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

The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5-3.3), Barthel index (<60) (odds ratio, 3.8; 2.2-6.7), NIHSS (4.9; 1.7-14) and Rankin scale (>/=2) (3.4; 1.4-8.3). UTI was associated with Barthel index (1.9; 1.2-2.9), NIHSS (2.2; 1.2-4.0) and Rankin scale (3.1; 1.6-4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.
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PMID:Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial. 1469 88

It is not known whether all rehabilitation day-hospital patients need to be assessed for urinary tract infection (UTI). The aims of this study were to identify patients at high risk to develop UTI and to determine whether there was an association between the amount of post-void residual urine (PVR) and UTI. We surveyed 211 consecutive patients admitted to the day-hospital unit of a geriatric rehabilitation center between June 1998 and February 1999. The main diagnoses were stroke, orthopedic surgeries and deconditioning. Urine samples for general analysis and bacteriology were collected from each patient upon admission. PVR was measured using portable ultrasound. Telephone interviews were conducted with 141 patients, 3-11 months after the initial screening. The prevalence of UTI at admission was higher in women (P=0.007), and patients with decreased functional level (P=0.001). The incidence rate correlated with the functional level but not with gender or main diagnosis. The relative risk of dependent patients to develop UTI was 7.5 times higher than in independent patients. Significant amounts of PVR were equal in males and females. The relative risk of individuals with significant amounts of PVR to develop UTI was 1.63 times greater then those with negligible and moderate amounts of PVR. Gender, degree of functional level and main diagnosis had no effect on the relationship between PVR and UTI. We conclude that low functional level and significant amounts of PVR are risk factors for prevalence and incidence of UTI in elderly patients in a rehabilitation day-hospital. There is no need for routine urine analysis in every elderly patient admitted to rehabilitation day-hospitals, however, PVR measurements by portable ultrasound are valuable.
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PMID:Is routine screening for urinary tract infection in rehabilitation day-hospital elderly patients necessary? 1476 8

This study was designed to investigate the prevalence of risk factors, etiology, clinical course and outcome of the first-ever ischemic stroke in patients aged at least 85 when compared with younger patients with ischemic stroke. We studied 802 patients with first-ever ischemic stroke, including 103 patients at the age of 85 and more, and 699 patients at the age of 60-84. We collected data regarding the prevalence of risk factors, etiology of stroke, severity of neurological deficit and the presence of consciousness disturbances. The major complications were registered and the infarction volume was assessed using computed tomography. Mortality and functional status of the survivors were assessed on the 30th and 90th day after stroke using Barthel Index. Very old patients with ischemic stroke were characterized by greater percentage of women and higher frequency of ischemic heart disease; diabetes, obesity and smoking were all noted less frequently in this group. Very elderly subjects presented more frequently with TACI syndrome (24.3% and 14.6%, respectively; p < 0.05). They had greater neurological deficit in all days of assessment and were more likely to have the consciousness disorders on admission (39% and 22.3%, respectively; p < 0.001). Urinary tract infection was the only major complication more frequently seen in very old subjects (53.4% and 35.3%, respectively; p < 0.05). The studied groups did not differ regarding etiology of stroke, the length of hospital stay and the incidence of other complications. 30th and 90th-day mortality was greater among very elderly subjects (28.1% vs 16.4% and 46.6% vs 24.6%, respectively; both p < 0.05). The disability assessed 30 and 90 days after stroke was also much greater in very old patients. Very old patients with first ischemic stroke have greater neurological deficit, worse functional status and greater mortality after stroke. They are more likely to have ischemic heart disease and less likely to have diabetes or obesity. The causes of stroke, incidence of complications (with the exception of urinary tact infections), size of the lesion and length of hospital stay are similar in very old and younger patients with stroke.
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PMID:[First ischemic stroke in the very old: etiology, clinical course and outcome]. 1497 42

