XVII. European Stroke Conference
Nice, France
XVII. European Stroke Conference
Nice, France
"2nd Stroke
Meeting for Nurses – Physiotherapists – Speech and Occupational
Therapists - Study/Monitoring
Assistants
13th May 2008
Nice, France"
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Could stroke trigger be prevented by healthy family relationships?
A. Rochette
P. Gaulin
M. Tellier
Université de Montréal
CANADA
Background: Although major stroke risk factors are well documented, little is known about which life circumstances are perceived to be related to the actual triggering of a first stroke. The purpose was to explore self-perceived spontaneously-related life circumstances surrounding the trigger of a first stroke. Methods: A qualitative design with a phenomenological orientation was used. Nine individuals with a first stroke and less than 80 years of age were purposely recruited in the two weeks after stroke onset. An interview guide developed by experts was used. All interviews were transcribed verbatim and data analysis followed a rigorous process including team validation. Results: All participants had in common a spontaneous reference to a family conflict regarding a specific event they tended to avoid surrounding the trigger of the stroke, which was temporarily resolved following stroke onset. Essential themes emerging from the data refer to symbols such as having a big heart and money issues as well as ambivalent feelings of responsibility and guilt regarding social roles such as being a spouse or parent. Conclusions: This study provides a deeper understanding of the positive consequences the stroke had in temporarily resolving some family conflicts tainted by a lack of transparency and honesty regarding ambivalent feelings. Further exploration is needed as secondary prevention and health promotion campaigns could specifically target healthy transparent and honest family relationships as a potential protective factor against triggering a stroke, if these results are confirmed in future studies.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Early outcomes following minor stroke
T.L.Green
K.M.King
University of Calgary
CANADA
Abstract Introduction: The biopsychosocial recovery trajectory of male minor stroke patients and the potential impact of minor stroke on the marital dyad and previous life roles (i.e. family, work, and social roles) have not been clearly delineated. The aim of this study was to describe the early recovery trajectory of male patients and their wife-caregivers following minor stroke, as they make the transition from acute care to home environments. Methods A pilot study with a prospective, cohort design was conducted to describe the recovery trajectory of 38 minor stroke patients and their wife-caregivers over a three month period following hospital discharge. Results Improvement was noted in patients’ overall functional status (mRS) (p=0.025) and quality of life (χ² = 10.91. p = 0.012), while marital function deteriorated (p=0.025) over time. Significant correlations at three months post-discharge were found between patient HRQOL and depression (r=-.748, p<0.001) and depression and wife-caregiver marital function (r=.610, p<0.001); wife-caregiver depression and marital function (r=.578, p<0.001) and marital function and caregiver strain (r= -.620, p<0.001). Discharge predictors of marital function at three-months were patient mRS (p=0.033) and SS-QOL scores (p=0.049), and wife-caregiver SF-12v2 physical domain scores (p=0.021). Conclusions Despite minimal functional impairment post-stroke, participants experienced increased depression, deterioration in marital function over time, and difficulty returning to previous life roles. Given the very short hospitalization period following minor stroke, patients and caregivers require preparation for short and long-term adjustments that may influence successful recovery following minor stroke. Word count: 240
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Emerging Roles: creating future stroke specialist consultant practitioners through an innovative formal post-graduate training programme for nurses and AHP's.
