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

The hospital mortality rate for stroke patients is now approximately 20%. Those who survive stroke are discharged to home disabled and the responsibility for providing adequate care to the patient has fallen primarily on family members. Maintaining the patients in the community may be ideal but it is not without cost. Although it is known that the role of family is critical to stroke rehabilitation, relatively few studies have examined caregiving within context of stroke, and nursing care is still limited to the patients ignoring family caregivers. Therefore, this study using grounded theory method was carried out to explore and explain the experiences of family caregivers from the time of the incidence throughout the course of stroke. The informants of the study were 24 family caregivers caring for the patients with stroke at hospitals or their homes. The study was conducted from March through August, 1992. Data were collected through in-depth interviews, telephone interviews and participant observation. Data collection and analysis were conducted concurrently allowing theoretical sampling and facilitating hypotheses to evolve. According to the results, caregiving has been associated with a range of negative experiences including emotional crisis, physical discomfort, guilty feeling, anxiety, feeling of social isolation, depression, hopelessness, and financial difficulties. Caregiving activities, commitment, recovery pattern accounted for the experiences of family caregivers, and the experiences varied according to the phases of the patient's recovery. The experiences of family caregivers are; emotional crisis upon a sudden occurrence of stroke; physical discomforts during hospitalization and the period the patients need an assistance with bathroom; feeling of social isolation beginning after discharge; and depression, hopelessness thereafter. Anxiety regarding the recurrence of stroke and the patient's prognosis was intensified with the patient's discharge to home. Guilty feeling was related to the caregiver's perceived role inadequacy. The type of relationship between caregiver and patient, sex of caregiver, and caregiver's financial status correlated to the experiences of family caregivers. Considering all the factors being related to such experiences as mentioned above, the following hypothesis were evolved. (1) The family caregivers who perceive that the patient's recovery has not reached their expectation feel higher level of anxiety. (2) Daughters-in-law feel the caregiving experiences more negative than spouses or adult-children. (3) Unmarried adult-children and daughters-in-law feel more of social isolation, depression, and hopelessness when the period of caregiving lasts longer. (4) Family caregivers who are male and self-supportive receive higher family support and feel the caregiving experiences less negatively.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Experience of family caregivers caring for patients with stroke]. 795 84

Recent randomized studies have demonstrated that percutaneous transvenous mitral commissurotomy (PTMC) has similar efficacy compared to surgical commissurotomy. Compared with surgery, PTMC is associated with shorter hospital stays, reduced patient discomfort, and significantly lower costs. The challenge of PTMC remains to provide increased safety. The most serious risks of balloon commissurotomy include cardiac perforation and embolic stroke. The creation of severe mitral regurgitation also limits the effectiveness of the procedure and occasionally leads to the requirement for emergency mitral valve replacement. Since 1986, procedure-related mortality has ranged from 0-2.7% with lower mortality rates reported recently. The most frequent cause of procedure-related death has been left ventricular (LV) perforation. This is almost exclusively a complication associated with the double balloon technique, which requires LV guidewires. Cardiac perforation due to inadvertent atrial perforation during transseptal catheterization may occur with the Inoue technique as well, but this tends to be less severe and has not resulted in death. Embolic stroke has occurred in 1.1-5.4% of cases. The incidence of embolic events has been favorably influenced by routine preprocedure transesophageal echocardiography (TEE), eliminating patients with left atrial thrombi. Significant mitral regurgitation occurs in 3.3-10.5% of patients undergoing balloon mitral commissurotomy. Fortunately, mitral regurgitation infrequently requires emergency surgery (0.3-3.3% of cases). Iatrogenic atrial septal defects are usually of no clinical consequence. Their frequency has been reduced with the use of the Inoue balloon catheter system and they rarely require surgical repair.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Complications related to percutaneous transvenous mitral commissurotomy. 799 42

