Strategies adopted to manage physical and psychosocial challenges after returning home among people with stroke: A qualitative study

Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors’ performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one''s own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors’ recovery outcomes.     

Deceleration capacity for rapid risk stratification in patients suffering from acute ischemic stroke: A prospective exploratory pilot study

Deceleration capacitiy for rapid risk stratification in stroke patientsCerebral ischemia is a major cause of neurologic deficit and patients suffering from ischemic stroke bear a relevant risk of mortality. Identifying stroke patients at high mortality risk is of crucial clinical relevance. Deceleration capacity of heart rate (DC) as a parameter of cardiac autonomic function is an excellent predictor of mortality in myocardial infarction and heart failure patients.The aim of our study was to evaluate whether DC provides prognostic information regarding mortality risk in patients with acute ischemic stroke.From September 2015 to March 2018 we prospectively enrolled consecutive patients presenting at the Stroke Unit of our university hospital with acute ischemic stroke who were in sinus rhythm. In these patients 24 hours-Holter-ECG recordings and evaluation of National Institute of Health Stroke Scale (NIHSS) were performed. DC was calculated according to a previously published algorithm. Primary endpoint was intrahospital mortality.Eight hundred seventy eight stroke patients were included in the study. Intrahospital mortality was 2.8% (25 patients). Both DC and NIHSS were significantly different between non-survivors and survivors (Mean ± SD: DC: 4.1 ± 2.8 ms vs 6.3 ± 3.3 ms, P < .001) (NIHSS: 7.6 ± 7.1 vs 4.3 ± 5.5, P = .02). DC achieved an area under the curve value (AUC) of 0.708 for predicting intrahospital mortality, while the AUC value of NIHSS was 0.641. In a binary logistic regression analysis, DC, NIHSS and age were independent predictors for intrahospital mortality (DC: HR CI 95%: 0.88 (0.79–0.97); P = .01; NIHSS: HR CI 95%: 1.08 (1.02–1.15); P = .01; Age: HR CI 95%: 1.07 (1.02–1.11); P = .004. The combination of NIHSS, age and DC in a prediction model led to a significant improvement of the AUC, which was 0.757 (P < .001, incremental development index [IDI] 95% CI: 0.037 (0.018–0.057)), compared to the individual risk parameters.Our study demonstrated that DC is suitable for both objective and independent risk stratification in patients suffering from ischemic stroke. The application of a prediction model combining NIHSS, age and DC is superior to the single markers in identifying patients at high mortality risk.     

Changes in cognitive characteristics according to 3 intensity changes by 8 vibration frequencies (STROBE)

In this study, we attempted to observe changes in cognitive characteristics according to 3 intensity changes (Level 1: 0.25 gravity, Level 2: 0.38 gravity, Level 3: 1.3 gravity) at 8 vibration frequencies (10, 50, 100, 150, 200, 225, 250, 300 Hz).The subjects were twelve male (22.1 ± 0.6 years old) and twelve female (21.5 ± 0.8 years old) healthy, right-handed adults with normal cognitive abilities. An experimental trial consisted of a stimulation phase (0.1 sec) in which a vibration stimulus was presented and a rest phase (6 sec) in which no vibration stimulus was presented. A selected stimulus was presented on the first knuckle of the right index finger 5 times (trials). Cognitive characteristics scores according to changes in intensity at each frequency were sampled using a subjective assessment sheet consisting of eighteen items (“ticklish,” “shivery,” “push,” “convex,” “thick,” “numb,” “slow,” “fast,” “shallow,” “strike,” “weak,” “strong,” “dense,” “blunt,” “heavy,” “light,” “stab”, “no stimulus”). To identify the cognitive characteristics according to intensity changes by frequency, the 3 intensities were designated as variables, and a curve estimation regression analysis was performed.At 10 Hz, cognitive characteristics of ’blunt’ increased with the intensity, and ’weak’ decreased. In 100 and 225 Hz, increase or decrease in intensity led to opposite cognitive characteristics (‘weak-strong’ in 100 and 225 Hz, ‘light-heavy’ in 225 Hz). In 100 and 225 Hz, as the intensity increased, expressions on the sense of surface such as ’blunt’ were superior, and the shape of an object (thick) and dynamics (push) differed with the change in intensity. In addition, in 225 Hz, decrease in intensity led to increase in cognitive characteristics such as ’light’ and ''shallow. ’Fast’ was unique in that it only appeared as the intensity increased at 300 Hz.     

