Neurology Ward Research Articles

Recurrence of Ischemic Stroke Patients with Common Risk Factors

Background: Mortality and morbidity due to recurrent ischemic stroke is gradually increasing in Bangladesh due to gradual increase of life expectancy. Previously many studies were done to identify the risk factors of ischemic stroke. But there was scanty data about risk factors of recurrent ischemic stroke. So,it is time demanding to find out those risk factors for ischemic stroke recurrence to reduce the mortality and morbidity from recurrent ischemic stroke. The objective of the study was to determine the frequency of recurrence ischemic stroke events within one year of follow up after discharge from hospital admitted due to first ever stroke.
 Methods: This is a prospective cohort study. This study was conducted on 150 patients admitted in Neurology ward of BSMMU, presenting with first ever ischemic stroke. Patients mRS were evaluated three monthly interval for one year. Sudden onset mRS deterioration than previous one during this one year period was categorized as recurrence.
 Results: Stroke recurrence was found in 30 patients including 8 patients who died due to stroke recurrence. the most frequent age group was > 75 years representing 44.4% who developed recurrence of stroke The cumulative risk of recurrence rate was 14.7% at three months, 15.3% at six months, 17.3% at ninth months,20% at one year. Old age, Male sex, Hypertension, DM and dyslipidemia were the most common risk factors among recurrent stroke patients.
 Conclusion: It was concluded that in hospital admitted patients of first ever stroke, recurrence events was more in patients of older male patients with multiple risk factors.First three months was the worst period for recurrence after index stroke.
 Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 33-38

Progressive multifocal leukoencephalopathy in Finland: a cross-sectional registry study

ObjectiveTo investigate if progressive multifocal leucoencephalopathy (PML) incidence has increased in Finland like in the neighbouring Sweden.MethodsNational administrative registries were searched for all PML admissions aged 16 years or more in 2004–2014 on all neurological and internal medicine wards in Finland. The mortality data of the patients was extracted from the national causes of death registry. National level data on annual predisposing drug use was obtained from the national pharmaceutical authority.ResultsWe identified 35 PML cases (57% male) with a peak in 2010–2011 that amounted to 49% of all cases. The annual incidence for the entire study period was 0.072/100,000 person-years (95% CI 0.050–0.10) with no temporal trend (p = 0.18). Mean age was 57 years (22–88 years) with no sex difference (p = 0.42). Neoplasms (60%), HIV infection (17%) and systemic connective tissue disorders (CTD, 14%) were the most common predisposing conditions. MS was recorded in three cases (9%). The national level use of drugs that predispose to PML increased during the study period, with the exceptions of alemtuzumab and fludarabine. Overall survival was 85% at 90 days, 79% at 1 year, and 66% at 5 years. Survival was worst in patients with malignancy and best in patients with CTD.ConclusionsPML most often occurs in patients with malignancies and patients with HIV or CTD cover a third. PML incidence in Finland is lower than in Sweden and shows no temporal trend despite increasing use of predisposing drugs. Mortality after PML varies according to the predisposing condition.

Parkinson's Disease in Intensive Care Unit: An Observational Study of Frequencies, Causes, and Outcomes.

Objective:To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit (ICU) among Parkinson's disease (PD) population so that preventive measures can be developed.Methods:We prospectively observed patients with diagnosis of PD admitted to ICU from January 2014 to December 2016. Based on etiology for hospital admission, they were divided into two groups – related to PD (further divided into direct or indirect) or not associated with PD at all. Etiology for hospitalization was determined from history and investigational data. The primary outcome was death or discharge from the hospital. Factors contributing to ICU admission were analyzed by comparing these patients with a cohort of 50 PD patients admitted to the neurology ward during the same study period. All values were expressed as mean (standard deviation) and percentages using SPSS version 16.0.Results:Fifty-three (36%) out of a total of 146 patients required ICU admission. Most common causes leading to admission in decreasing order of frequency were fever (34%), delirium (16%), falls (12%), encephalopathy (8%), gastrointestinal emergencies (6%); while direct disease-related severe dyskinesias were seen only in two patients (4%). 13.7% needed mechanical ventilation and mean duration of ventilation was 5.94 days with mortality rate of 20%. Significant factors predicting ICU admission, and thus, poor outcomes were age >65 years, history of previous admission within the last 12 months, delirium, and hypoalbuminemia. There was no significant association between the incidence of ICU admission and duration of disease or severity of the disease.Conclusions:Poor outcome in PD patients is due to systemic causes, hence multidisciplinary teamwork may improve outcome in these patients.