Routine questioning may be inadequate to identify angina pectoris or prolonged discomfort due to myocardial ischemia. The clinician must ask patients if they have had any unpleasant sensations in the chest, neck, throat, jaw, arms, elbow, wrist, or back that they have not noticed previously. Once the patient uses a word to describe the discomfort, the physician should use the same word and inquire about the duration of the discomfort and precipitating causes, including the less common and unusual ones discussed in this editorial.
Heart Dis Stroke
PMID:Angina pectoris: words patients use and overlooked precipitating events. 814 5

Chest rheography was used to study central hemodynamics in 134 healthy males aged 18-28 in comfortable weather conditions and discomfortable ones, that is at equivalent-effective temperature 17-24 degrees C and above 27-30 degrees C, respectively. In trained subjects from native and non-native population under comfortable weather conditions heart rate (HR) proved to be significantly reduced as compared to untrained subjects (57.6 +/- 1.1 and 56.2 +/- 1.2 against 73.9 +/- 1.7 and 70.4 +/- 0.9), whereas stroke volume in trained males was significantly larger (by 14.2 and 14.0%, respectively). Minute blood volume (MBV), cardiac and stroke indices, systolic and diastolic pressure showed no significant differences. Heat discomfort gave rise to a slow-pulse trend in trained subjects from both native and non-native populations, in untrained subjects, especially non-natives heart rate accelerated. MBV increased in trained native and non-native examinees by 11.0 and 11.1%, respectively, while in untrained natives the rise reached 17.2%. This was secured by stroke volume elevation by 14.3, 10.7 and 11.2%, respectively (p < 0.05), in non-natives by acceleration of heart rate by 11.2%. A trend to lowering of arterial pressure was more marked in untrained examinees of both populations. It is evident that in conditions of arid zone heat discomfort trained subjects from both native and non-native populations exhibited adequate hemodynamic responses, whereas strain was observed in circulatory system functioning when it adapted to heat discomfort in untrained non-natives.
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PMID:[Adaptive and non-adaptive reactions of central hemodynamics to conditions of heat discomfort]. 830 4

We studied the results for seventeen patients (eighteen feet) who had had a triple arthrodesis at an average age of sixty-six years (range, fifty-two to eighty years). There were twelve women and five men. The procedures had been performed to correct deformities of the hindfoot and midfoot caused by an untreated rupture of the posterior tibial tendon in ten patients; by rheumatoid arthritis in three patients (four feet); and by neuropathic arthropathy (associated with diabetes mellitus), trauma, old poliomyelitis, and a stroke in one patient each. The average duration of follow-up was forty-two months (range, twenty-seven to 156 months). At the most recent follow-up examination, three patients had a non-union (one, of the talonavicular joint and two, of the calcaneocuboid joint), six patients (seven feet) had progressive degenerative joint disease involving the ankle, seven had progressive degenerative changes in the mobile joints of the feet, two had had an infection but both infections had healed, and one had had postoperative collapse of the foot because of premature, unauthorized weight-bearing. In one patient, a staple across the subtalar joint had been removed because of pain caused by impingement of the staple on the tip of the fibula. Over-all, fourteen of the seventeen patients were satisfied with the result of the operation. All seventeen had less pain postoperatively, but eleven still had some discomfort.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Triple arthrodesis in older adults. Results after long-term follow-up. 844 13

Selective control of cell function by applying specifically configured, weak, time-varying magnetic fields has added a new, exciting dimension to biology and medicine. Field parameters for therapeutic, pulsed electromagnetic field (PEMFs) were designed to induce voltages similar to those produced, normally, during dynamic mechanical deformation of connective tissues. As a result, a wide variety of challenging musculoskeletal disorders have been treated successfully over the past two decades. More than a quarter million patients with chronically ununited fractures have benefitted, worldwide, from this surgically non-invasive method, without risk, discomfort, or the high costs of operative repair. Many of the athermal bioresponses, at the cellular and subcellular levels, have been identified and found appropriate to correct or modify the pathologic processes for which PEMFs have been used. Not only is efficacy supported by these basic studies but by a number of double-blind trials. As understanding of mechanisms expands, specific requirements for field energetics are being defined and the range of treatable ills broadened. These include nerve regeneration, wound healing, graft behavior, diabetes, and myocardial and cerebral ischemia (heart attack and stroke), among other conditions. Preliminary data even suggest possible benefits in controlling malignancy.
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PMID:Beneficial effects of electromagnetic fields. 849 42