Exploring community-dwelling stroke survivors’ experiences of receiving a nurse-led theory-based stroke self-management programme: A qualitative study

International evidence-based guidelines recommend self-management support for stroke survivors to improve their health outcomes. We developed a 4-week nurse-led stroke self-management programme (SSMP) and conducted a randomised controlled trial to assess its effects. This paper reports the findings of a qualitative study nested within the randomised controlled trial to explore stroke survivors’ experiences of SSMP participation. Semi-structured interviews were conducted with all adult participants who were clinically diagnosed with a first or recurrent ischaemic or haemorrhagic stroke, residing at home, communicable in Cantonese, had a Montreal Cognitive Assessment score below the second percentile, and participated in at least 1 SSMP session. All interviews were conducted in Cantonese, lasted approximately 45 minutes, and were audio-recorded. Interview data were transcribed verbatim and analysed thematically. Sixty-four stroke survivors (mean age 66.33 years, SD 12.34) were recruited, and 59 were interviewed via phone immediately after completion of SSMP. Three themes were derived. Overall, participants were satisfied with the SSMP. Their understanding of self-management was improved, and they recognised its importance in recovery. Their confidence in self-management was also enhanced through the use of multifaceted strategies. Suggestions were made to enhance their participation experiences, including increased home visits and group sessions, making group session attendance optional and arranging them more accessibly, meeting the survivors who shared their survival experiences in the videos, and access to the videos online. This study concurred that the SSMP enhanced stroke survivors’ self-efficacy in self-management. Rearrangement of the programme format and enhancements in accessibility could be further examined to enable more effective stroke self-management.     

Prognostic indicators for the onset of ischaemic versus haemorrhagic stroke in stable coronary artery disease

The incidence of stroke may be increased in patients with coronary artery disease (CAD). We aimed to investigate the specific risk factors for the development of ischaemic and haemorrhagic stroke in stable CAD patients.Patients with stable CAD were prospectively enrolled for future cardiovascular events in Taiwan. All the patients had received coronary interventions and were stable for least 1 month before enrolment. The incidence of ischaemic stroke was identified and confirmed by telephone and hospital records. Baseline characteristics, including demographic data, lipid profiles, medications, and biomarkers for potential inflammatory and atherosclerosis, were analysed.In total, 1428 patients (age, 63.07 ± 11.4 years; 1207 males) were under standard medical treatment and regularly followed-up for at least 4 years. Multivariate logistic regression analysis showed that baseline serum myeloperoxidase (MPO) level (hazard ratio [HR]: 1.89, 95% CI: 1.16–3.10, P = .01) and statin use (HR: 0.37; 95% CI: 0.17–0.79, P = .01) were independently associated with the onset of ischaemic stroke. Age (HR: 1.07, 95% CI: 1.00–1.14, P = .04) and angiotensin receptor blocker (ARB) use (HR: 0.37, 95% CI: 0.17–0.79, P = .01) were independently associated with future onset of intracranial haemorrhage (ICH), implying the different mechanisms of ischaemic stroke and ICH.Age and ARB use were related to ICH onset. Baseline MPO level and statin use were independently associated with longer and shorter future ischaemic stroke onset in stable CAD patients, respectively. Further studies are indicated to confirm the potential mechanisms and advance individual risk stratification for the onset of different types of stroke in clinical CAD.     