L. Cullen
H Kirk
L. Johnson
Wessex Institute, NHS Education South Central
UNITED KINGDOM
The NHS Plan (2000) and the NHS Improvement Plan (2004) outlined plans to modernise healthcare in the UK. Key to these modernisation initiatives are new clinical leadership roles for Nurses and Allied Health Professionals (AHP’s) – termed Consultant Practitioners (CP’s). These roles are the pinnacle of an individuals clinical career and represent both clinical excellence and academic capability. Each post is structured around four core functions: • Expert Practice • Professional Leadership • Education, training and development • Practice and service development through research and evaluation In order to function effectively with the freedom and autonomy envisaged for them, individuals in these posts need to be recognised as experts by their peers and colleagues. Yet despite the first appointments being made in 2000 for Nursing and 2002 for AHP’s, there has previously been no formal training in place to prepare individuals for these key roles. The Wessex Institute (Winchester, UK) is the first organisation to develop a structured post-graduate developmental framework to enable individuals to progress from newly-qualified levels of practice through to CP capability, providing them with clear evidence of academic and clinical capability. The first cohort of trainees are now in the second year of their four year training programme, during which they will develop highly proficient and expert skill in each of the four domains of the CP role, within the specialism of neurological rehabilitation with a particular emphasis on stroke. This poster will present an outline of the above post-graduate training scheme, with reference to the potential role of consultant practitioners in the delivery of excellent stroke care and the development of world class stroke services, from the perspective of the trainees themselves, presenting the experiences of those trainees now in the second year of this challenging and novel training programme.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Nursing in acute stroke: Early management and stroke unit care – a Canadian perspective
T.L.Green
N.A.Newcommon
University of Calgary
CANADA
Introduction: The Calgary Stroke Program instituted an acute stroke response system that relies heavily on the skills and expertise of a stroke nurse practitioner (SNP). As an advanced practice nurse, the SNP conducts the initial patient assessment in the emergency department, coordinates diagnostic investigations, and initiates appropriate therapeutic interventions. As the patient moves from the emergency department, continuity of care is achieved as the SNP maintains the role of patient care coordination following admission to the inpatient acute stroke unit through to discharge. Purpose: The purpose of this presentation is to describe the Calgary Stroke Program acute response system, emphasizing the key roles of the SNP in facilitating evidence-informed patient care. Particular emphasis will be placed on the emergency and acute stroke unit components of care, highlighting the unique contributions of nursing to improved patient outcomes. The role of the staff nurse and the advanced practice nurse in relation to the interdisciplinary team, acute stroke unit care, and clinical research will be discussed. Discussion: The SNP has been instrumental in achieving better thrombolytic door-to-needle times, improving patient satisfaction with acute stroke care, and advancing the nursing discipline through autonomous practice.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Optimizing Stroke Rehabilitation through Interdisciplinary Management and Innovative Knowledge Translation Strategies
N. Korner-Bitensky
S. Wood-Dauphinee
R. Teasell
J. Desrosiers
McGill University
CANADA
INTRODUCTION: The quality of stroke care impacts on survival and function. Yet, little is known about the actual practices of clinicians in stroke rehabilitation. OBJECTIVES: This presentation: 1. describes the findings of the Canada-wide survey where we identified typical assessments and interventions used in the treatment of individuals with stroke. 2. explores practice styles of clinicians, and how they impact on treatment choices;3: introduces clinicians to StrokEngine (www.strokengine.org). SUBJECTS: A representative sample of 1804 rehabilitation specialists {664 occupational therapists (OT); 655 physical therapists (PT); 50 physiatrists; and 435 speech-language pathologists (SLP)} working across stroke care (acute, in-patient rehabilitation, community) was surveyed. METHODS: Prompted by case vignettes of typical patients, clinicians described their “usual practices”. We used a valid measure to identify clinicians' practice traits. RESULTS: Study participation was >90%. Identification of critical stroke sequalae such as dysphagia was high by physiatrists and SLP but lower, 58% and 54% respectively, by OT and PT. Important social concerns such as driving and family support were rarely identified. Type of urinary incontinence was almost never correctly identified and interventions were rare. Standardized assessment practices varied greatly – with more than 400 tools being used. Interestingly, the largest proportion of clinicians, 55%, was pragmatic. Seekers, while rare (4%), were significantly more likely to choose assessment tools based on reliability and validity, whereas pragmatics looked for practicality. CONCLUSION: Stroke rehabilitation is complex. We found serious gaps in best practice implementation and a great need for knowledge translation strategies. To help fill this gap we have created an internationally available web-based tool which we will introduce to clinicians.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Nursing home experiences of community-based stroke care in Ireland: the Irish National Audit of Stroke Care (INASC).
