Stroke is a leading cause of long term disability in the United States. The therapeutic benefits of intravenous thrombolytics is time dependent in an acute ischemic stroke patient and is an important determinant of 90 day and one year functional outcomes. This study investigated areas in the stroke alert process of a community based primary stroke care center that resulted in the delay of administration of thrombolytics within 60 minutes of an acute ischemic stroke patient's arrival to the emergency room. A retrospective descriptive design was utilized and chart reviews were done on 40 patients that received thrombolytics in the emergency room. Patient characteristics and time variables associated with the various steps in the stroke alert process were extracted. Findings showed that only 7.5% of the patients received thrombolytics within the recommended 60 minutes, with the longest time interval associated with time from arrival to the emergency room to time of evaluation by teleneurologist. There were no significant differences in the characteristics of patients who received thrombolytics within 60 minutes and those patients that received thrombolytics after 60 minutes. Recommendations were made for changes in organizational and practice strategies to improve timely administration, and for future research involving the effects of quality improvement initiatives

Thesis (MPhil)--Stellenbosch University, 2009. / A research assignment submitted in partial fulfilment of the requirements of the degree Master of Philosophy (MPhil) in rehabilitation at Stellenbosch University / ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributes significantly to the burden of disease and is the largest cause of disability. Rehabilitation can significantly improve recovery and outcomes of stroke survivors particularly if implemented in the correct manner and through using certain approaches. The aim of this study was to examine the practice of doctors with regards to stroke rehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular, attention has been given to the degree to which doctors in the private health care sector shared information with first time stroke patients. The study design was retrospective and descriptive in nature. Data collection was primarily of a quantitative nature although some qualitative data has been collected to elaborate on quantitative findings. Two self-designed questionnaires were used to collect data. Data from doctor-participants were collected to examine the use of care protocols. Data from both groups of participants were collected to determine which practices were prefered. In particular it was sought to ascertain what team work approach was favoured by doctors. To do this the method of communication among team members was examined. It was also sought to ascertain how information regarding diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning was shared. In total thirty-five doctors and forty-eight patients were interviewed. Quantitative data was captured on an excel spreadsheet and analysed with the help of a STATISTICA software package. A p value of less than 0.05 was deemed statistically significant. Results showed that none of the doctor participants had any formal rehabilitation qualification. It was found that stroke care protocols were used by 46% of doctor participants, while 89% acknowledged the advantages of a set protocol. The majority of doctors (57%) operated as part of a multidisciplinary team. Communication between team members regarding the patient’s management plan was done on a very informal basis with only 11% of doctors using ward rounds and none using team meetings for this purpose. Opinions differed between the two study groups on the frequency of information sessions (p = .00039). Only six % of doctors included the patient and family in the rehabilitation team. A large discrepancy was seen when it came to opinions on sharing information regarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference between the opinions of patients and doctors on these issues was statistically significant. Opinions also differed between the two groups when the frequency of information sessions was compared (p = 0.00039). Only 28% of patient participants were included in the decisionmaking process regarding further post-acute rehabilitation and in most cases the final decision was made by the doctor or the medical insurance company. Qualitative data highlighted some patients’ dissatisfaction regarding the post-acute rehabilitation process and indicated a problem with regard to the recognition of early stroke warning signs by general practitioners and the emergency treatment of these. The conclusion was that there is a great need for further motivation and education of doctors with respect to advanced research projects, further specialisation as well as the implementation of important rehabilitation modalities. It is also important that the patient himself acts as a fully-fledged team member. Recommendations were that administrators in both, the private and public health care sectors as well as non-government organisations and government welfare organisations identify the reasons for doctors’ hesitation to implement existing knowledge; that they make stroke rehabilitation training available and that they ensure that doctors implement the existing and new knowledge on all aspects of acute and post-acute stroke rehabilitation i.e. use of set care protocols, team work approach and sharing information on diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning when managing stroke patients. It was also recommended to promote more research projects which are implemented in the private health care sector. / AFRIKAANSE OPSOMMING: Beroerte is reeds die grootste enkele oorsaak van gestremdheid in Suid Afrika en steeds aan die toeneem in insidensie. Navorsing het bewys dat rehabilitasie geskoei op wetenskaplik bewese metodes die uitkomste van beroerte lyers beduidend kan verbeter. Daarom was dit die doel van die studie om vas te stel tot watter mate dokters, werksaam in die privaat sektor in die Wes Kaapse Metropool, bewese rehabilitasie metodes implimenteer tydens behandeling van akute beroerte pasiënte. Spesifieke areas waaraan aandag geskenk is, was die gebruik van beroerte protokolle, die volg van die interdissiplinêre spanwerk benadering, kommunikasie metodes tussen spanlede en die deurgee van inligting met betrekking tot die diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning aan pasiënte na `n eerste beroerte. Die studie was retrospektief en beskrywend van aard. Daar was primêr kwantitatiewe data ingesamel met behulp van twee self ontwerpde vraelyste. ‘n Klein hoeveelheid kwalitatiewe data is aanvullend ingesamel om kwantitatiewe bevindings toe te lig. 35 dokters en 48 pasiënte het aan die studie deelgeneem. ‘n STATISTICA sagteware pakket is gebruik vir die analise van kwalitatiewe data. ‘n P waarde van minder as 0.05 is as statisties beduidend beskou. Nie een van die dokters wat aan die studie deelgeneem het, het nagraadse opleiding in rehabilitasie gehad nie. 46% van dokters het beroerte protokolle gebruik in hulle praktyke, terwyl 89% gevoel het dat die gebruik van protokolle voordele inhou. Waar spanwerk gebruik was (57% van dokters), is die multidissiplinêre benadering gevolg. Kommunikasie tussen spanlede het meesal op `n informele basis geskied. Geen dokter het spanvergaderings gehou nie. 11% van dokters het saalrondtes gehou waartydens met spanlede gekommunikeer is. 6% van dokters het die pasiënt en familie ingesluit in die rehabilitasie span. Volgens dokters was daar beduidend meer inligting sessies met pasiënte gehou as volgens pasiënte (p = 0.00039). Die verskil in mening tussen die twee groepe is ook waargeneem met betrekking tot die hoeveelheid inligting wat verskaf is oor diagnose, prognose, risiko faktore, post akute rehabilitasie en onslag beplanning (P waardes het gewissel van 0.00013 tot 0.0041). 25% van pasiënte het deelgeneem aan die besluitnemings proses oor opvolg rehabilitasie. Die finale besluit hieroor was in die meerderheid van gevalle deur die dokter en die mediese versekeringsskema geneem. Dit het uit die kwalitatiewe data geblyk dat van die pasiënte ongelukkig was met die opvolg rehabilitasie wat hulle ontvang het. Voorts het pasiënte gevoel dat algemene praktisyns beter ingelig behoort te wees oor die vroeë waarskuwingstekens van beroerte sowel as die noodbehandling van die tekens. Die navorser het tot die gevolgtrekking gekom dat dokters oortuig moet word van die belang van verdere navorsing, spesialisasie in rehabilitasie en die implementasie van bewese beroerte rehabilitasie metodes. Sy beveel aan dat administrateurs van beide die privaat en staatssektor sowel as verteenwoordigers van nie regerings organisasies betrokke raak om bogenoemde te bewerkstellig. Daar moet vasgestel word waarom dokters huiwerig is om bestaande kennis te implemteer. Beroerte rehabilitasie opleiding moet beskikbaar gestel word aan dokters en dokters moet aangemoedig word om bewese kennis soos die gebruik van protokolle, interdissiplinêre spanwerk en verskaffing van inligting oor diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning toe te pas in die praktyk. Die doen van meer navorsing in die privaat sektor word ook aangemoedig.

