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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Socio-economic background, functional status, multiple pathology and medical conditions requiring care have been evaluated in 506 elderly subjects living in nursing homes in Turin (Italy). In the sample 78.8% are women, mean age 84.2 years, only 21.2% are men, mean age 76.3 years. Particularly in the oldest age classes women are more represented than men. Most subjects (94.3%) require help in at least one Activity of Daily Living (ADL). Part of the sample (21.2%) comes from home, 13.2% from acute wards, 9.1% from long term care wards, 6.3% from mental hospitals, 26.3% from residential homes. Education level is rather low. Before retirement, many men were workmen (38.3%), while many women were housewives (46.6%). Multiple pathology is very common: 23.7% of patients suffer from 4 pathologies, more than 5 diseases are present in 18.8%, while only 4.7% of subjects have less than two pathologies. Half of the sample (52.6%) is affected by dementia, 37.6% by cardiovascular diseases, 29.1% by chronic obstructive lung disease and 25.5% by stroke. Bone fractures are present in 22.1% of the subjects. Severe impairments in strength and/or motility in at least two limbs affect 43.7% of patients, double incontinence 49.2%, severe disturbances in speech and communication 35.4%. The prevalence of care needs is higher in women compared with men. More females than males need aid in walking, help in eating, diapers, pressure sores prevention and bedposts.
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PMID:Health and functional status in elderly patients living in nursing homes. 1537 2

The purpose of this paper is to assess the morbidity, mortality, and clinical outcome of simultaneous bilateral total knee arthroplasty. We reviewed 4100 simultaneous bilateral total knee replacements. The knees were subjected to two Kaplan-Meier survival analyses, with failure equal to revision for aseptic loosening and failure equal to patient death. Complications and Knee Society scores were considered. The average Knee Society knee score was 90 points 3 years postoperatively and 87 points 10 years postoperatively. The complication rates were as follows: deep infection (0.8%), superficial infection (0.3%), cardiac (6 arrhythmia, 5 congestive heart failure, 1 cardiac insufficiency, 3 complete heart block, 2 myocardial infarction and cardiac arrest, and 14 myocardial infarction only) (1.5%), intestinal ileus (0.5%), gastrointestinal ulcer (0.4%), thrombophlebitis (0.9%), cerebrovascular accident (0.3%), and urinary (1 BPH-obstruction, 4 renal failure, 2 transurethral resection of the prostate, 16 urinary tract infection, and 2 urinary retention/incontinence) (1.2%). The 10-year prosthesis survival probability was 98.3%. The 10-year patient survival probability was 78.6%. Twenty-five (1.2%) patients died within the first postoperative year. The patients who died within 1 year postoperatively were older than the rest of the group. Higher age and male gender were factors related to increased mortality. The complication rates and clinical outcomes were similar to unilateral total knee arthroplasty. With regard to death early in the postoperative course, simultaneous bilateral total knee arthroplasty may pose a greater risk to the patient than a unilateral procedure. However, the early deaths may be related to older age at the time of surgery.
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PMID:Debate: simultaneous bilateral knee replacements: the outcomes justify its use. 1553 24

The patient discussed in this care study is a 91-year-old woman admitted to hospital from her own home. She presented with reduced mobility, constipation, increased confusion and reduced oral intake. Her history included small vessel disease and a stroke. On admissions she also had a number of grade two pressure ulcers on her buttocks. The surrounding skin appeared macerated and the patient complained of pain when the skin was cleaned after she was incontinent of both urine and faeces. It was expected that the wound would be fast healing, as it was superficial, but the healing rate proved otherwise. This article will focus on incontinence management as well as ways of aiding in healing a pressure ulcer where skin is macerated and the patient has many risk factors.
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PMID:Managing and caring for a patient with a complicated wound. 1556 99