M. Royston
S. Cowman
H. Mc Gee
F. Horgan
D. O'Neill
A. Hickey
Royal College of Surgeons in Ireland
IRELAND
Background Stroke survivors often require nursing home placement in the months or years after their stroke episode. An exploration of the prevalence and profile of stroke in Irish nursing homes was undertaken. This survey specifically assessed nursing home service provision as perceived by nursing home managers. The view of the service user is an integral part of any service quality evaluation, and a small interview survey was conducted with a sample of nursing home residents who had a history of a stroke. Standardised measures were used for functional ability (Barthel Index) and depression (Hospital Anxiety and Depression Scale (HADS). Methods A stratified sample of 60 nursing homes was surveyed and 3,239 residents were identified, one sixth (N= 570) of whom had a history of stroke. Sixty managers reported service views and 18 patients answered similar questions. Results There were high levels of dependency (>80% mobility problems, >60% cognitive problems, >50% swallow or communication difficulties. Of those residents interviewed, 28% were depressed (HADS). However access to multidisciplinary services for this vulnerable group was poor, e.g., 60% and 83% reported that access to physiotherapy and occupational therapy respectively was low. Care needs of this group were not addressed in a systematic manner. Access to a psychologist or counsellor was almost non-existent. Many opportunities for secondary prevention were missed. Discussion These nursing home patients were generally considered ‘discharged from active rehabilitation’ from the acute services. Thus nursing homes face many challenges as chronically sick people require complex healthcare. A shift in focus of policy makers and health care specialists, from ‘recovery and discharge’ to ‘quality of life and well-being’, is required to optimise community-based services for patients following stroke.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Everything the Neuroscience Nurse needs to know about the Care of the Intraventricular Hemorrhage Patient
T.J.Kiernan
M.I.Aguilar
Mayo Clinic Arizona
USA
This is a 68-year-old male with a 2 week history of headaches, who awoke one morning in normal state of health. A headache started and evolved into the “worst headache” of his life. A CT scan was completed upon ED admission showing a left intraventricular hemorrhage (IVH) (Figure 1). He became nauseous and then had emesis. His neurological exam was normal with the exception of somnolence and disorientation to place. He was derived not to be surgical candidate due to minimal signs and symptoms. He was managed medically and throughout his hospital stay remained stable. his patient had a “benign” presentation and an uncomplicated hospital course, however, IVH can have variable presentations and outcomes. The bedside nurse is required to understand the unpredictable course of the IVH patient and recognize subtle clues of the neurological exam to assist the team in the care of this patient. Primary IVH has a remote occurrence of 30%, whereas secondary IVH an extension of an intraparenchymal or subarachnoid hemorrhage into the ventricular system, has a 70% incidence. The mortality rates are estimated to be between 50% and 80%. Etiologies of IVH include hypertensive intracranial hemorrhage (ICH), saccular aneurysms and arteriovenous malformations (AVM), bleeding secondary to a neoplastic process, coagulopathy and trauma. The literature does not note the prevalence when etiology is unknown. The most common complications resulting from IVH are hydrocephalus, cerebral ischemia, vasospasm and persistent neurological deficits. Treatment for IVH varies from medical management to percutaneous or open drainage. ICH guidelines support minimally invasive surgery. Although uncommon, this condition carries a high mortality and early identification of neurological changes by nursing staff can have significant impact in neurological outcome.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
The introduction of evidence-based practice in acute stroke assessment: a realistic evaluation.
S. Hamilton
S.M.McLaren
A. Mulhall
University of Teesside
UNITED KINGDOM
Background The implementation of research evidence in stroke care is a key priority but translating this into clinical practice presents many challenges. A number of change management strategies are available but their usefulness is often unclear. This paper describes the use of a realistic evaluation approach to identify the effectiveness of a change management strategy (comprising evidence-based guidelines, an opinion-leader, new recording system, and an educational programme) to improve multidisciplinary stroke assessment. Realistic evaluation is particularly useful as it emphasizes that an intervention cannot be viewed in isolation from the context in which its is implemented. Aim To identify the effectiveness of the implementation strategy. Methods Data were collected in two phases (before and after the implementation of change in stroke assessment). Methods included: interviews and focus groups with nurses (n=18), doctors (n=15), allied health professionals (n=12), service managers (n=9) and patients (n=6); team questionnaire to all professional staff (72% response = 125/175); analysis of publicly available hospital documents and reflective diary of the project leader. Data were analysed using a thematic analysis. Results Results from both data collection phases were synthesised to produce a coherent description of the change process. Themes emerged around organisational issues, leadership, and theories of change. Furthermore, lessons learned were also identified. Data were developed into context-mechanism-outcome configurations to highlight key issues that arose from the change management strategy. Results showed that the implementation strategy was more successful with nurses and allied health professionals than medical staff. Conclusion Realistic evaluation was useful for identify the effectiveness of the change strategy. However, this was a complex approach to use. This paper discusses some of the difficulties encountered.