Effects of CHADS2 Score, Echocardiographic and Haematologic Parameters on Stroke Severity and Prognosis in Patients with Stroke due to Nonvalvular Atrial Fibrillation

The aim of this study is to evaluate utility of CHADS2 score to estimate stroke severity and prognosis in patients with ischemic stroke due to non-valvular atrial fibrillation (AF) in addition to evaluate effects of hematologic and echocardiographic findings on stroke severity and prognosis. This prospective study included 156 ischemic stroke cases due to non-valvular AF in neurology ward of Trakya University Medical School between March 2013-March 2015. National Institute of Health Stroke (NIHS) score was used to evaluate severity of stroke at admission. Carotid and vertebral Doppler ultrasonography findings, brain computed tomography (CT) and magnetic resonance imaging (MRI) of the cases were evaluated. Left atrial diameter and ejection fraction (EF) values were measured. CHADS2 score was calculated. Modified Rankin Scale was used to rate the degree of dependence. Effects of age and sex of the patients, presence of diabetes mellitus (DM), Congestive Heart Failure (CHF), Cerebrovascular Disease (CVD) and C-reactive protein (CRP) levels on CHADS2, NIHS, and mRS were evaluated. In patients with age ≥75, mean NIHS score was 3.3 points and mean mRS score was 1.02 points higher, than in patient below 75 years of age. Compared with the mild risk group, cases in the high risk group had older age, higher serum D-dimer, fibrinogen and CRP levels and lower EF. A positive relation was detected between stroke severity and Hemorrhagic Transformation (HT), previous CVD history, and presence of CHF. A significant association was found between increased stroke severity and Early Neurological Deterioration (END) development. Older age, higher serum fibrinogen, D-dimer, CRP and lower EF values were associated with poor prognosis. History of CVD and presence of CHF were associated with poor prognosis. END development was found to be associated with poor prognosis. In the high-risk group, 30.3% (n = 33) had END. Among those in the high-risk group according to the CHADS2 score, END development rate was found to be significantly higher than in the moderate risk group (p <0.05). There was a strong positive correlation between CHADS2 and NIHS scores. mRS score increased with increasing CHADS2 score and there was a strong correlation between them. Effect of stroke severity on prognosis was assessed and a positive correlation was found between NIHS score and mRS value. Our study demonstrated the importance of CHADS2 score, haemostatic activation and echocardiographic findings to assess stroke severity and prognosis. Knowing factors which affect stroke severity and prognosis in patients with ischemic stroke may be directive to decide primary prevention and stroke management.

The Prevalence of Stroke Survivors in Urban Slums in Enugu, Nigeria

Background: Stroke is one of the commonest non-communicable diseases and the commonest cause of death in adult neurology wards. Stroke preva-lence in sub Saharan Africa has dramatically increased over the past decades possibly due to changing life styles, poverty, poor health infrastructures which had led to increased risk factors for stroke. Poor nutrition and lack of access to standard medical care, predispose to high rates of stroke morbidity and mor-tality hence possible low prevalence. Little is known about the prevalence of stroke in people with low socio-economic status in Nigeria. Objectives: The main objective of this study was to determine the prevalence of stroke in two urban slums in south east Nigeria. Materials and Methods: This was a cross sectional descriptive study carried out in two slums in Enugu, South East Nige-ria. Participants were screened using a stroke specific questionnaire and further examined by two independent neurologists for evidence of focal neurological deficits. Analysis was done by SPSS version 22. Results: A total of 1440 par-ticipants were surveyed in the study; 769 (53.4) females and 671 (46.6%) males. About 22.3% (321) screened positive for various neurological diseases out of which 17 (5.3%) had evidence for stroke giving an overall prevalence of 1.2% (males 9 (1.3%) vs females 8 (1%) p = 0.6). The mean age of stroke sur-vivors was 60.1 years, similar in males and females (p = 0.6). The odds ratio for stroke from 40 years showed progress increment doubling between 60 and 70 years and tripled between 40 and 70 years. Age, lower level of education, positive history of hypertension, sickle cell disease, leg swelling and use of snuff positively are correlated with clinical diagnosis of stroke. Conclusion: The prevalence of stroke in two urban slums in Enugu metropolis was 12/1000. Hypertension, diabetes, use of snuff, and low levels of education were signifi-cant risk factors for stroke. Public health educational measures, promoting prevention and early detection of diabetes should be encouraged.

