE's utility may be greatest in guiding faculty development initiatives.     

Program evaluation of an intervention approach for staff assaulted by patients: preliminary inquiry

1. Eosinophils are thought to play an important role in the pathophysiology of allergic diseases and pharmacological suppression of their recruitment is considered to be of therapeutic benefit. In the present study we have assessed and compared the effects of treatment with dexamethasone and cyclosporin A on the accumulation of 111In-labelled eosinophils and local oedema formation in sites of acute inflammation in guinea-pig skin. 2. When injected locally 150 min prior to i.d. administration of antigen in a passive cutaneous anaphylactic (PCA) reaction, dexamethasone (10(-9) to 3 x 10(-7) mol per site) dose-dependently inhibited oedema formation by up to 50%. Similarly, oedema formation induced by PAF and lipopolysaccharide (LPS), but not by zymosan-activated plasma (ZAP), was significantly inhibited by dexamethasone. In contrast, 111In-eosinophil accumulation measured in response to i.d. injection of PAF, LPS and ZAP or in the PCA reaction was not altered. 3. Systemic treatment with dexamethasone (4 mg kg-1, i.v., 150 min pretreatment period) inhibited both oedema formation and 111In-eosinophil accumulation induced by PAF, ZAP, LPS and in the PCA reaction. 4. The effects of i.d. injection of cyclohexamide (2 x 10(-7) mol per site) on 111In-eosinophil accumulation and oedema formation induced by PAF, ZAP or in a PCA reaction were evaluated in order to assess the dependency of these responses on protein synthesis. Cycloheximide had no effect on the responses measured. In contrast, 111In-eosinophil accumulation, but oedema formation, induced by LPS was inhibited by 30%. 5. Acute (10 mg kg-1, i.v., 15 min pretreatment) or prolonged (10 mg kg-1, s.c. daily for 3 days) systemic treatment with cyclosporin A had no effect on 111In-eosinophil accumulation or oedema formation induced by PAF, ZAP, LPS or in the PCA reaction. 6. In conclusion, we demonstrate preferential inhibitory effects of dexamethasone on 111In-eosinophil accumulation according to its site of administration. In addition we show that dexamethasone inhibits protein synthesis-independent acute inflammation in guinea-pig skin. Finally, our results do not support the concept that eosinophils are an important cellular site of action for the inhibitory effects of cyclosporin A in a guinea-pig model of allergic inflammation.     

Socioeconomic characteristics of patients with stroke

We studied the socioeconomic status of 206 stroke patients seen at Escola Paulista de Medicina--S?o Paulo in the period of 1991-1992. We found that 25% of patients were less than 50 years old; men were married significantly more often than women; 82% of patients had less than 8 years of formal education and 60% of the families survived with US$ 98 to 198. The socioeconomic impact caused by a stroke is very important. Low education and poverty influence the treatment and prevention of the disease. The Social Assistance Service can detect and attempt to solve the social problems in order to obtain a better control of systemic diseases and risk factors for stroke, and to give orientation concerning the local resources.     

Reducing maternal smoking and relapse: long-term evaluation of a pediatric intervention

Simultaneous recordings of action potentials (APs) of multiple single motor units (MUs) were obtained in brachialis and biceps (caput breve) muscles during sinusoidally modulated isometric contractions of elbow flexor muscles and during sinusoidal flexion/extension movements in the elbow against a preload in the extension direction. The results show that MUs typically fire in one short burst for each sinusoidal cycle. The mean phase lead of the bursts of APs relative to a sinusoidally modulated isometric torque in the elbow joint or relative to sinusoidal movements in the elbow increases gradually with frequency. The increase of the mean phase lead during isometric contractions was very similar for all MUs and could be explained well by modeling the force production of MUs with a second-order linear low-pass system. For sinusoidal flexion/extension movements each MU reveals a specific, reproducible phase lead as a function of frequency. However, there is a large variability in phase behavior between MUs. Also, the modulation of the firing rate for sinusoidal isometric contractions versus sinusoidal movements appeared to be different for various MUs. In simultaneous recordings some MUs clearly revealed a larger firing rate in each burst for movements relative to isometric contractions, whereas other MUs revealed a smaller firing rate. This suggests that some MUs are preferentially activated during movements whereas others are preferably activated during isometric contractions. The results demonstrate task-dependent changes in the relative activation of MUs within a single muscle for sinusoidal isometric contractions and movements.     