The Georgia Department of Public Health has been engaged in a registry-based quality improvement initiative to monitor and improve the quality of stroke care. It is important to evaluate effectiveness of the quality improvement initiative in order to expand the effort to other sites or disease conditions. The studies, included in this dissertation, addressed whether acute ischemic stroke patients cared for by hospitals participating in the Georgia Coverdell Acute Stroke Registry (GCASR) had a better survival than those treated at other facilities, assessed whether quality of care as measured by nationally accepted ten performance measures is associated with improved patient outcome and evaluated the impact of intravenous alteplase treatment on 1-year mortality. Three data sources – GCASR, Georgia Discharge Data System and the death data – were used for analyses. These data sources were linked applying both a hierarchical deterministic and a probabilistic linkage methods. Survival after stroke incident was analyzed using the extended Cox proportional hazard model. Generalized estimating equation (glimmix procedure) and conditional logistic regression were applied, respectively, to assess the association of quality of care and intravenous alteplase use with 1-year mortality. Acute ischemic stroke patients treated at nonparticipating facilities had a hazard ratio for death of 1.14 (95% confidence interval, 1.03–1.26; p-value = .01) after the first week of admission compared with patients cared for by hospitals participating in the registry. Among patients treated in GCASR-participating hospitals, patients who received the lowest and intermediate quality care respectively had a 3.94 (95%CI: 3.27, 4.75; p-value <0.0001) and a 1.38 (95%CI: 1.12, 1.62; p-value=0.002) times higher odds of dying in one year compared to those who got the best quality stroke care. Patients who were eligible but did not receive IV alteplase had a 1.49 (95%CI: 1.09-2.04; p-value=0.01) times higher odds of dying within one year than those who were treated with the thrombolytic agent. The results strongly suggest that registry-based quality improvement effort has brought significant improvements in ischemic stroke patients’ outcomes. Therefore, it is critical that hospitals adopt a quality improvement strategy to change the process of care delivery for a better patient outcome.