Efficacy of sequential N-butylphthalide therapy on psychiatric and behavioral functions in acute ischemic stroke

Background:Stroke can cause physical and mental problems. This study examined how the sequential therapy of N-butylphthalide (NBP) could effectively improve physical movement, life activities, and psychological disorders in stroke patients.Methods:This double-blind, randomized controlled trial included middle-aged or elderly patients with acute ischemic stroke that had commenced within 48 hours before enrolment in the study. The experimental group was administered 100 mL NBP injections twice a day in the first 14 days, and a sequential 200 mg NBP soft capsule 3 times a day for the next 76 days. The control group was administered 100 mL NBP placebo injections twice a day in the first 14 days and 200 mg sequential NBP placebo soft capsule 3 times a day for the next 76 days. Primary outcomes were the National Institutes of Health Stroke Scale, the Barthel Index of activities of daily living, and Modified Rankin Scale which were evaluated at day 0, day 14, and month 1 or at day 14, month 3, and month 6. Secondary outcomes included the Hamilton Anxiety Scale and the Hamilton Depression Scale, all were evaluated on day 0, month 3, and month 6. Moreover, the adverse reaction of NBP or other serious adverse events were evaluated at each time.Results:Our therapy significantly increased the Barthel Index of activities of daily living scores, decreased the National Institutes of Health Stroke Scale and Modified Rankin Scale scores, and the incidence of the Hamilton Anxiety Scale and the Hamilton Depression Scale of ischemic stroke patients (P < .05).Conclusion:Our results indicated that 90 days’ sequential therapy with NBP as an additional therapy in the treatment of ischemic stroke can better improve patients’ psychological and behavioral functions without significant side effects.     

Effect of education and muscle relaxation program on anxiety,depression and care burden in caregivers of acute stroke survivors: A randomized,controlled study

This study intended to discover the effect of education and muscle relaxation (EMR) program on anxiety, depression and care burden among caregivers of acute stroke survivors.This randomized, controlled study enrolled a total of 110 caregivers of first-ever acute stroke patients, and randomly assigned to EMR (N = 55) and control (N = 55) groups. The caregivers in the EMR group received 12-month health education and progressive muscle relaxation, and those in control group were provided common rehabilitation advices. Hospital Anxiety and Depression Scale (HADS) and Zarit Caregiver Burden Scale in caregivers were evaluated at the time of patients’ discharge from hospital (M0), then at month(M) 3, M6 and M12 after the discharge.HADS-anxiety score, anxiety rate and severity were similar at M0, M3, while were reduced at M6 and M12 in EMR group compared to control group. Furthermore, HADS-depression score was similar at M0 and M3 but was decreased at M6 and M12 in EMR group compared with control group, however, there was no difference of depression rate and severity between the 2 groups at each time point. Moreover, Zarit Caregiver Burden Scale score was similar at M0 and M3, but was decreased at M6 and M12; meanwhile, degree of care burden was similar at M0, M3 and M6, but was reduced at M12 in EMR group compared to control group.EMR program decreases anxiety, depression and care burden in caregivers of acute stroke survivors, suggesting its potential in improving mental health and further promoting quality of lives in these caregivers.     

The cognitive dysfunction related to Alzheimer disease or cerebral small vessel disease: What's the differences

Alzheimer disease (AD) and sporadic cerebral small vessel disease (CSVD) are common cognitive disorders. Both AD and CSVD have mental symptoms including chronic progressive cognitive impairment, dysfunction, and behavioral abnormalities. However, the differences on the cognitive dysfunction of AD and CSVD remain unclear. It is necessary to elucidate the cognitive dysfunction differences of AD and CSVD, and to identify the potential risk factors.AD or sporadic CSVD patients treated in our hospital from December 1, 2018 to May 31, 2019 were included. And we selected healthy participants as controls. The mini-mental state examination and Montreal Cognitive Assessment Scale were used for neuropsychological assessment, and related medical information were collected and compared.A total of 190 patients were included. The total mini-mental state examination scores in AD, CSVD group were significantly less than that of control group, there were significant differences in the domains of directional ability, attention and computing ability, delayed recall, and visual perception (all P < .05); the total Montreal Cognitive Assessment Scale scores in AD, CSVD group were significantly less than that of control group. There were significant differences in the domains of visual space and execution, immediate remember, attention and computing ability, language, delayed recall, and directional ability (all P < .05); diabetes was a risk factor both for AD (hazard ratio = 1.63, 95% confidence interval: 1.35–1.97) and CSVD (hazard ratio = 1.15, 95% confidence interval: 1.08–1.27).The cognitive dysfunctions of AD are difference to that of CSVD patients, and diabetes is the risk factor both for AD and CSVD, future studies are needed to further identify the prevention and treatment of AD and CSVD.     

