In Saskatchewan, stroke is the third leading cause of death as well was the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary (or recurrent) stroke. Despite this knowledge, secondary stroke prevention is often overlooked in the care of stroke/TIA patients. With the vision of decreasing the incidence and impact of stroke in Saskatchewan, the Saskatchewan Integrated Stroke Strategy (SISS) was recently implemented. The purpose of this study is to begin the development of an evaluation measurement system for the SISS based on the guidelines and measures from the Canadian Stroke Strategy (CSS) specifically pertaining to secondary stroke prevention.<p> This multi-year cross-sectional study is an analysis of de-identified health data derived from linkage of administrative and laboratory data. Select indicators from the CSS Performance Measurement Manual involving medications use for secondary stroke prevention (antihypertensives, antilipidemics, anticoagulants) and intermediate health outcomes (serum LDL cholesterol, INR) are calculated. Regression is used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended secondary stroke prevention. The target population is Saskatchewan residents who have been hospitalized for a stroke or TIA between April 1, 2001 and March 31, 2008.<p> The results of this study indicated that secondary stroke prevention in Saskatchewan is sub-optimal in the management of hypertension, dyslipidemia, and atrial fibrillation. Although there has been some improvement over the time period, a significant number of patients are not taking the recommended medications at discharge from acute care. Similarly, a considerable number of patients are not receiving the appropriate laboratory tests within the year following their stroke event. Through regression analysis it was revealed that a number of correlates (ie. age, income, on medication before the stroke event) were significantly associated with receiving these specific elements of secondary stroke prevention, suggesting potential differences in provision of care. Finally, regional differences in secondary stroke prevention were found for a number of the outcomes, which may indicate differences in care throughout the province.<p> The findings of this study serve as a baseline for evaluation of the impact of the Saskatchewan Integrated Stroke Strategy in the area of secondary stroke prevention. The results make apparent the fact that secondary stroke prevention in Saskatchewan can be improved, and that there is much opportunity for future research in this area.

Bakgrund: Stroke drabbar 30000 personer årligen och cirka 12000 får afasi till följd av stroke. Vid afasi blir den verbala kommunikationen bristfällig. Detta kan leda till försvårad kommunikationsmöjlighet mellan patienten och sjuksköterskan. Syfte: Syftet med studien var att belysa olika sätt att underlätta kommunikationen i vårdsituationer för patienter som har drabbats av expressiv afasi till följd av en stroke. Metod: En systematisk litteraturstudie baserad på åtta vetenskapliga artiklar, där sökningar gjordes i Cinahl, PubMed och PsycINFO. Artiklarna var etiskt granskade och kvalitetsgranskades utifrån en modifierad granskningsmall av Forsberg &amp; Wengström (2008). Analysen gjordes utifrån Lundman och Hällgren- Graneheims (2008) kvalitativa innehållsanalys. Resultat: Analysen resulterade i tre teman; kontaktskapande, trygghet och språkrehabilitering. I temat kontaktskapande framkom det att beröring, kroppsspråk, avsätta tid, och accepterande inställning var av stor vikt. I temat trygghet visade sig uppmuntran, stärka självkänsla, utveckla förtroende vara av betydelse, och i temat språkrehabilitering framkom att melodisk sång, rytmiskt tal samt familjens delaktighet i träningen. Slutsats: Studien visar på flera olika sätt att skapa en god kommunikation och förståelse mellan patient och sjuksköterska. På grund av afasin kan det vara svårt att få reda på patientens vilja och det gäller att ge patienten tid att kommunicera så att vården inte bedrivs mot patientens vilja, med risk att skapa ett onödigt lidande. Det är av stor vikt att sjuksköterskan kan hjälpa patienten med rehabiliteringen och hitta sätt som underlättar patientens kommunikationsförmåga.