Effect of a stroke protocol on hospital costs of stroke patients

OBJECTIVE: To determine the impact of a protocol on hospitalization costs for patients admitted with stroke. DESIGN AND SETTING: Nonrandomized control trial in an urban community hospital with 376 beds. PATIENTS: All patients admitted with a diagnosis-related group code of 014 (cerebrovascular disease) were included (N = 390). Patients with subdural hematoma (N = 2) or subarachnoid hemorrhage (N = 2) were excluded. INTERVENTION: A protocol for treatment of acute stroke was developed that included a critical path for nursing care, an algorithm for emergency department care, and suggested admission orders for physicians. MAIN OUTCOME MEASURES: The hospital information system computer database was searched for hospitalization charges, length of stay, tests performed, and treatments provided. RESULTS: Patients treated with the protocol had lower charges compared with historical (p = 0.026) and concurrent (p = 0.02) control groups. Lower charges were accounted for by a decreased length of stay in the protocol group compared with historical (p = 0.001) and concurrent (p = 0.13) controls. Tests and treatments provided were similar except that carotid Doppler studies and deep venous thrombosis prophylaxis were more frequently done in those treated with the protocol (p = 0.001 for carotid Doppler and p = 0.026 for deep venous thrombosis prophylaxis). There were no differences in outcome measures such as death or discharge disposition. Medical complications were similar in all groups. CONCLUSIONS: There were significant savings in hospitalization cost for patients with acute stroke after introduction of a treatment protocol. These savings were almost entirely related to decreased length of stay. The protocol led to modest differences in tests ordered and treatments provided.     

Unilateral saccadic pursuit in patients with sensory stroke: sign of a pontine tegmentum lesion

BACKGROUND AND PURPOSE: Pure hemisensory syndrome can be caused by small strokes occurring in a number of regions, including the thalamus and pons. Differentiation of the pontine sensory syndrome from the thalamic sensory syndrome has generally been made on the basis of distribution of sensory loss and involvement of specific sensory modalities but not without uncertainties and difficulties. Because the pontine tegmentum plays a pivotal role in generating horizontal eye movement, we attempted to discriminate these 2 syndromes by analyzing horizontal eye movements in stroke patients with pure hemisensory syndrome. METHODS: Horizontal saccade, pursuit, vestibulo-ocular reflex (VOR), and VOR cancellation (VORC) were evaluated using electro-oculography in 6 patients with hemisensory syndromes, 3 due to pontine stroke and 3 due to thalamic stroke, and all were verified by MRI or CT. In addition, somatosensory evoked potentials (SEPs) were recorded. RESULTS: Smooth pursuit and VORC directed toward the side of the lesion were impaired unilaterally in patients with pontine sensory stroke, whereas those 2 movements were intact bilaterally in patients with thalamic sensory stroke. Saccade and VOR were preserved in all patients. SEPs were normal in all patients with pontine and thalamic sensory strokes. No difference was found in the pattern of sensory disturbance between the 2 types of stroke patients. CONCLUSIONS: Ipsilateral impairment of the smooth pursuit system may be a sign of a pontine lesion in patients with hemisensory stroke.     

Dolichoectasia of the intracranial arteries in patients with first ischemic stroke: a population-based study

OBJECTIVE: The objective of this study was to estimate the frequency of intracranial arterial dolichoectasia among patients with first ischemic stroke and to compare clinical characteristics, survival, and recurrence in those with and without the abnormality. BACKGROUND: Dolichoectasia may cause cerebral infarction by thrombosis, embolism, stenosis, or occlusion of deep penetrating arteries. METHODS: The chi-square, Fisher's exact, and logrank tests were used to compare clinical characteristics, survival, and recurrence for patients with and without dolichoectasia among the 387 residents of Rochester, MN, who had brain CT or MRI for first cerebral infarction from 1985 through 1989. RESULTS: Twelve patients (3.1%) had dolichoectasia. Patients with dolichoectasia were more likely to have had stroke fitting a clinical and radiographic pattern of lacunar infarction than those without (42% and 17% respectively; p=0.04). Dolichoectasia was detected in the vertebrobasilar system in eight patients (66.7%), in the carotid system in two patients (16.7%), and in both circulatory systems in two patients (16.7%). There were no significant differences in the following characteristics among those with and without dolichoectasia: age, sex, hypertension, diabetes, smoking, and preceding transient ischemic attack. Patients with dolichoectasia had better survival (relative risk [RR] for death, 0.26; p=0.04) after first cerebral infarction but higher rates of stroke recurrence (RR, 2.4; p=0.02). CONCLUSIONS: Dolichoectasia is detected in 38 of patients with first cerebral infarction and is associated with better survival but higher rates of stroke recurrence.     

Neuro-ultrasonographic evaluation of ischemic stroke

INTRODUCTION AND DEVELOPMENT: The development of new management strategies for acute stroke demands better understanding of the ischemic mechanism, cerebrovascular anatomy, and cerebral hemodynamics for individual patients. The use of carotid duplex sonography, transcranial Doppler sonography, and echocardiography allows evaluation of the key areas of interest in a prompt, safe, accurate, and cost effective manner. CONCLUSIONS: Knowledge of these methods is essential for neurologist caring for patients with stroke.     

Rehabilitation of patients who have suffered a stroke with an aphasic syndrome

A total of 70 patients with aphasic syndromes following a cerebral stroke were treated in a neurological department, a polyclinic and at home. The main diseases which led to the brain stroke were hypertensive disease and general atherosclerosis. The aphasic disturbances were due to hemorrhagic strokes in 19 patients and ischemic-in 51 patients. Training of speech rehabilitation began from the end of the first and the beginning of the second week after the stroke. The inclusion of logopedic lessons into the general complex of restorative therapy, a continuity in conditions of a hospital and a polyclinic, a possibility of a dynamical observation of the patients, dispensarization-all these measures according to the authors' opinion are important and necessary for rehabilitation of the patients who had strokes with the aphasic syndrome.     