In Malaysia, there is limited information on the mortality and morbidity after an acute stroke in hospitalised patients. The objective of the study was to identify the type, time of onset, and frequency of medical and neurological complications following an acute ischaemic stroke. Consecutive patients with acute ischaemic stroke who were admitted to Hospital Universiti Kebangsaan Malaysia from June 2000 to January 2001 were observed. The complication rate was 20.9%. The most common individual complication was pneumonia (12.3%), followed by septicaemia (11.0%), urinary tract infection (4.3%), and upper gastrointestinal haemorrhage (3.7%). The overall mean length of stay was 7.48 days. The independent risk factors for complications were diabetes mellitus (OR 2.87; 95%CI 1.06 to 7.78), middle cerebral artery (MCA) infarcts (OR 10.0; 95%CI 4.1 to 24.3), and Glasgow coma score (GCS) less than 9(OR 3.8; 95%CI 1.03 to 14.3). Infection was the commonest complication observed. Patients with diabetes mellitus, poor GCS and large MCA infarcts had a higher risk of developing complications.
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PMID:Risk factors and complications of acute ischaemic stroke patients at Hospital Universiti Kebangsaan Malaysia (HUKM). 1519 Jun 24

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

Little is known about the hospital inpatient care of patients with idiopathic Parkinson's disease (PD). Here, we describe the features of the emergency hospital admissions of a geographically defined population of PD patients over a 4-year period. Patients with PD were identified from a database for a Parkinson's disease service in a district general hospital with a drainage population of approximately 180,000. All admissions of this patient subgroup to local hospitals were found from the computer administration system. Two clinicians experienced in both general medicine and PD then reviewed the notes to identify reasons for admission. Admission sources and discharge destinations were recorded. Data regarding non-PD patients was compared to PD patients on the same elderly care ward over the same time period. The total number of patients exposed to analysis was 367. There was a total exposure of 775.8 years and a mean duration of 2.11 years per patient. There were 246 emergency admissions to the hospital with a total duration of stay of 4,257 days (mean, 17.3 days). These days were accounted for by 129 patients (mean age, 78 years; 48% male). PD was first diagnosed during 12 (4.9%) of the admissions. The most common reasons for admission were as follows: falls (n=44, 14%), pneumonia (n=37, 11%), urinary tract infection (n=28, 9%), reduced mobility (n=27, 8%), psychiatric (n=26, 8%), angina (n=21, 6%), heart failure (n=20, 6%), fracture (n=14, 4%), orthostatic hypotension (n=13, 4%), surgical (n=13, 4%), upper gastrointestinal bleed (n=10, 3%), stroke/transient ischemic attack (n=8, 2%), and myocardial infarction (n=7, 2%). The mean length of stay for the PD patients on the care of elderly ward specializing in PD care was 21.3 days compared to 17.8 days for non-PD patients. After hospital admission, there was a reduction in those who returned to their own home from 179 to 163 and there was an increase in those requiring nursing home care from 37 to 52. Infections, cardiovascular diseases, falls, reduced mobility, and psychiatric complications accounted for the majority of admissions. By better understanding the way people with PD use hospital services, we may improve quality of care and perhaps prevent some inpatient stays and care-home placements.
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PMID:Emergency hospital admissions in idiopathic Parkinson's disease. 1588 38

Interventions designed to effectively implement and disseminate clinical practice guidelines (CPG) fall into different categories. A systematic review of the effectiveness and costs of different guideline development, dissemination and implementation strategies was recently undertaken by the Health Technology Assessment (HTA) Programme in UK. Overall, the majority of comparisons reporting dichotomous process data observed improvement in care. However, there was considerable variation in the observed effects both within and across interventions. Evaluation studies provided evidence that adherence of physicians to CPG is a strong predictor of the stroke outcome. Cochrane Collaboration performed a systematic review including studies published up to 2004 that compared integrated clinical pathways (ICP) for stroke care with standard medical care. They found no significant difference between ICP and control groups in terms of death or discharge destination. Patients managed with a care pathway were more dependent at discharge, less likely to suffer a urinary tract infection, less likely to be readmitted and more likely to have neuroimaging. A positive effect was reported from a validation study of a multifaceted strategy for stroke care ICP implementation in Italy.
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PMID:Strategies for dissemination and implementation of guidelines. 1675 55