Syfte: Syftet med litteraturstudien var att belysa vuxna anhörigas upplevelser av livet efter att en närstående drabbats av stroke och fått bestående funktionshinder. Metod: Studien genomfördes som en litteraturstudie, 16 vetenskapliga artiklar granskades och sammanställdes sedan utifrån perspektiven fysiskt, psykiskt och socialt. Huvudresultat: Litteraturstudiens resultat visar att anhöriga till strokedrabbade påverkades ur ett fysiskt, psykiskt och socialt perspektiv. De kände sig utmattade till följd av det ökade ansvaret som stroken förde med sig. Deras liv vändes upp och ner och många var missnöjda med vården och dess bemötande. Anhöriga upplevde brist på information och kände att de saknade kunskap om området. Känslor som oro, frustration, sorg, nedstämdhet och skuldkänslor beskrevs. De anhöriga kände sig tvingade att hålla tillbaka sina känslor och de uppgav att stöd från familj, vänner och personal var viktigt och gav dem styrka. Kvinnliga anhöriga visade sig vara mer utsatta än manliga. Anhöriga kände tacksamhet för att den strokedrabbade överlevt. De upplevde brist på egentid, stagnerade framtidsplaner och många kände sig socialt isolerade. De förändrade rollerna som stroken innebar upplevdes som påfrestande. Slutsats: Kunskap om hur anhöriga upplever livet efter en närståendes stroke kan ge vägledning i sjuksköterskans arbete med att stödja och informera anhöriga. / Purpose: The purpose of this study was to illuminate the adult relatives experiences of life after a close person suffered a stroke and become permanently disabled. Method: The study was conducted as a literature review, 16 research articles were examined and then compiled from a physically, mentally and socially perspective. Main results: The literature study shows that relatives of stroke survivors were affected from a physical, mental and social perspective. They felt fatigued as a result of the increased responsibility that the stroke resulted in. Their lives were turned upside down and many were dissatisfied with the care and treatment. Family members felt a lack of information and felt they lacked knowledge of the area. Feelings of anxiety, frustration, grief, depression and guilt were described. The relatives felt compelled to hold back their emotions and they indicated that support from family, friends and staff was important and gave them strength. Female relatives were found to be more vulnerable than male relatives. Relatives felt gratitude for the survival of the stroke victim. They experienced lack of own time, stagnated plans of the future and experienced being socially isolated. The changed roles was experienced as stressful. Conclusion: Knowledge about how family members experience life after a stroke of a close one, may give guidance to the nurse in the work of supporting and informing relatives.

Bakgrund: Närstående har en betydelsefull roll och får ta ett stort ansvar när någon nära drabbats av stroke. Det är inte ovanligt att livet förändras för alltid och närstående hamnar i en krissituation. Professionell hjälp och stöd till närstående under sjukhusvistelse är en viktig del i sjukvården. Syfte: Syftet var att belysa närståendes upplevelser av stöd från sjukvårdspersonal efter att en nära person drabbats av stroke. Metod: En systematisk litteraturstudie utfördes. Totalt tretton artiklar inkluderades i resultatet, tio kvalitativa och tre kvantitativa. Artiklarna kvalitetsgranskades med hjälp av granskningsmallar för kvalitativa respektive kvantitativa artiklar. Analysen inspirerades av en metod för innehållsanalys som genomfördes i sju steg vilket resulterade i två kategorier och fjorton underkategorier. Resultat: Närståendes upplevelser av stöd resulterade i kategorierna: upplevelser av stöd och upplevelser av otillräckligt stöd som omfattades av underkategorierna; trygghet, förnöjsamhet, tillit till information, att bli sedd, okunnighet, utelämnande, att bli tagen för givet, maktlöshet, ensamhet, osynlighet, otillräcklighet och upp till mig själv gällande rollen. Slutsats: Det är inte självklart att närstående får det stöd de önskar i sjukvården. Viktigt är dock för närstående att få känna samhörighet, delaktighet och vara en del i sammanhanget vilket främjar närståendes relation till sjukvården.

Syftet med studien var att beskriva hur personer som har drabbats av stroke upplever sin livskvalitet samt vilka faktorer som associeras med livskvalitet. Designen var en beskrivande litteraturstudie och litteratur söktes i databaserna Medline (via PubMed) och Cinahl. Efter urvalet återstod 15 artiklar som inkluderades i studien. Artiklarna granskades och fyra huvudkategorier kunde utrönas: livskvalitet efter stroke, fysiska, psykiska och sociala faktorer som associeras med livskvalitet. Resultatet visade att personer som har drabbats av stroke ofta uppvisar sänkt livskvalitet. Fysiska faktorer av betydelse var försämrade kroppsfunktioner och kognitiv nedsättning. Äldre personer och kvinnor skattade ofta sin livskvalitet lägre jämfört med yngre och män. Den viktigaste psykiska faktorn var depression. En social faktor av betydelse för sänkt livskvalitet var minskat socialt deltagande. Slutsatsen med studien var att kunskap kring hur personer som har drabbats av stroke upplever sin livskvalitet och vilka faktorer som associeras med livskvalitet kan ge vägledning för vilken typ av stöd och rehabilitering som behövs. / The purpose of the study was to describe how persons who have had a stroke experience their quality of life and which factors are associated with quality of life. The design was a descriptive literature study and literature was sought in the databases Medline (via PubMed) and Cinahl. After the selection a sample of 15 articles was included in the study. The articles were reviewed and four main categories were found: quality of life post stroke, physical, psychological or social factors associated with quality of life. The result showed that persons who had a stroke often show decreased quality of life. Physical factors of importance were impaired body functions and decreased cognitive function. Older persons and women often measured their quality of life as lower compared to younger persons and men. The most important psychological factor was depression. A social factor of importance related to reduced quality of life was decreased social participation. The conclusion of the study was that knowledge about how persons who had a stroke experience their quality of life and which factors are associated with quality of life could give guidance for what kind of support and rehabilitation is needed.

No description available.

No description available.