Effect of Comprehensive Nursing Care Strategies, on the Outcome of Stroke Patients

A quantitative study with quasi-experimental pre-test – post-test, control group design, was conducted on 200 stroke patients, 100 in experimental and 100 in control group, to assess the effectiveness of comprehensive Nursing Care Strategies for stroke patients on the outcome in patients with stroke in a selected hospital of Kashmir during June 2012 to June 2013. Baseline assessment was determined by pre-test on first day of admission in neurology ward of Sheri-Kashmir Institute of Medical Sciences (SKIMS). The first post-test was conducted on 7th day after implementation of comprehensive Nursing Care Strategies to stroke patients for five days. Second post-test was conducted on 10th day after discharge, in neurology OPD during first follow-up visit. Findings revealed significant difference in stroke severity, activity level, physiological parameters, biochemical parameters and prevention of complications in experimental group which shows the effectiveness of the intervention.

Effect of implementing designed educational training program for neurological nurses on clinical outcomes of stroke patients

Background: Stroke is a major cause of functional disability, it increased the need for continuous nursing care. Nurses need to pay attention not only to the physical recovery after stroke, but also to the psychological and social recovery. Therefore, it is important to provide training courses to nurses about care of stroke patients.Aim: This study was conducted to evaluate the effect of implementing designed educational training program for neurological nurses on clinical outcomes of stroke patients.Methods: Design: A quasi experimental research design was utilized. Setting: Data were collected from Neurological Intensive Care Units, Wards and Neurological outpatient clinics of Tanta Main University Hospital. Sample: All nurses (n = 35) who are providing direct care for stroke patients and a purposive sample of 30 stroke patients. Tools: Three tools were used to collect data. Tool (I): Assessment of nurses’ knowledge questionnaire sheet about stroke; Tool (II): Observational checklist to evaluate nurses’ practice regarding care of stroke patients; and Tool (III): Patient’s clinical outcomes assessment sheet.Results: The results revealed that there were significant improvements in nurses’ knowledge and practice regarding care of stroke patients post training program at p &lt; .01. Also, significant improvements in self-care and activities of daily living among stroke patients were observed from immediately to 2 months later post application of training program.Conclusions: The study findings revealed that the implementation of designed educational training program within 2 months were successful for improving nurses’ knowledge and practice regarding care of stroke patients. Furthermore, there was improvement in activities of daily living and self-care among stroke patients.Recommendations: It is recommended to generalize implementation of designed educational training program for neurological nurses as a routine hospital care for stroke patients.

Assessment of Nurses' Knowledge toward Children with GuillainBarre Syndrome at Pediatric Hospitals in Baghdad City

Objectives: The study aimed to assess the level of pediatric nurses' knowledge toward children with Guillain-Barresyndrome (GBS) and to find out the relationships between nurses' knowledge and their demographic data.Methodology: A purposive “non probability” sample of (30) nurses was selected from medical neurological wards andRespiratory Care Units of Children Welfare Pediatric Teaching Hospital, Child’s Center Pediatric Teaching Hospital,AL-Kadhemia Teaching Hospital, Baghdad Teaching Hospital, and Neurological Science Hospital which has startedfrom March 5th 2009 to April 30th 2009. The study instrument consists of two parts. The first part is concerned withnurses' demographical characteristic and the second one is concerned with nurses’ knowledge which is divided into twosections. Section one consists of (20) items which are related to nurses’ knowledge about general information ofGuillain-Barre Syndrome, and section two (12) items concerning nurses’ knowledge in relation to nursing care of GBS.Data were collected through a special constructed questionnaire format which includes multiple choice questions. A selfadministrationmethod was used. Data were analyzed by using SPSS packed version (10.0), a descriptive statisticalanalysis (frequencies, percentage, quartile, and mean of scores), and inferential statistical analysis (chi-square) wereused.