Incontinence is common following stroke, but there is little stroke-specific evidence to guide treatment and interventions for this condition. National clinical guidelines for stroke specify that all wards should have management protocols for urinary incontinence and yet, according to the recent Sentinel Stroke Audit result, many wards do not have this information available. This article describes the implementation of guidelines on a stroke unit within an NHS associate teaching hospital and describes the impact on patient care using clinical audit. The results indicate that patient care and outcome is improved following implementation. Recommendations are being made for information sharing and further research.
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PMID:The use of practice guidelines for urinary incontinence following stroke. 1558 84

The medical analysis of illnesses and causes of death of Serbian rulers in the Middle-Ages, is difficult. Only a tentative diagnosis can be made. In addition to their religious character old Serbian biographies offer many information; they are, however, often insufficient and fragmentary. While the true state of health of Serbian rulers cannot be known, there are some descriptions and documents useful for such attempts. Stroke was presumed to be the cause of death of some Serbian medieval rulers. According to his biographers, Teodosije and Domentian, King Stefan Prvovenchani (First-Crowned) (1217-1228) had two apoplectic accidents. When the first stroke occurred, he was paralytic, bedridden and loozing his general strenght. According to St. Sava he very well recovered after the first stroke. The second stroke, in the near future, was fatal. Some authors supposed the abuse as ethyl that impaired his health. King Stefan Urosh II Milutin (1282-1321) died as a seventy years old man. His biographer, Archbishop of Petsh, Danilo II wrote about a sudden onset of the disease. King Milutin was paralyzed and aphasic. In the terminal stage, he was unconscious and insensible. Preceding stresses may be an aetiological factor. According to Constantine the Philosopher, biographer of despot Stefan Lazarevitsh (1402-1427), this ruler died when he was 53 years old. The onset of the disease was sudden. Despot showed motor weakness, dyscoordinated movements, disordered balance and sensorium, speaking disturbances, and paralysis. He died in coma next morning, on July 18, 1427. This clinical feature suggests possible cerebro-vascular insult. It is not clear whether the existing rheumatic disease played a certain role in the aetiolotgy of stroke in this case. Some data suggested the emotional lability and incontinence as warning symptoms.
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PMID:[Stroke as a probable cause of death in some Serbian medieval rulers]. 1629 49

The psychopathology of stroke encompasses several psychiatric and behavioral disorders that have high prevalence in the geriatric population, reduce the patient autonomy and increase the caregiver's burden. These disorders are usually associated with other cognitive and neurological deficits, and are labelled as neuropsychiatric when the whole clinical picture is consistent with the specific dysfunction of a neural system or brain region. Thus the neuropsychiatry of stroke comprises disorders of the perception/identification of the self and the environment (anosognosia of hemiplegia, misidentification syndromes, confabulations, visual hallucinations, delirium and acute confusional state), amotivational syndromes (apathy and athymhormia), disorders of emotional reactivity (blunted affect, emotional incontinence, irritability, catastrophic reactions), poor impulse or ideation control (mania) and personality changes. The clinical profile of the subcortical vascular dementia also points to specific brain dysfunction (frontal-subcortical pathways) that manifests with behavioral (depression, emotionalism, irritability) and cognitive symptoms (psychomotor retardation, attention, executive and memory deficits). However, post-stroke depression and anxiety, which have a more variable clinical presentation and might be assimilated, for several aspects, to post-traumatic or adaptive disorders, are disorders less characterized in their neural correlates.
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PMID:[Psychopathology of stroke]. 1631 15

The aim of this study was to evaluate the long-lasting effect of pelvic floor muscle training (PFMT) in women with urinary incontinence after stroke measured by quality of life parameters. Twenty-four (24/24) women with urinary incontinence after stroke, who had completed a prospective, randomised controlled and single-blinded trial evaluating the effect of 12 weeks PFMT, were included in this follow-up study. The follow-up assessments were done by telephone interview 6 months after the intervention. The effect was evaluated by The Short Form 36 (SF-36) Health Survey Questionnaire and Incontinence Impact Questionnaire (IIQ). Twenty-four subjects completed the study. In the treatment group, the SF-36 showed a trend to a long-lasting effect in one of the eight domains and the IIQ showed a tendency to decreased impact of UI in two sub-scales compared to the control group. Our data indicated that PFMT may have a long-lasting effect measured by quality of life parameters.
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PMID:Is there a long-lasting effect of pelvic floor muscle training in women with urinary incontinence after ischemic stroke? A 6-month follow-up study. 1667 51