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Establishing a National Stroke Nursing Network: A Canadian Perspective
T.L.Green
C. Bolton
L. Williams
Foothills Medical Centre
CANADA
The stroke nurse, as a member of the multidisciplinary team, is key to the recovery of the patient and family. In 2005, a proposal was submitted to the Canadian Stroke Network to support a collaborative relationship that (a) recognized the critical work of Canadian stroke nurses and (b) gave voice to their experiences on the frontline of stroke care in remote, rural and urban settings. This proposal aligned with planning and implementation of the Canadian Stroke Strategy (CSS) by providing insight into potential opportunities and challenges. This collaboration between stroke nurses and the Canadian Stroke Strategy has enabled nurses to actively contribute to the vision of the CSS, which is: A coordinated and integrated approach to stroke prevention, treatment and rehabilitation will exist in every province and territory in Canada by 2010. A forum of 42 nurses from across Canada met to discuss critical issues and gaps related to stroke nursing, focusing on clinical practice, education and research. The result was an action plan identifying four key initiatives instrumental to building a stroke nursing network. These included development of a communication strategy, participation in national stroke care initiatives, supporting standardized stroke nursing and patient education content, and promoting awareness of the value of various nursing roles. The creation of a National Stroke Nursing Council was also identified as a starting point from which to initiate change. The National Stroke Nursing Council currently consists of 13 nurses representative of Canadian geographic areas and key practice roles across the stroke continuum, including research, clinical practice and education. The purpose of this presentation is to describe the process of building a Canadian national stroke nursing network, identify the key initiatives, comment on achievements to date, and outline next steps in the development of collaborative stroke nursing practice.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Modified Functional Independent Measure (FIM) improved communication among multi-disciplinary team (MDT) members
S.Ö.Ostraiher
H.M.-Z.Malka-Zeevi
A. Ali
M.L.M.Livne
B.G.B.Gross
SARA O. THE FIRST AUTHOR WILL BE PRESENCE AT THE CONGERSS
Department of Neurology, Western Galilee Hospital, Nahariya, Israel
ISRAEL
Background: Care of stroke patients in a specified stroke unit significantly reduces mortality, handicap and institutionalization after stroke. The multidisciplinary team (MDT) approach that encourages early mobilization, communication between patients and caregivers, and co-ordination between disciplines, has been strongly advocated. According to daily reporting, the nursing staff can determine a therapeutic program for each individual patient. Objective; To examine the difference in quality of communication among members of an MDT caring for acute stroke patients, using either free flowing communication daily reports or a modified FIM questionnaire to assess a patient’s condition. Methods: The medical records of consecutive patients with free flowing reports (FFR) were compared to reports using a modified FIM scale during 3 month period January-March 2008, in the acute stroke unit. Results: No difference in length of hospitalization was noted between the groups. Occupational therapist (OT) daily reports were 1.7 ± 1.2 days in FFR group compared to 2.8 ±1.9 days in FIM reports (p=0.05). No difference was recorded in physiotherapist (PT) daily reports in both groups. Use of FIM form resulted in earlier start of rehabilitation (31% began on Day 2 and 25% Day 3) compared to later rehabilitation start in the FFR group (27% of patients began on Day 4) (P=0.007) . With the use of FIM, the MDT members had 72% complete agreement concerning the patient’s functional evaluation, while the MDT members agreed only 46% of the time when the form was not used. Conclusions: Using a structured report form including a modified FIM scale resulted in more consistent and more detailed reporting, leading to more accurate assessment and a chance to significantly improve evaluation of patients’ needs. Improved team communication creates close collaboration and full agreement concerning treatment. Further research is required to substantiate this pilot study.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
IS THE STROKE SPECIALIST NURSE ABLE TO DECIDE ON ELIGIBILITY FOR THROMBOLYSIS?