Serum vitamin D deficiency in subjects with severe acquired brain injury and relationship with functional severity

ABSTRACTBackground: Vitamin D may be important for the development and function of the nervous system. Low serum vitamin D levels have been detected in several neurological diseases.Objective: To ascertain the relationship between 25(OH)D serum level and disability in subjects with severe acquired brain injury (sABI).Design: Prospective cross-sectional studyMethods: Consecutive subjects with sABI admitted to neuro-rehabilitation were enrolled. A sample of subjects from the neurological ward was considered the control group. Vitamin D serum levels and blood parameters were measured at admission. Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Level of Cognitive Functioning (LCF) were used in assessing disability.Results: A total of 104 subjects (34 F, 70 M; mean age 53.9 ± 15.2 years) were enrolled: 54 (19 F, 35 M) with sABI and 50 (15 F, 35 M) subjects as control group. Deficient mean serum levels of vitamin D (19.2 ± 9.4 ng/mL) were detected in the subjects with sABI and a significant inverse correlation between vitamin D serum levels and DRS score was detected (p = 0.04).Conclusion: Subjects with sABI showed vitamin D deficiency that might correlate to disability severity. The reason is unclear and might represent a secondary phenomenon resulting from the inflammatory process.

PMD60 - DEVELOPING A COMPREHENSIVE TREATMENT COST COMPARISON MODEL IN GUILLAIN-BARRE SYNDROME AND MYASTHENIA GRAVIS TO COMPARE THE TOTAL COST OF IVIG BASED TREATMENT VERSUS CENTRIFUGAL THERAPEUTIC PLASMA EXCHANGE

Published literature that discusses the total cost of treatment by means of Intravenous Immunoglobulins (IVIG) versus Therapeutic Plasma Exchange (TPE) in Guillain-Barré Syndrome (GBS) and Myasthenia Gravis (MG) applies different cost drivers, making it difficult to compare studies. Simultaneously medical professionals as well as hospital administrators are – given the recent shortages of IVIG – considering comparing these 2 treatment options from a clinical benefit as well as from a cost point of view. This study intends to map the different cost drivers for both treatment options and to suggest how these could be incorporated in a single cost model. A systematic literature review was performed on the drivers of cost for TPE and IVIG treatments in GBS and MG. Searches were performed on PubMed as well as through the ISPOR Scientific Presentations Database. 25 peer-reviewed publications were identified between 2000 and 2018. For each of those publication the main drivers of cost per treatment type were identified. The most frequently applied drivers of cost for a hospital treating GBS or MG patients by means of IVIG or TPE are: patient volume, total length of stay, treatment choice, time per treatment procedure, type of staff involved, cost of staff, patient days at the neurology ward, patient days at the intensive care unit, need for mechanical ventilation, adverse events of treatment, weight of the patient, drug price, central versus peripheral access line, diagnostic tests, capital equipment cost, disposable cost and severity of disease. A comprehensive cost model in GBS or MG to compare IVIG and TPE treatment, should consider costs that starts from the moment the patient is brought to the hospital (e.g. diagnostic test) until the patient leaves the hospital (e.g.ed cost) and that maps costs from multiple divisions within the hospital (e.g. pharmacy costs, staff costs, hospital department costs).

PHARMACIST INTERVENTION ON IDENTIFICATION OF DRUG INTERACTIONS IN TERTIARY CARE HOSPITALS

Objective: The aim of this study was to assess the potential drug interactions (pDIs) among hospitalized patients in cardiac and neurology wards in 3 tertiary care hospitals.Methods: A prospective, observational study was carried out for a period of 12 mo. A sample of 1330 patients was assessed for pDDIs using Micromedex®-2.7and drugs.com and www.dugs.com.Results: A total of 1330 patients were analyzed and it was found that 685 were cardiac and 645 were neurology patients. The study identified 524 (76.49%) cardiac patients and 425 (65.89%) neurology patients, with potential drug-drug interactions (pDDIs) higher in male cardiac [298 (56.87%)] and male neurology [235 (55.29%)] patients, compared to females. Incidences of pDDIs were found to be higher in the age group of 60-70 y in cardiac [193 (36.83%)] and neurology [165 (38.84%)] patients and incidences of interactions based on duration of (4-6 d) hospital stays in cardiac were 380 (72.53%) and 275 (64.70%) in neurology patients respectively. Moreover, 51.90% cardiac patients and 57.41% neurology patients were found to be prescribed with more number of drugs in cardiac and neurology (7 drugs) patients, were found to have developed higher incidences of pDDIs. The most common drug interacting pair was between aspirin and clopidogrel combination, observed in 245 cardiac and 316 in neurology patients. Drug-food interactions (DFIs) were found with between atorvastatin-citrus fruits in cardiac and phenytoin-protein rich foods in neurology patients. The most common drug-disease interaction (D-DIs) was found to between isosorbide dinitrate–myocardial infarction in cardiac and carbamazepine-seizuresin neurology respectively.Conclusion: It is recommended that physicians should be aware of the interactions among those drugs while prescribing, and careful monitoring is also required.