Atrial fibrillation in older stroke patients: association with recurrence and mortality after first ischemic stroke

Oxidation of dichlorofluorescin and dihydrofluorescin and transport of their oxidation products were studied in Saccharomyces cerevisiae cells given diacetates of these compounds. It was found that addition of peroxidase significantly accelerates the formation of dichlorofluorescein and fluorescein, indicating that peroxidase activity may be a limiting factor in studies of cellular oxidation using these probes. A significant leakage of dichlorofluorescin and dihydrofluorescin, and of their oxidized forms from the yeast cells, was found, without any apparent lag period. This phenomenon complicates interpretation of data obtained with the fluorescent precursors used but, on the other hand, points to the possibility of using measurements of dichlorofluorescein or fluorescein in the extracellular medium for studies of cellular oxidation processes.     

Echocardiographic evaluation of patients with a left ventricular device

Limited donor heart availability is primarily responsible for the renewal of interest in mechanical left ventricular assist devices (LVADs) as a bridge to transplantation. Donor availability is unlikely to increase significantly in the near future. Experience to date has shown that many patients can be maintained long enough to undergo transplantation, and LVADs may be acceptable as alternate therapy in some who may not be candidates for transplantation. However, criteria for noninvasive evaluation of patients on LVADs have not been developed. In a prospective study using serial echocardiography, we found that aortic valve opening, aortic forward flow, nonlaminar flow in the left ventricle, and mismatch of Doppler derived cardiac output at the pulmonic valve and device output are associated with device malfunction. Echocardiography was diagnostic in five of six patients with clinical instability unrelated to the device. These findings suggest that echocardiography is helpful in the routine evaluation of patients on LVADs.     

The effect of mesoglycan in patients with cerebrovascular disease: a psychometric evaluation

Mesoglycan is a preparation of natural glycosaminoglycans, containing mainly heparan sulphate and dermatan sulphate. A clinical trial was conducted to evaluate the efficacy and the tolerability of once-daily mesoglycan in 30 patients with clinical evidence of cerebrovascular insufficiency. Clinical effectiveness was assessed using psychometric and neurological scales: Sandoz Clinical Assessment for Geriatric Patients (SCAG); Parkside Behaviour Rating Scale Modified; Geriatric Depression Scale; and Anxiety Evaluation. Mesoglycan was given as a single oral once-daily dose of 100 mg for a period of 6 months. This treatment was shown to have positive effects on the cognitive and behavioural parameters evaluated. The effects on SCAG were already evident after 3 months' treatment and a significant improvement was observed after 6 months in those patients with a moderate to severe disease. During the treatment period only one patient suffered an adverse reaction attributed to the drug investigated.     

Nutritional assessment, intervention, and evaluation of weight loss in patients with non-small cell lung cancer

All animals that are exposed to predators must distinguish dangerous from nondangerous threats and respond correctly. In reptiles, emerging hatchlings are vulnerable to a wide range of predators, particularly if they emerge during daylight. In these experiments I tested the response of pine snake, Pituophis melanoleucus, hatchlings incubated at 22-23, 27-28, or 32-33 degreesC to visual and vibratory stimuli to examine antipredator behaviour. Emerging hatchlings were exposed to one of five conditions: (1) hawk model, (2) white head model with no facial features, (3) white head model with black eyes, (4) a person, or (5) a vibration without a visual stimulus. I tested the null hypotheses of no differences in response as a function of predator type or incubation temperature. Emergence behaviour when undisturbed was affected by incubating temperature, and antipredatory behaviour was affected by both predator type and incubation temperature. Pine snake hatchlings responded more protectively (withdrawal into tunnels) than defensively (striking), responded with less intensity to a vibration compared with visual predator stimuli, and required longer to respond to a head model without eyes than to all other predator types. Given the relatively small size of hatchlings, it is adaptive for them to withdraw into the nest rather than attack a predator. Hatchlings from eggs that were incubated at medium temperatures required less time to emerge from their underground nests when undisturbed, and had stronger protective responses than snakes incubated at other temperatures. These results suggest that hatchlings incubated at medium temperatures are generally less vulnerable to predators than hatchlings incubated at higher or lower temperatures. Copyright 1998 The Association for the Study of Animal Behaviour.     

RCT of a psychological intervention for patients with cancer: I. Mechanisms of change.

Little is known about the therapeutic processes contributing to efficacy of psychological interventions for patients with cancer. Data from a randomized clinical trial yielding robust biobehavioral and health effects (B. L. Andersen et al., 2004, 2007) were used to examine associations between process variables, treatment utilization, and outcomes. Novel findings emerged. Patients were highly satisfied with the treatment, but their higher levels of felt support (group cohesion) covaried with lower distress and fewer symptoms. Also, specific treatment strategies were associated with specific outcomes, including lower distress, improved dietary habits, reduced symptomatology, and higher chemotherapy dose intensity. These data provide a comprehensive test of multiple therapeutic processes and mechanisms for biobehavioral change with an intervention including both intensive and maintenance phases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)