Methodologies that allow prolonged drug administration in animal models, while minimizing surgery and anesthesia, are an important contribution towards studies in awake conditions. Commercially available drug delivery systems like pellets can be customized for the evaluation of experimental therapies with minimal or no discomfort to animals. Our objective was to evaluate pharmacokinetic and physiologic parameters after subcutaneous implantation of rapid 24 h release nimodipine pellets in rats for their potential use as a delivery system for stroke therapeutics. A day prior to the study Sprague-Dawley rats were anesthetized (halothane, N2O, O2) for femoral vessel cannulation and later returned to their cages. On the day of the study the rats were briefly anesthetized (identical regimen as before), and assigned to two groups: nimodipine (NP) and placebo (PL). NP rats received either 0.5 (n = 4), 1 (n = 3), 2 (n = 2), 4 (n = 2), or 15 (n = 5) mg pellets (Innovative Research of America Inc., Sarasota, FL, USA) and PL, rats (n = 5) received placebo pellets. Nimodipine plasma levels were measured at 1, 3, and 6 h. In addition, the 15 mg NP group was followed at 18 and 24 h. Immediately following decapitation the brain was removed for later determination of nimodipine tissue concentration. The NP 15 mg group showed a significant decline of 10% in MABP from base line to 24 h post implantation (p < 0.001). All NP animals achieved at least 83% of their highest plasma concentration at 1 h and 94% at 3 h. A high degree of correspondence (r2 = 0.95, y = 0.36 + 0.28x, n = 16) between the plasma and brain concentrations of nimodipine was present. Although a significant drop in MABP was observed the drop was no greater than 10% in 24 h. Plasma nimodipine levels for the 15 mg animals were within the cerebrovascular effective range. This is the first report to show that 24 h release nimodipine pellets subcutaneously implanted in rats are a reliable delivery system that allows rapid rise and constant nimodipine plasma levels. Therefore, 24 h release pellets are a suitable alternative to other delivery systems like osmotic pumps.
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PMID:Evaluation of a novel nimodipine delivery system in conscious rats that allows sustained release for 24 h. 891 4

A patient with a history of diabetes, coronary artery disease, stroke, previous renal transplantation, and multiple hospital admissions for recurrent pancreatitis was transferred to the hospital from a chronic care facility because of fever and severe epigastric discomfort. At the time of admission, she was receiving hyperalimentation through a central venous TPN catheter. Multiple blood cultures obtained on the first and second hospital days yielded pure cultures of the yeast, Pichia ohmeri. The patient developed acute renal failure, and despite high-dose amphotericin B therapy, ultimately expired.
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PMID:Pichia ohmeri fungemia. 957 30