Abstract Stroke is a potentially lethal cerebrovascular event. Many research studies devoted to the treatment of stroke. In a recent study, sphingosine-1-phosphate (S1P) has the function of reducing the brain infarct volume. However, no study has yet demonstrated that lysophosphatidic acid (LPA) has this function. LPA and S1P are thought to be the two functionally important LPLs with high structural similarity. Although the neuroprotective function of S1P in TIA rat was confirmed, the effects of LPA on the brain damage after ischemic stroke of animal remain unclear. In this study we evaluated the neuroprotective effects of LPA1/3 receptor agonist (VPC31143; VPC) on rat brains subjecting to permanent middle cerebral artery occlusion (PMCAO). A reliable surgical model of rat PMCAO was first established. Thereafter, the animals were divided into control, vehicle, high-dose VPC, and low-dose VPC groups. The vehicle group received intraperitoneal (i.p.) injection of 3% bovine serum albumin (BSA; 1 ml/kg) 30 minutes after PMCAO surgery. The high-dose VPC and the low-dose VPC group respectively received 0.8 mg/kg and 0.25 mg/kg of i.p. injection of VPC (in 3% BSA) 30 minutes after PMCAO surgery. The mortality rate, infarct volume ratio, and the neurobehavioral outcome were measured 24 hours after PMCAO and statistically analyzed for the difference between treatments. Analyses of the experimental results showed that VPC treatment significantly reduced the mortality rate and the infarct volume ratio of the rats 24 hours after PMCAO. The neurobehavioral scores also showed the improved outcome in stroke rats treated with VPC. The beneficial effect of VPC to the ischemic brain was thought to be mediated through the PI3K signal transduction pathway. Further studies at the transcriptional and the translational levels will further confirm this postulation.

Objective¡G The purpose of this research is to explore the influences of the global budget implementation on the older stroke patient's outcome and medical quality. In further analysis, this study compared the differences of the older stroke patient's rehospitalization and complication across age groups, genders, regions, and the hospital¡¦s characters. Analysis of the real extent of the Global budget policy on the readmission of patients was focused on stroke-related outcomes and costs. This study also reviewed the Global budget policy on whether it has effective control of medical resources, and measured its impact on medical care of patients, thus to control costs and improve quality of care. Method¡G The data were derived from the National Health Insurance database and the Taiwan census data. The study periods were 1999-2000 and 2004-2005. In this research, descriptive analysis was used to examine the older stroke patient's outcome and medical quality. T -test and chi-square was used to investigate the outcome and medical quality differences between medical institutions and personal characteristics. Logistic regression and linear regression model were used to detect and describes data trends. Results: Regarding Taiwan's overall four years of the older stroke patient's rehospitalization and complication, the status of infection and medical expenses showed significant growth trend after the Global budget policy implementation. For the medical institutions characteristics, the infection status of the non-for-profit hospital, medical center hospital, district hospital, teaching and non-teaching hospital were showing significant growth. For the personal characteristics, the infection status of male, female, aged 70-74, south and east regional were with significant growth. Conclusion¡G According to the study results, we found that the Global budget policy implemented in Taiwan was still need to be improved. We suggest the policy makers and the hospitals may use the ¡uGlobal budget policy implemented¡vas an indicator to monitor the quality of care and the outpatient care quality in Taiwan¡¦s healthcare system. Thus not only can reduce the unnecessary expenditure, but also can offer the general public better quality of healthcare and improve their quality of life.

Previous literature has shown that depression is the most common major emotional result following a stroke. Although the prevalence and severity of this issue have been well documented, limited research has been done to identify the evolution of post-stroke depressive symptoms in the acute phase following a stroke. During this period of time, the patient is faced with a number of significant changes from his / her previous level of functioning. These issues can include loss of physical functioning, loss of independence, changes in living arrangements, and an increased reliance on the support and care of others. The purpose of the current study was to examine fluctuations in depressive symptoms as each participant progressed through rehabilitation and discharge, and to gather qualitative information pertaining to the contributing factors that could play a role in this issue. A sample of nine participants between the ages of 50 and 85 was obtained from a regional rehabilitation unit. Data and clinical information were collected using an intensive case study design. Participants were asked to complete the Geriatric Depression Scale (GDS) at three-day intervals while on the rehabilitation unit and following discharge. This information was interpreted in the context of qualitative information gathered through reports from the participant, his or her significant other / family member, nursing and professional staff members on the rehabilitation unit, and patient records. Other analyses performed included an examination of the interactions between performance and motivation during the rehabilitation process and role of discharge site in the development and course of depressive symptoms. When examined as a whole, the information collected across all nine participants would suggest that following discharge there was a statistically significant increase in the level of post-stroke depressive symptoms. While the individuals were on the rehabilitation unit, the depressive symptoms decreased significantly and this trend continued following discharge, but the slope was not as significant as that which was observed on the rehabilitation unit. The results also suggested that there is a significant difference between the progression of depressive symptoms between groups separated based on discharge site.