K.A.Coughlan
P.S.Loh
C. Bladin
Eastern Health, Box Hill Hospital
Monash University
AUSTRALIA
Background: The Acute Stroke Nurse (ASN) as first responder to CODE STROKE calls establishes eligibility for thrombolysis by obtaining history and assessment using protocol-defined inclusion and exclusion criteria. Details are relayed to the Acute Stroke Team whilst reviewing the CT Brain and the final decision on stroke thrombolysis is made by the treating Neurologist. The aim of this study is to investigate agreement on treatment decisions documented by the ASN and treating Neurologist/Stroke Physician. Methods: A prospective study of all Code Stroke calls attended by the ASN from April 2007- March 2008. Treatment decisions and ASPECTS scores made independently by the ASN were analysed for concordance with treating Neurologist / Stroke Physician. Results: Of all Code Stroke calls in this time period the ASN attended 71% (211/299). Confirmed ischaemic strokes accounted for 52% (109/211), stroke mimics 34%(72/211), intracerebral haemorrhage 8%(17/211) and 6%(13/211) were TIAs. Treatment with thrombolysis was given to 26%(28/109) of the ischaemic strokes. Inter-observer agreement on ASPECTS scores ranged from moderate to substantial (k=0.499 - k=0.627). Consensus on stroke mimic was excellent 99% (71/72). Of those ischaemic strokes excluded from thrombolysis, agreement was reached in 95% (77/81) of cases. Of the patients who did receive thrombolysis consensus was reached in 68%(19/28). Relative contraindications to stroke thrombolysis as reasons for exclusion, were points of disagreement. Discussion: An appropriately trained and experienced ASN who has developed specialist skills, is competent to safely assess the majority of patients using protocol-defined criteria. This may mean that some patients are excluded from thrombolysis by the ASN based on perceived relative contraindications to treatment; however the availability of a stroke expert health professional in smaller centres may improve their overall treatment rates.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Early Supported Discharge for Hospitalised Stroke Patients – Preliminary Experience in Singapore
L.T.Yue
National University Hospital
SINGAPORE
Aim: Intensive rehabilitation during the early post-stroke period is important to optimise outcome in disabled stroke patients. Due to limited availability of both in-patient and out-patient rehabilitation facilities, stroke patients often have prolonged hospitalisation in the acute hospital or discharged home without receiving appropriate out-patient rehabilitation. Early Supported Discharge (ESD) has been reported successful in facilitating early hospital discharge of stroke patients and improving outcome by providing intensive rehabilitation in their home environment via a mobile team of therapists. We aim to examine the feasibility and possible benefits of ESD for stroke patients in Singapore. Method: A hospital-based ESD team that consisted of a nurse, a physiotherapist, an occupational therapist and a neurologist was set up at a tertiary hospital. Hospitalised stroke patients with residual mild to moderate disability who would benefit from further rehabilitation but did not require in-patient medical or nursing management were offered home rehabilitation. Data on patient characteristics, length of stay (LOS) and outcome determined by functional independence measure (FIM) and modified Rankin scale (mRS) were prospectively collected. Results: From Aug 2007 to April 2008, 42 patients (24 men, 18 women) with mean age of 67.8 years (range 38-93) entered the ESD programme. Their average LOS in the acute hospital was 5.4 days, shorter than the LOS of 80 patients discharged to convalescent or rehabilitation hospitals (9.3 days) during the August 2007 to March 2008. Of the 35 patients who successfully completed ESD, mean FIM score improved from 90.5 to 106.9. MRS score ranged from 2 to 5 before initiation and 1 to 4 upon completion of ESD, with 14 patients improved by 2 points, 17 patients improved by 1 point and 4 patients remained unchanged in their mRS scores. Conclusion: ESD for stroke patients is feasible in Singapore.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Fabry's disease in a non-selective young stroke population
N. Wilson
J. Slark
P. Sharma
Imperial College Cerebrovascular Research Unit (ICCRU)
UNITED KINGDOM
Introduction Fabry’s disease is a hereditary lysosomal storage disease. It is an unusual but important cause of stroke affecting primarily young patients under the age of 55 years. A recent German study suggested between 2-5% of patients under the age of 55 who had suffered a cryptogenic stroke had a significant mutation within the alpha-GAL gene 1. Study objectives We carried out a similar study to determine whether similar frequencies were likely in an unselected UK stroke population. Methods A retrospective study was conducted at the Hammersmith Hospitals Acute Stroke Unit (HHASU). All consecutive, unselected stroke patients aged <56 years and admitted to HHASU between September 2005 and April 2007 were assessed. Patient notes were obtained from medical records and information was retrieved from them. Results There were 295 patients admitted of which 55 were aged <56 years (38 male; 80% ischaemic stroke; 30% hypercholesterolemia; 7% diabetic; 7% patent forum ovale; 36.8% hypertension in males, 17.6% in females; 15.8% male smokers, 29.4% female smokers). Of these 19/55 (34.5%) had true cryptogenic stroke and 20/55 (36.4%) had similar risk factors to the previous study, i.e., hypertension, hypercholesterolaemia and smoking. The remaining patients had additional risk factors and were not considered for this study. Ten of these patients so far have randomly been selected for deficiency of α-galactosidase A activity analysis. Of these ten, none were abnormal. Conclusions Our data suggests a high proportion of cryptogenic stroke (36.4%) in our population - higher than the previous study (27%) (1) – which could harbor Fabry’s disease. However, so far none have had an abnormality of α-galactosidase A activity. References Rolfs A et al. Lancet 2005; 366; 1794-1796 Acknowledgments This study was partly funded by an unrestricted grant from Genzyme.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