Rate of complications due to carotid angioplasty in a tertiary university hospital

Introduction: Stenoses greater than 50% in the cervical internal carotid artery cause up to 8% of all ischemic strokes. Carotid artery stenting (CAS) is an effective alternative to prevent cerebrovascular events to occur. According to recommendations from the American Heart Association/American Stroke Association, CAS is indicated for symptomatic patients with internal carotid stenosis greater than 70% (measured by non-invasive methods), as long as the risk for periprocedural stroke or death is less than 6%. There is few information about complication rates of CAS in developing countries. Objectives: The primary goal of this study was to evaluate the frequency of any stroke or death until hospital discharge after CAS in symptomatic patients with carotid stenosis in a tertiary university hospital. Other complication rates were also assessed as secondary aims. Methods: A single-center retrospective study based on the analysis of charts from patients submitted to CAS between April 2011 and March 2016. Inclusion criteria were: age ≥ 18 years old, admission and follow-up by neurologists from the Neurology Ward, performance of CAS according to the hospital´s protocol (carotid stenosis ≥70%, patients with transient ischemic attack (TIA), amaurosis fugax or minor stroke in the last 180 days, and life expectancy greater than a year). Patients not followed by neurologists after CAS were excluded. Results: A total of 65 patients were included: 3 (4.6%) suffered stroke or death after CAS. Two of these patients presented ischemic strokes and one, an hemorrhagic stroke that lead to death. Myocardial infarctions were not identified, as well as carotid ruptures or dissections, hyperperfusion syndrome, artery perforations, stent thrombosis or encephalopathy. Minor complication rates were: 12.3% for hypotension, 9.2% for bradycardia, 1.5% for TIA, 3.1% for carotid vasospasm and 6.2% for acute kidney injury. The total rate of minor complications was 23.1%, and none of then led to permanent harm. Conclusions: The rate of stroke or death in a reference tertiary service in a developing country was in line with international recommendations.

High Il-1β Serum as a Predictor of Decreased Cognitive Function in Mild Traumatic Brain Injury Patients.

BACKGROUND:Traumatic brain injury (TBI) exerts a significant impact on society with regards to physical, affective, and cognitive impairment. The consequent cognitive sequelae include a problem in memory, attention, concentration, and processing speed. Following traumatic brain injury, inflammatory response developed, characterised by increased interleukin 1-β (IL-1β) levels in the blood. IL 1-β at pathophysiological concentration has been reported to cause an inhibition of the expression of long-term potentiation (LTP) in the areas CA1, CA3, and dentate gyrus of the hippocampus.AIM:This study aims to determine whether high IL-1β serum is a predictor of decreased cognitive function in mild TBI.METHODS:This is a prospective cohort study conducted at the emergency room, surgical and neurologic ward at Sanglah Hospital from November 2017 until January 2018. As many as thirty-five mild TBI with normal IL-1β serum (< 0.0565 pg/ml) and thirty-five of those with high IL-1β serum (≥ 0.0565 pg/ml) subjects were included within the corresponding period. The decrease of cognition after trauma was measured seven days later.RESULTS:This study demonstrated that group with high IL-1β serum levels were at higher risk of suffering from cognitive impairment after TBI when compared with the group with normal IL-1β serum levels (RR = 2.6; 95% CI 1.49-4.55, p < 0.001).CONCLUSION:Mild TBI with high serum IL-1β levels were more than twice likely to experience decreased cognitive function than those with normal IL-1β levels.

