In the diploma thesis called Nursing Care as a Complication Prevention Tool in the Patient Stroke Center, we dealt with various aspects of nursing care in the stroke center. The development of nursing research in the stroke center lags behind the development of rapidly growing medical knowledge. With the development of medical care, nursing care should respond flexibly. The research intent was to get comprehensive information on preventing complications in patients in the stroke center using nursing care. We have investigated the complications that may arise in patients with acute stroke and how they can be affected by nursing care. We have set three goals: to find out what stroke complications can be influenced in the acute phase by nursing care, to identify nursing activities by nurses in stroke centers to prevent complications and to identify obstacles and limits of preventive nursing care in the stroke center. These objectives correspond to five identified research questions. We were interested in the opinions of the staff on the provided nursing care and we also wanted to know the perception of the care provided by the patients themselves. We have tried to identify key nursing care sites, identify weaknesses and possible shortcomings, and have sought to find the basis for possible improvement in care. The qualitative research strategy was chosen to achieve the objectives of the thesis. The technique of data collection was an individual depth semi-structured interview with ten respondents. The interviews were subjected to qualitative analysis using the ATLAS.ti program. By coding, a total of 104 codes have been identified, grouped into 20 categories. We identified 18 complications that can occur with a stroke patient. For all these complications, we have found interventions to be prevented or alleviated. The results also show that nurses working in the stroke center should have specialized education for intensive care rather than college education. Specialized education in neurological issues, which nurses can acquire through post-graduate stroke seminars and exercises, is also suitable. We have identified systemic barriers to nursing care, including lack of material, lack of time and lack of staff. As obstacles on the part of nursing staff we have identified nursing indifference, poor mood, poor collaboration with the patient, hurried care, physical limitations (back pain, fatigue), lack of awareness, knowledge or skills and inadequate teamwork. As obstacles on the part of the patient we have evaluated speech disorders, perception disorder, unconsciousness, faulty adaptation, lack of cooperation, lack of understanding, distrust, negation, aggression, restlessness, disorientation, apathy, depression, overvaluation of own abilities, conflict with the patient's family. During the research, other interesting facts emerged that do not directly relate to the goals and research questions.

PDFには「高橋 由佳子」と記載 / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21955号 / 医博第4497号 / 新制||医||1037(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 古川 壽亮, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

OF MASTER THESIS Tittle of master thesis: Use of individual types of positioning on patients after stroke in the acute and subacute phase of rehabilitation from the perspective of occupational therapy. Stroke is one of the diseases that most affects the human population. It can result in temporary disability, permanent consequences and death. The patient's positioning after a stroke can affect many risks of secondary changes. The aim of this work is to find out how occupational therapists are involved in the positioning of patients in the acute and subacute phase after a stroke in stroke centers in the Czech Republic and how the positioning in stroke centers takes place. The literature and recommended procedures show that the correct positioning after a stroke in the acute and subacute phase prevents the development of immobilization syndrome and secondary changes. Positioning patients after a stroke can affect muscle tone, shoulder pain, prevent subluxation in the joints, maintain passive and active range in the joints, etc. In patients after a stroke, agitation should occur from the affected side to support the return of sensorimotor functions and to involve the affected parties to activities. The occupational therapist is most involved in positioning the affected upper limb, especially to...

O Brasil é um país em desenvolvimento que luta para reduzir sua desigualdade social extrema. Isso se reflete na falta de infraestrutura de cuidados de saúde, principalmente para a classe de baixa renda, que depende exclusivamente do sistema de saúde pública. No Brasil, menos de 1% dos pacientes com acidente vascular cerebral (AVC) têm acesso a trombólise intravenosa em uma unidade especializada de AVC e as limitações para a implementação da trombectomia mecânica nos hospitais públicos aumentam a carga social do AVC. Objetivo: Avaliar a viabilidade da trombectomia mecânica como parte do tratamento de rotina em um hospital universitário público brasileiro. Pacientes e Métodos: Foram coletados dados prospectivos de todos os pacientes com acidente vascular cerebral isquêmico (AVCI) agudo tratados por trombectomia mecânica de junho de 2011 a março de 2016. A trombectomia combinada foi realizada em pacientes elegíveis para trombólise intravenosa e com presença de oclusão de grandes artérias. Para os pacientes não elegíveis para trombólise intravenosa, foi realizada a trombectomia mecânica desde que não existisse evidência de isquemia significativa de circulação anterior (escala de pontuação Alberta Stroke Program Early CT > 6), dentro de uma janela de tempo de 6 horas; e também para pacientes com AVCI ao desperdar ou de circulação posterior, independente do tempo de início dos sintomas. Resultados: Um total de 161 pacientes foram avaliados, resultando em uma taxa de recanalização global bem sucedida de 76% e taxa de hemorragia intracraniana sintomática de 6,8%. Após 3 meses, 36% dos pacientes apresentaram um índice da Escala de Rankin modificada inferior ou igual a 2. A taxa de mortalidade geral foi de 23%. Conclusão: Nosso estudo foi a primeira série grande de trombectomia mecânica no Brasil e demonstrou resultados aceitáveis de eficácia e segurança, mesmo em condições restritas, fora do cenário ideal dos estudos clínicos randomizados. / Brazil is a developing country struggling to reduce its extreme social inequality, which is reflected on shortage of health-care infrastructure, mainly to the low-income class, which depends exclusively on the public health system. In Brazil, less than 1% of stroke patients have access to intravenous thrombolysis in a stroke unit, and constraints to the development of mechanical thrombectomy in the public health system increase the social burden of stroke. Objective: Report the feasibility of mechanical thrombectomy as part of routine stroke care in a Brazilian public university hospital. Patients and methods: Prospective data were collected from all patients treated for acute ischemic stroke with mechanical thrombectomy from June 2011 to March 2016. Combined thrombectomy was performed in eligible patients for intravenous thrombolysis if they presented occlusion of large artery. For those patients ineligible for intravenous thrombolysis, primary thrombectomy was performed as long as there was no evidence of significant ischemia for anterior circulation stroke (Alberta Stroke Program Early CT score >6) within a 6-hour time window, and also for those patients with wake-up stroke or posterior circulation stroke, regardless of the time of symptoms onset. Results: A total of 161 patients were evaluated, resulting in an overall successful recanalization rate of 76% and symptomatic intracranial hemorrhage rate of 6.8%. At 3 months, 36% of the patients had modified Rankin Scale score less than or equal to 2. The overall mortality rate was 23%. Conclusion: Our study, the first ever large series of mechanical thrombectomy in Brazil, demonstrates acceptable efficacy and safety results, even under restricted conditions outside the ideal scenario of trial studies.