An Innovative, Multi Agency Form of Early Supported Discharge (ESD) Service For Stroke Patients In Liverpool, UK, Demonstrates Beneficial Patient, Carer, Staff And Service Outcomes
L. Roxburgh
J.L.Jones
J. Dickens
Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, England
UNITED KINGDOM
Background The ESD component of the Royal Liverpool & Broadgreen Hospitals stroke care pathway provides tailored care, rehabilitation and carer support on transition from the hospital in-patient setting, up to six months post stroke; a groundbreaking example of this emerging concept, driven by UK Government directives underpinned by research evidence (1,2,3). Method New partnerships have been forged between health and social care teams and the voluntary sector.The therapy element consists of highly trained support staff, occupational therapists and physiotherapists, delivering individualised interventions to meet the patients’ goals.Treatment delivery in various settings including out-patient rehabilitation units, in-patient and day service social care facilities and the patient’s own home, provides patient choice.The service has been evaluated against a framework of outcomes. Results There has been 45% reduction of combined hospital acute stroke unit and stroke rehabilitation unit length of stay. ESD has dealt with over 60% of Trust stroke population, far exceeding its target.The service has achieved high levels of patient satisfaction. Patients and carers have increased their uptake of leisure, re-enablement and support services in the community, which may reduce carer breakdown and hospital readmission for social reasons, and improve social reintegration. In addition, therapists have become involved in training of social service staff, improving care patients receive. Conclusion Development of this broad, inter agency, multi disciplinary interpretation of the ESD model has resulted in a flexible, imaginative patient centred approach to stroke care planning.Service development has demanded a cultural shift for both health and social care staff, evolving as a successful model for other patient populations. 1.Department of Health, UK(2008) 2.Langhorn et al(2005) 3.The Cochrane Database(2008)
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Management of Dysphagia in acute stroke patients - procedure protocol in a stroke unit
M.J.Duarte
A.I.Pinto
A. Caseiro
M.G. Abreu
A. C. Almeida
Nursing in a stroke unit in Europe
PORTUGAL
Background: One of the most important risks in the acute phase after stroke is aspiration pneumonia. According to researches, adding nurse practitioners to an acute stroke team can reduce complications, leading to the decreased hospital stays fewer deaths and better patient recovery. Steps generally accepted in the prevention of aspiration are the correct position in bed, safety precautions in feeding, namely the use of fluid thickeners, and the immediate institution of rehabilitation. our stroke unit has a protocol regarding dysphagia, performed by the nursing staff, consisting of oral administration of a small quantity of water before every meal, under observation of a nurse. Our objective was to evaluate the efficacy of this protocol in the prevention of aspiration pneumonia in acute stroke patients. Methods: A population of 500 patients admitted to our Unit in the period of one year (2007) was studied. Patients with acute and ischemic stroke, intracranial hemorrhage, subarachnoide bleeding and venous thrombosis were included. Dysphagia was assessed as difficulty in swalling liquids. Respiratory infection was confirmed by clinical. analytical and radiological criteria. Results: Of the total 500 patients studied, 36 (7,2%) patients had liquid dysphagia. Of the total patients with dysphagia, 3 (8,3%)patients had documented respiratory infection. Discussion: Our results show a low prevalence of respiratory infection in patients with dysphagia in a stroke unit, when compared with the literature. Our protocol of assessement of dysphagia, together with general safety measures regarding feeding, is adequate in the prevention of aspiration pneumonia.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Rehabilitation Nursing in a stroke unit - The Plan of Rehabilitation
M.J.Duarte
M.A.Menezes
Stroke Unit
PORTUGAL
Background: Stroke is the major cause of cognitive and physical disabilities in our country.Rehabilitation nursing treatment of acute stroke patients in a stroke unit improves functional outcome and increases the possibility of earlier discharge to home and is knowned that shorter time to start of mobilization/training is an important factor associated with discharge to home. Methods:We retrospectively analysed the Plan of Rehabilitation prepared by the nurse with the speciality of rehabilitation( powders degree course) during a period of six months in our stroke unit. Results: Of the total 35 patients in acute phase stroke with a reabilitation plan, 90% of the patients needed a precocius start of mobilization.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
PREDICTORS OF MOBILITY LEVEL OF STROKE PATIENTS AFTER REHABILITATION IN ACUTE CARE SETTING?