Many diseases have multifactorial origins. There is increasing evidence that mild dehydration plays a role in the development of various morbidities. In this review, effects of hydration status on acute and chronic diseases are depicted (excluding the acute effects of mild dehydration on exercise performance, wellness, cognitive function, and mental performance) and categorized according to four categories of evidence (I-IV). Avoidance of a high fluid intake as a precautionary measure may be indicated in patients with cardiovascular disorders, pronounced chronic renal failure (III), hypoalbuminemia, endocrinopathies, or in tumor patients with cisplatin therapy (IIb) and menace of water intoxication. Acute systemic mild hypohydration or dehydration may be a pathogenic factor in oligohydramnios (IIa), prolonged labor (IIa), cystic fibrosis (III), hypertonic dehydration (III), and renal toxicity of xenobiotica (Ib). Maintaining good hydration status has been shown to positively affect urolithiasis (Ib) and may be beneficial in treating urinary tract infection (IIb), constipation (III), hypertension (III), venous thromboembolism (III), fatal coronary heart disease (III), stroke (III), dental disease (IV), hyperosmolar hyperglycemic diabetic ketoacidosis (IIb), gallstone disease (III), mitral valve prolapse (IIb), and glaucoma (III). Local mild hypohydration or dehydration may play a critical role in the pathogenesis of several broncho-pulmonary disorders like exercise asthma (IIb) or cystic fibrosis (Ib). In bladder and colon cancers, the evidence on hydration status' effects is inconsistent.
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PMID:Hydration and disease. 1792 62

Dutch GP's (General Practitioners) take care of people living in homes for the elderly. The population of these homes is selected on the basis of poor functioning on ADL (activities of daily living). We expected to find a group of elderly people within these homes that need more complex primary care. We describe the characteristics of care for an institutionalized elderly population and compare these to the care provided to their independently living peers. The design of this study is a matched case-control study in a Dutch General Practice in the study period 1/1/1998 to 1/7/2004. Our main results show that the rate of cognitive problems is two times, the prevalence of depression even three times higher in older people living in a home for the elderly than in those who live independently. Locomotory problems are a frequent problem in homes for the elderly. Rates of chronic pulmonary problems, atherosclerosis-related diseases and urinary tract infection are higher, whereas no significant differences for CVA, diabetes and cancer were found. Institutionalized older patients use more different types of medication. GP's do not have more contacts with people living in a home for the elderly than with older people living independently. We conclude that people living in homes for the elderly have complex problems, and need special attention for their specific vulnerability. Differences in care are not primarily explained by chronic disease but by problems with mobility, confusion, depression and cognition.
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PMID:[Primary care in homes for the elderly]. 1863 98

This article presents the case of a victim of cerebral vascular accident with long duration of urinary catheterization, who developed a purple urine bag syndrome (PUBS) because of deficiency of knowledge and skills in home care and lack of communication and support among family members. In this case, the main caregivers also experienced psychophysical fatigue and fear, which diminished family coping ability. During the period of nursing care, from March 10 to August 15, 2006, we carried out 10 home care visits and eight telephone consultations. Exiting urinary tract infection, constipation, and compromised coping and ineffective family were identified as the three main nursing care issues. As we successfully instilled trust and developed a positive relationship with the patient, we provided continuous and comprehensive nursing care to resolve the PUBS issue her which was causing her anxiety, and her constipation, as well as stabilizing her family function. Consequently, through this care experience involving a sick elderly patient, we promoted the function of nursing home care. From this case intervention, we found that health education should be closely followed up in order to maintain its effectiveness. Insufficient communication skills, however, were identified through meetings with the patient's family. We suggested related family communication skills and practices should be included in clinical nursing training courses to enhance skills in dealing with family issues and life quality among patients and their families.
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PMID:[An experience providing home care to a victim of cerebral vascular accident and purple urine bag syndrome]. 1866 88


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