Incontinence is a discrediting and stigmatising condition for those who experience it, as it signifies a person who is lacking in self-control. For their carers, the very nature of undertaking 'dirty work' signifies a low status and low paid job. Those health care professionals higher in status and financial reward put distance between themselves and bodywork, especially bodywork that deals with bodily decay. However, little is known or has been highlighted about the social consequences that living with and dealing with incontinence can have on informal carers. In this paper we examine the notion of dirty work and 'unbounded' bodies in the role of informal carers. Through qualitative interviews with carers of stroke survivors the negative social consequences of dealing with incontinence for both the survivor and the carer are explored. We also examine the strategies employed by carers and stroke survivors in order to manage the symptom in an attempt to prove the adult status of the survivor and to protect both the identity of the survivor and the carer. The embarrassment of leakage and the moral danger of odour can lead some carers and survivors to make decisions that can isolate both within the confines of their home. In this sense the very meaning of home is transformed into an isolated and marginalised space.
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PMID:The social consequences of living with and dealing with incontinence--a carers perspective. 1836 34

We have studied the recovery of walking ability on being discharged from a department of physical medicine and rehabilitation in patients with hemiplegia after stroke, and the factors influencing this recovery. This prospective study was based on 93 patients. The patients, who were considered to be ambulatory, were able to move 10 metres on their own or with supervision when they were discharged. The potentially influential factors studied were: age, the aetiology and the side of hemiplegia, co-morbidity, the delay in starting rehabilitation, the neurological damage evaluated by the middle cerebral artery scale of Orgogozo, the initial functional damage evaluated by the functional score carried out within the scale of Functional Independence Measure (FIM), the existence of aphasia, of a depressive or hemineglect syndrome, presence of superficial or profound sensory disorders, incontinence at the start of rehabilitation and at one month after stroke, the existence of cognitive or psychiatric disorders. The non-parametric Mann-Whitney, the chi2, and the correlation test were used. The threshold of significance was .05. Based on 93 patients (47 women and 46 men, average age 64.8) 87.1% were walking at discharge, on average 3 months after stroke. The predictive factors or those linked to an absence of recovery were the presence of superficial sensory disorders, the initial neurological damage, the initial functional damage, the presence of a depressive syndrome, and urinary incontinence. We stress the significance of the sensorimotor and initial functional damage, and of incontinence in establishing a prognosis for recovery of walking ability, in order to decide the objectives and the rehabilitative treatment for each patient.
J Stroke Cerebrovasc Dis
PMID:Prognostic factors in the recovery of the ability to walk after stroke. 1790 95

A significant proportion of stroke survivors suffer from persistent and significant fatigue which is linked to reduced independence and case fatality. Despite its high prevalence and detrimental effects, studies of post-stroke fatigue (PSF) interventions are scarce. Only one randomised controlled trial of post-stroke fatigue treatment (i.e. fluoxetine) was identified, and though improving post-stroke emotional incontinence and depression in patients with fatigue this did not improve PSF itself. Despite there being no literature on its efficacy, patient and family education/counselling has been identified as an important rehabilitation intervention for the management of stroke-related fatigue, which has been found effective in other patient groups (i.e. cancer, multiple sclerosis, and those with traumatic brain injury). Factors contributing to the lack of evidence for PSF management are identified and it is concluded that there is a need to better differentiate those most likely to suffer PSF, to validate existing assessments of fatigue, and to evaluate the efficacy of fatigue management and treatment strategies in stroke survivors.
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PMID:Post stroke fatigue--where is the evidence to guide practice? 1797 87


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