B.E.HUSEYINSINOGLU
O. ERKAN
H. HARABATI
E. ALTINDAG
R. TOLUN
Y. KRESPI
Florence Nightingale Hospital/Stroke Unit
TURKEY
Background and Purpose: Factors predicting outcome in early stroke rehabilitation are not well known. The aim of this study was to determine the factors relating to independent mobility as early as at discharge from the hospital. Methods: From the 193 patients admitted to the stoke unit between February 2006 and February 2007, 50 patients met the inclusion criteria for a detailed pre-rehabilitation assessment. They were all first ever stroke patient with at least a score of 1 at the 5th, 6th or 7th item of NIH scale on admission. Patients with TIA, subarachnoide hemorrhage, recurrent stroke or insufficient level of cooperation were excluded. All patients had motor and balance assessment with Modified Motor Assessment Scale (MMAS) and Tinetti Balance Test (TBT), respectively. The presence of sensory or vision loss, cognitive impairment, speech or neglect disorder and dysphagia were noted. Sex, age, type and side of the lesion and length of hospital stay were also recorded. The level of mobility at discharge was measured by Rivermead Mobility Index (RMI) and a score of ≥8 was set as a cut-off of independent mobility. All patients received 2 physical therapy sessions a day by two physical therapists. Results: There were 27 men and 23 women with a mean age of 66,8 years (SD, 12.6). 48 had ischemic stroke and 39 had hemispheric stroke. In univariate analysis, age (p<0,01), MMSA (p<0,01) and TBT at admission (p<0,01) were significantly related to the mobility level at discharge. Men had significantly higher mobility level then women (p<0,05). Neglect (p<0,05) and cognitive impairment (p<0,01) were predictors of lower mobility level. Age (p<0,05) and TBT (p<0,01) were the only independent factors associated with independent mobility in logistic regression analysis. Discussion: In the acute stage of stroke independent walking can be predicted by a simple balance test and this is important in identifying early rehabilitation needs.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Awareness and perceptions of blood pressure in the general public
J.S.Slark
N.PWilson
P. Sharma
Imperial College NHS Trust
UNITED KINGDOM
Background and Aims Current literature indicates that there is little knowledge or understanding amongst the general public about the role of blood pressure in contributing to heart disease and stroke. This study aimed to identify the knowledge and perceptions of blood pressure in a randomly selected population of residents in London. The objective was to identify local gaps in knowledge and understanding in order to develop primary and secondary prevention strategies. Method and results As part of an awareness campaign, members of the public were offered blood pressure testing. Individuals were asked relevant questions to identify their perception and understanding of blood pressure. Of the 338 participants the mean age was 54 years old. 30% of the total population had known hypertension and took medication, however of those people 41% were unable to guess a normal BP and a further 32% of that group still had a systolic BP of >140mmHg. Looking at the total population a massive 56% were unable to guess a ‘normal’ BP and of that group alone 28% had a systolic BP of > 140mmHg. Of those few who were able to guess a ‘normal’ systolic Bp of between <121 and >100mmHg had the lowest incidence of a systolic BP of >140mmHg. Conclusions These results suggest a significant lack of understanding of the concept of ‘blood pressure’ in the general public population with individuals having little knowledge of what a ‘normal’ BP should be and even less understanding of their own BP. An identified need exists for greater information provision and education for the general public surrounding BP aiming to empower individuals to take responsibility for their own health needs and to encourage members of the public to understand the significance and consequence of BP on their health. Acknowledgments: This work is supported by Hammersmith Hospitals Special Trustees and Hammersmith and Fulham Primary Care Trust.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Total-cholesterol levels predict vascular death in patients undergoing carotid endarterectomy: results from 5-year follow-up study