Background: Stroke is a common health problem and one of the most frequent causes of disability among adults. Stroke is a collective term for cerebral infarction or brain bleeding, both of which can lead to death. Due to the injury caused by a stroke, patients may experience various symptoms depending on which part of the brain that is affected. Symptoms can include paralysis, difficulty swallowing, language disorders, and cognitive impairment. The severity of symptoms varies depending on the type of stroke, and some individuals may develop residual functional disabilities. Aim: The aim of this study was to highlight patients’ experiences regarding post-stroke nursing care. Method: The design of this study was a literature review where eight qualitative articles were analyzed using Friberg’s (2017) five-step method. Results: Two categories and six subcategories emerged from the analysis. Patients wished to be more involved in their care and wanted to be well-informed and engaged in their situation. Patients have different experiences when it comes to being a patient, which can include the feeling of questioning why this happened to them, facing obstacles, not being seen as a person, or fearing that something might be overlooked in their care. Conclusion: This study showed that patients’ experiences are important for nurses to go forward with the care the patients’ need. Patients expressed that the information they were given and in the way it was given, made the patients feel involved in their care. / Syftet med denna litteraturstudie var att belysa patienters upplevelser av omvårdnaden efter en stroke. När en patient drabbas av en stroke uppstår syrebrist i en specifik del av hjärnan på grund av antingen en hjärnblödning eller hjärninfarkt. Stroke kan ge svårigheter med motoriken och/eller kommunikationen och är den vanligaste orsaken till funktionsnedsättningar hos vuxna. Resultatet från studien visar att patienterna behöver klar och tydlig information, vara delaktiga i sin vård samt få stöd från både personal, närstående och andra patienter för att uppleva en god omvårdnad. Dessutom framkom det att patienterna upplever trygghet, säkerhet, delaktighet, tillit, rädsla, panik och ilska under vårdtiden. Studien pekar också på behovet av förbättringar i kommunikationen mellan patienter och sjuksköterskor, samt att informationen som patienterna erhåller bör anpassas utefter deras individuella behov och kunskapsnivå. Genom förbättringar inom dessa områden visar studien att patienterna känner sig mer delaktiga i sin vård. Stöd från vårdpersonal, anhöriga och andra patienter är avgörande för patienternas välbefinnande. Denna stöttning förbättrar miljön runt omkring patienterna och skapas en känsla av trygghet. Under vårdtiden uttryckte patienterna olika upplevelser, såsom minskad tillit till sina kroppar. Studien påvisar brister i omvårdnaden efter en stroke, där patienterna upplevde att sjuksköterskorna brast i delgivningen av informationen och möjligheten att göra patienterna delaktiga. Vidare upplevdes att det finns brister i sjuksköterskornas kommunikationsförmåga. Detta resulterade i upplevda brister i omvårdnaden och hinder för en personcentrerad vård. Resultatet i denna litteraturstudie baseras på åtta kvalitativa artiklar om patienters upplevelser efter en stroke.

No description available.

<p>Diss. (sammanfattning) Umeå : Umeå universitet, 2003</p> / digitalisering@umu

When suffering a stroke, the time to treatment is one of the key factors to increase the chance of desirable recovery. To ensure proper treatment, a diagnosis has to be made before treatment can begin. The potential consequences of treating a misdiagnosis can be severely harmful or even deadly. A Mobile Stroke Unit (MSU) is an ambulance equipped with the necessary tools to diagnose and begin treatment of stroke before reaching a hospital, reducing the time to initial treatment. We contribute a model to identify suitable locations of MSUs within a geographical region. We propose a Multi-State Particle Swarm Optimization (MBPSO) algorithm variation to solve this problem. Furthermore, we demonstrate the use of the model in a scenario created in the Southern Healthcare Region of Sweden in order to properly communicate and evaluate the model. The objective of our MBPSO variation is to find locations within a geographical region which are suitable for placing MSUs. The results of the solution shows that populations previously not covered by stroke care within one hour of an emergency call has the potential to be covered up to 81%.

no / Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Background Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.