Validation of the Geriatric Check in acohort of hospitalized neurological patients

The Geriatrie-Check was developed as ascreening tool for the identification of older patients with geriatric treatment requirements in hospitals. It was recommended by the Baden-Wuerttemberg Hospitals Association for routine use in hospitals in 2014 although no published validation studies are available. The test takes 3-5 min. Validation of the Geriatrie-Check in aprospective cohort of hospitalized neurological patients with and without geriatric characteristics. In this prospective cross-sectional observational study at the University Hospital Tübingen, Germany the Geriatrie-Check was compared with acomprehensive geriatric assessment in 107 neurological inpatients aged 70years and older (41% women, mean age 76.7years). The Geriatrie-Check classified 61patients (57%) as geriatric patients. These patients with apositive result in the Geriatrie-Check had ahigher percentage of frailty (according to Fried etal.), higher values in the Gérontopôle frailty screening tool, higher values in the geriatric screening according to Lachs et el., slower gait speed, lower grip force, needed longer for the timed up-and-go test, had agreater fear of falling in the Falls Efficacy Scale - International, lower scores in the Mini Mental State Examination, needed more time to perform the Trail Making TestA and B, had higher values in the Beck's Depressions InventarII and lower values in the visual analogue scale of the EQ-5D. Ahigher percentage of patients took more than five different drugs. The Geriatrie-Check has been shown to be auseful and valid tool for the identification of geriatric inpatients in neurological wards due to the good agreement with the results of the geriatric assessment.

The Evaluation of the Construct and Convergent Validity and Reliability of Psychological Inflexibility in Pain Scale in Individuals With Migraine Headache

Background: The migraine headache is one of the common chronic pains. Recent psychopathological approaches emphasized more on acceptance than the control of pain. Psychological inflexibility in pain scale (PIPS) is a tool to assess pain acceptance. Objectives: The current study aimed at evaluating the psychometric properties of PIPS. Methods: The study sample comprised of 250 individuals with migraine headache. They were selected from patients admitted to neurological ward of Shahid Beheshti Hospital and private neurology clinics in Kashan, Iran in summer 2015. After preparation of the PIPS (translation and back-translation), participants completed the PIPS and chronic pain acceptance questionnaire (CPAQ). The factor structure and correlation of PIPS with CPAQ were examined. Results: The results of exploratory factor analysis (EFA) showed two factors of pain avoidance (10 items) and cognitive fusion factor (six items) for this scale. The confirmatory factor analysis (CFA) confirmed the obtained model in comparison with the original model (group factor analysis (GFA), CFA, and the Tucker-Lewis index (TLI) ≥ 0.90; the root mean square error of approximation (RMSEA) 90% confidence interval (CI) = 0.03 - 0.06). Also, the convergent validity of this scale was confirmed with CPAQ (r =.66, P < 0.001). The reliability of the scale by internal consistency and test-retest method was good. Conclusions: The Persian version of PIPS has appropriate psychometric features in Iranian society and it can be used to measure this characteristic.

Evolución de la atención al ictus en un hospital de tercer nivel

Objective: to learn about the evolution of patients hospitalized and treated at the Stroke Unit of a third-level hospital following the current model of treatment, compared with those patients previously hospitalized and treated in a conventional Neurology ward. Method: an observational retrospective study, on patients managed at the Hospital Universitario Central de Asturias after suffering a stroke, conducted in two stages: before the Stroke Unit was set up (January, 1st to 31st, 2009), and after implementing the unit (January, 1st to 31st, 2014). A notebook for data collection was designed. The TOAST classification system was used, as well as the NIHSS scale (for stroke severity) and the modified Rankin scale (level of physical disability after a stroke). A review of electronic clinical records was conducted through Cerner Millenium. Analysis was conducted with the SPPS statistical package, version 22.Results: the study included 152 patients in 2009 and 132 patients in 2014; their mean age was 73.92 years, and the majority were male (62.9%). There was a reduction in hospitalization days and mortality during admission between 2009 and 2014. There was a twofold increase in the number of activations of the Stroke Code protocol. The application of recanalization treatments increased from 16.1% to 20.4%. The early initiation in physical therapy increased from 7% to 33% since the creation of the Stroke Unit; those patients who did not require physical therapy increased from 42% to 80%.Conclusions: the implementation of the Stroke Unit and the activation of the Stroke Code have contributed to improve the results in identification, classification, treatment, follow-up and results at discharge, in patients hospitalized for stroke.