C. Collado
B. Gomez
R. Pons
J. Krupinski
Hospital Universitari de Bellvitge, Department of Neurology, Stroke Unit, Fundacio IDIBELL
SPAIN
Background: Carotid endarterectomy (CEA) is currently performed in subjects with carotid artery stenosis over 70%, as clinical trials demonstrated a significant benefit for stroke prevention. Only few studies addressed long-term outcome of these patients and there is not a biological marker that predict the prognosis after CEA. Methods: This study included 139 patients (113 male, 26 female aged 46 to 84 years) undergoing CEA. The presence of vascular risk factors and previous treatment with antiplatelets or statins was recorded. Patients were followed by clinical visit for 5 years and all complications were recorded. Biochemical parameters: cholesterol (total-c, LDL-c, HDL-c, TG), fibrinogen, glycaemia and high sensitivity C reactive protein, were measured prior to surgery and at 5 year follow-up. Results: There were symptomatic CAD (n=27) and ischaemic stroke patients (n=10), including 2 fatal strokes, 9 fatal CAD (cardiac arrest or myocardial infarction). Total cholesterol levels, measured prior to CEA, predicted vascular death: fatal stroke or CAD during five year of follow-up (OR, 2,0; P<0.05; 5,8+/-1 vs. 4,9+/-1 mmol/l fatal vs. non-fatal events, respectively). Patients suffering form stroke prior to CEA had significantly higher LDL-c levels than patients who presented with TIA (3,6±1 vs. 2,6±1 mol/l, p<0.05). None of the other clinical or biochemical parameters evaluated predicted other endpoints at 5 year i.e. non-fatal stroke, symptomatic CAD (non-fatal myocardial infarction, cardiorespiratory arrest, coronary revascularization, or angina) symptomatic PVD or other nonvascular death. Discussion: This study demonstrated that total cholesterol level is a predictor of fatal vascular outcome in elderly patients subjected to CEA. Further study should address the question if aggressive treatment of hypercholesterolaemia and rigorous dietary control reduce number of fatal vascular events in these population.
Session:
Lunch Poster Session
Date:
Tuesday 13 May 2008
Time:
12:30 - 13:30
Room:
Voyer of room Athena
Nurse-led assessment of suspected TIA patients in an urban teaching hospital
J. Dawson
L.N.Smith
TJQuinn
C. Ritchie
A. Hill
K.R.Lees
University of Glasgow
UNITED KINGDOM
Background Urgent assessment and intervention after TIA is beneficial but challenges existing models of service provision. We examined the feasibility of a nurse-led TIA clinic. Methods A training course for senior stroke nurses was developed comprising paper-based materials, lectures, online tools, and supervised practice over one year. Selected patients referred with suspected TIA underwent structured assessment by the nurse using a proforma based on a validated TIA risk scoring system and locally-developed assessment tools. A final dichotomised diagnosis of ‘TIA likely’ or ‘TIA not likely’ was recorded. Patients assessed in the nurse-led clinic were subsequently seen by an experienced stroke physician : 95% agreement with this ‘gold standard’ diagnosis defined success of nurse assessment. Waiting time until review at both clinics was compared. Results 4 nurses completed training. 57 patients were then assessed at 25 nurse-led clinics. Median (IQR) time from referral to nurse assessment was 3 (2-6) days. The equivalent interval for the conventional clinic was 7.5 (3-19) days. Nurse evaluation was concordant with the physician in 42 patients (73.6%). False positive and false negative assessment occurred in 10 (17.5%) and 5 cases (8.8%) respectively. Positive predictive value of nurse assessment was 0.75, negative predictive value was 0.69. The training involved 80 days of physician time. Conclusion Provision of a nurse-led service may reduce waiting times but there is a considerable physician cost to training and supervision, limited diagnostic accuracy and less effective management of stroke mimics. The high incidence of non-stroke pathologies suggests that part-time nurses trained in exclusively cerebrovascular assessment should not replace physician assessment. Comprehensively trained staff and management support are crucial for changes in service delivery.