O Brasil é um país em desenvolvimento que luta para reduzir sua desigualdade social extrema. Isso se reflete na falta de infraestrutura de cuidados de saúde, principalmente para a classe de baixa renda, que depende exclusivamente do sistema de saúde pública. No Brasil, menos de 1% dos pacientes com acidente vascular cerebral (AVC) têm acesso a trombólise intravenosa em uma unidade especializada de AVC e as limitações para a implementação da trombectomia mecânica nos hospitais públicos aumentam a carga social do AVC. Objetivo: Avaliar a viabilidade da trombectomia mecânica como parte do tratamento de rotina em um hospital universitário público brasileiro. Pacientes e Métodos: Foram coletados dados prospectivos de todos os pacientes com acidente vascular cerebral isquêmico (AVCI) agudo tratados por trombectomia mecânica de junho de 2011 a março de 2016. A trombectomia combinada foi realizada em pacientes elegíveis para trombólise intravenosa e com presença de oclusão de grandes artérias. Para os pacientes não elegíveis para trombólise intravenosa, foi realizada a trombectomia mecânica desde que não existisse evidência de isquemia significativa de circulação anterior (escala de pontuação Alberta Stroke Program Early CT > 6), dentro de uma janela de tempo de 6 horas; e também para pacientes com AVCI ao desperdar ou de circulação posterior, independente do tempo de início dos sintomas. Resultados: Um total de 161 pacientes foram avaliados, resultando em uma taxa de recanalização global bem sucedida de 76% e taxa de hemorragia intracraniana sintomática de 6,8%. Após 3 meses, 36% dos pacientes apresentaram um índice da Escala de Rankin modificada inferior ou igual a 2. A taxa de mortalidade geral foi de 23%. Conclusão: Nosso estudo foi a primeira série grande de trombectomia mecânica no Brasil e demonstrou resultados aceitáveis de eficácia e segurança, mesmo em condições restritas, fora do cenário ideal dos estudos clínicos randomizados. / Brazil is a developing country struggling to reduce its extreme social inequality, which is reflected on shortage of health-care infrastructure, mainly to the low-income class, which depends exclusively on the public health system. In Brazil, less than 1% of stroke patients have access to intravenous thrombolysis in a stroke unit, and constraints to the development of mechanical thrombectomy in the public health system increase the social burden of stroke. Objective: Report the feasibility of mechanical thrombectomy as part of routine stroke care in a Brazilian public university hospital. Patients and methods: Prospective data were collected from all patients treated for acute ischemic stroke with mechanical thrombectomy from June 2011 to March 2016. Combined thrombectomy was performed in eligible patients for intravenous thrombolysis if they presented occlusion of large artery. For those patients ineligible for intravenous thrombolysis, primary thrombectomy was performed as long as there was no evidence of significant ischemia for anterior circulation stroke (Alberta Stroke Program Early CT score >6) within a 6-hour time window, and also for those patients with wake-up stroke or posterior circulation stroke, regardless of the time of symptoms onset. Results: A total of 161 patients were evaluated, resulting in an overall successful recanalization rate of 76% and symptomatic intracranial hemorrhage rate of 6.8%. At 3 months, 36% of the patients had modified Rankin Scale score less than or equal to 2. The overall mortality rate was 23%. Conclusion: Our study, the first ever large series of mechanical thrombectomy in Brazil, demonstrates acceptable efficacy and safety results, even under restricted conditions outside the ideal scenario of trial studies.