Atrial fibrillation (AF) is a frequent and costly health care problem representing the most common arrhythmia resulting in hospital admission. Total mortality and cardiovascular mortality are significantly increased in patients with AF compared to controls. In addition to symptoms of palpitations patients with AF have an increased risk of stroke and may also develop decreased exercise tolerance and left ventricular dysfunction. All of these problems may be reversed with restoration and maintenance of sinus rhythm. External electrical cardioversion has been a remarkably effective and safe method for termination of this arrhythmia. Originally described by Lown et al. in 1963, it has been a well accepted mode of acute therapy. However, this technique requires general anesthesia or heavy sedation. Internal atrial defibrillation has been evaluated as an alternative approach to the external technique for over 2 decades. Recent studies have shown that low-energy internal atrial defibrillation using biphasic shocks is an effective and safe means in restoring sinus rhythm in patients with AF and should be considered especially in patients in whom external cardioversion attempts have failed. IMPLANTABLE ATRIAL DEFIBRILLATOR: Recently, a stand alone IAD, the Metrix System (model 3000 and 3020), has entered clinical investigation. Atrial defibrillation is accomplished by a shock delivered between electrodes in the right atrium and the coronary sinus. The right atrium lead has an active fixation in the right atrium. The coronary sinus lead has a natural spiral configuration for retention in the coronary sinus, and can be straightened with a stylet. Both leads are 7 French in diameter and the defibrillation coils are each 6 cm in length. The electrodes may be placed using separate leads, or very soon by using a single bipolar lead. A separate bipolar right ventricular lead is used for R wave synchronization and post shock pacing. The Metrix defibrillator can be used to induce AF by using R wave synchronous shocks and can store intracardiac electrograms (EGMs) for up to 2 minutes from the most recent 6 AF episodes. The device can be programmed into one of the following operating modes: fully automatic, patient activated, monitor mode, bradycardia pacing only, and off. As AF is not life-threatening, in the automatic mode the device is only intermittently active in detecting and treating AF, and this "sleep wake-up" cycle interval is programmable. The device employs extensive processing both for detection and R wave synchronization. In April 1996, the phase I Metrix multicenter clinical trial was started. As of May 1997, a total of 51 Metrix systems had been implanted as part of the phase I multicenter clinical trial. Preliminary data suggest that both defibrillation thresholds and electrograms are stable over time (implant to 3 months). Detection accuracy has been excellent (100% specificity, 92.3% sensitivity) and there have been no errors of R wave selection for synchronization. No proarrhythmias have resulted from over 3700 shocks delivered. The device is effective in electrically converting 96% of the spontaneous episodes of AF. In 27% of episodes several shocks were required because of early recurrence of AF. In 5 patients, the atrial defibrillator was removed: 2 infections, 1 cardiac tamponade, 1 permanent loss of telemetry, 1 patient required His-Bundle ablation because of frequent episodes of drug refractory AF with rapid ventricular response. Initial clinical experience under controlled conditions with the Metrix system suggests that the implantable atrial defibrillator may offer a therapeutic alternative for a subgroup of patients with drug refractory, symptomatic, long lasting, and infrequent episodes of AF. Further efforts must be undertaken to reduce the patient discomfort associated with internal atrial defibrillation in an attempt to make this new therapy acceptable to a larger patient population with AF. (ABSTRACT TRUNCATED)
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PMID:[Atrial defibrillator]. 969 Jan 12

Neuromuscular stimulation may facilitate motor recovery after stroke or brain injury, reduce shoulder pain associated with hemiplegia, and reduce cerebral spasticity. However, the discomfort of surface neuromuscular stimulation significantly limits the clinical implementation of this modality for persons with hemiplegia. The study contained herein tests the hypothesis that stroke and brain injury survivors with chronic hemiplegia (>6 mo) and intact sensation tolerate percutaneous intramuscular stimulation better than surface stimulation. Four stroke and two traumatic brain injury survivors participated in the study contained within this article. Each subject received three pairs of percutaneous and surface stimulations of the paretic finger extensors. The order of the type of stimulation within each pair was randomly assigned. The stimulation parameters for each type of stimulation were normalized to produce the same torque at the metacarpophalangeal joint. Subjects rated their perceived level of discomfort using a 10-cm visual analog scale and the McGill Pain Questionnaire. A blinded evaluator administered the pain measures. Percutaneous stimulation was associated with significantly lower discomfort as reflected by the visual analog scale (0.74 v 3.3; 95% confidence interval of difference, -3.84, -1.28). The McGill Pain Questionnaire produced similar results with percutaneous stimulation associated with a significantly fewer number of words chosen to describe the discomfort (0.87 v 3.30; 95% confidence interval of difference, -3.50, -1.30) and significantly lower Pain Rating Index (1.47 v 6.27; 95% confidence interval of difference, -7.77, -1.83). Data suggest that percutaneous intramuscular stimulation is significantly better tolerated than surface stimulation and that percutaneous stimulation may enhance patient compliance with neuromuscular stimulation treatments.
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PMID:Comparison of discomfort associated with surface and percutaneous intramuscular electrical stimulation for persons with chronic hemiplegia. 986 39


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