The application of nursing handover checklist in management of patients in the neurology ward

The application of nursing handover checklist in management of patients in the neurology ward

Perceived stress and depression amongst older stroke patients: Sense of coherence as a mediator?

ObjectiveThis study aimed to explore the relationship between perceived stress, sense of coherence, and depression among older stroke patients. MethodsA demographic questionnaire, the Perceived Stress Scale (PSS), the Sense of Coherence Scale (SOC) and the Center for Epidemiologic Studies Depression Scale (CES-D) were distributed to 3000 older stroke patients from Neurology wards in six large general hospitals, and 2907 individuals completed the survey. Data analysis consisted of correlation, multiple linear regression, and structural equation modeling. ResultsThe total score of the SOC and perceived stress showed a negative correlation (r = −0.80, P ＜ 0.01), the total SOC of coherence and depression also resulted in a negative correlation (r = -0.77, P ＜ 0.01), and the total score of the perceived stress and depression resulted in a positive correlation (r = 0.82, P ＜ 0.01). The results of multiple regression analyses indicated that SOC mediated the association between perceived stress and depression, and the influence of perceived stress on depression was decreased by 16.0%with in the sense of being out of control dimension and was decreased by 12.3% within the feeling of tension dimension when sense of coherence was added to the model. The structural equation model confirmed that the sense of coherence had a partial mediation effect between perceived stress and depression. ConclusionSOC is the mediating variable between perceived stress and depression, and can reduce the influence of perceived stress on depression.

Wearables for gait and balance assessment in the neurological ward - study design and first results of a prospective cross-sectional feasibility study with 384 inpatients

BackgroundDeficits in gait and balance are common among neurological inpatients. Currently, assessment of these patients is mainly subjective. New assessment options using wearables may provide complementary and more objective information.MethodsIn this prospective cross-sectional feasibility study performed over a four-month period, all patients referred to a normal neurology ward of a university hospital and aged between 40 and 89 years were asked to participate. Gait and balance deficits were assessed with wearables at the ankles and the lower back. Frailty, sarcopenia, Parkinsonism, depression, quality of life, fall history, fear of falling, physical activity, and cognition were evaluated with questionnaires and surveys.ResultsEighty-two percent (n = 384) of all eligible patients participated. Of those, 39% (n = 151) had no gait and balance deficit, 21% (n = 79) had gait deficits, 11% (n = 44) had balance deficits and 29% (n = 110) had gait and balance deficits. Parkinson’s disease, stroke, epilepsy, pain syndromes, and multiple sclerosis were the most common diseases. The assessment was well accepted.ConclusionsOur study suggests that the use of wearables for the assessment of gait and balance features in a clinical setting is feasible. Moreover, preliminary results confirm previous epidemiological data about gait and balance deficits among neurological inpatients. Evaluation of neurological inpatients with novel wearable technology opens new opportunities for the assessment of predictive, progression and treatment response markers.

Is Prevalence of Hypertension Increasing in First-Ever Stroke Patients?: A Hospital-Based Cross-Sectional Study

Background: Stroke is a devastating and disabling cerebrovascular disease with some amount of residual deficit leading to economic loss. Recent Indian studies have shown a stroke prevalence rate of 471.58/100,000 populations. Hypertension has been known to be the main risk factor for causing stroke. Purpose: To investigate the prevalence of hypertension in first-ever stroke patients and its comparison with the previous stroke registry. Methods: The study was a hospital-based cross-sectional study. Consecutive patients, who were admitted in the Neurology ward of All India Institute of Medical Sciences (AIIMS), New Delhi, India, were recruited for the study from the period July 2012 to January 2014. The stroke units consisted of a computerized record containing the details of all the admitted patients. Results: A total of 260 patients were recruited in which 194 (74.6%) were ischemic and 66 (25.4%) were hemorrhagic stroke patients. Hypertension was present in 169 (65%) patients. When compared with the previous stroke registry of 2,628 patients, hypertension was recorded in 1,503 (57.2%) patients. Conclusion: Our data show that there is an increase in the proportion of hypertension among first-ever stroke patients reported in AIIMS in the years 2012–2014 as compared to that reported in during the period 1998–2011.