Does a combination treatment of repetitive transcranial magnetic stimulation and occupational therapy improve upper limb muscle paralysis equally in patients with chronic stroke caused by cerebral hemorrhage and infarction?: A retrospective cohort study

The clinical presentation of stroke is usually more severe in patients with intracerebral hemorrhage (ICH) than in those with cerebral infarction (CI); recovery of stroke-related muscle paralysis is influenced and limited by the type of stroke. To date, many patients have been treated by neurorehabilitation; however, the changes in the recovery of motor paralysis depending on the type of stroke, ICH or CI, have not been established. This study aimed to determine this difference in improvement of upper extremity paralysis using 2-week in-hospital NovEl intervention Using Repetitive transcranial magnetic stimulation combined with Occupational therapy (NEURO).We scrutinized the medical records of all patients with poststroke (ICH or CI) upper extremity muscle paralysis using Fugl-Meyer assessments (FMAs) who had been admitted to 6 hospitals between March 2010 and December 2018 for rehabilitation treatment. This was a multiinstitutional, open-label, retrospective cohort study without control patients. We evaluated the effects of NEURO on patients with CI and ICH by dividing them into 2 groups according to the type of stroke, after adjustment for age, sex, dominant hand, affected hand side, time since stroke, and prediction of recovery capacity in the upper extremity.The study included 1716 (CI [n = 876] and ICH [n = 840]) patients who had undergone at least 2 FMAs and had experienced stroke at least 6 months before. The type of stroke had no effect on the outcomes (changes in the FMA-upper extremity score, F_[4,14.0] = 2.05, P = .09, partial η² = 0.01). Patients from all 5 groups equally benefited from the treatment (improvement in FMA scores) according to the sensitivity analysis-stratified analysis (F = 0.08 to 1.94, P > .16, partial η² < 0.001).We conclude that NEURO can be recommended for chronic stroke patients irrespective of the type of stroke.     

Effect of home-based reablement program on improving activities of daily living for patients with stroke: A pilot study

Background:Administering activities of daily living (ADL) and recovery of ADL functions are the main treatment goals in rehabilitation for patients with stroke. Reablement is one form of rehabilitative intervention, which aims to restore ADL functions performed in the community. The purpose of this study was to investigate the effects of home-based reablement from 3 concepts of ADL (ie, actual performance, ability, and self-perceived difficulty) for patients with stroke.Methods:This was a single-blind pilot randomized clinical trial. Twenty-six patients were randomly assigned into 2 groups: home-based reablement group (n = 12) and control group (n = 14). The home-based reablement group received ADL training in the home environment for 6 weeks. The control group received conventional rehabilitation in the hospital. Outcome measures contained the Canadian Occupational Performance Measure (COPM) and the Barthel Index-based Supplementary Scales (BI-SS). The COPM was applied to identify patients’ level of performance and satisfaction with ADL training. The BI-SS included 3 ADL scales: actual performance, ability, and self-perceived difficulty.Results:The patients in the home-based reablement group showed statistically significant improvements in the ability scale and total score of the BI-SS than the control group (P < .05) and demonstrated moderate effect size (success rate difference = 0.34–0.42). No significant differences were noticed in the COPM and the other 2 scales of the BI-SS (actual performance and self-perceived difficulty), but small effect sizes were found (success rate difference = 0.17–0.22).Conclusions:For patients with stroke, the 6-week home-based reablement program had similar effects with the control group on patients’ perceived performance, satisfaction, and difficulty in ADL, but it displayed potential for enhancing their ability in executing ADL tasks.     

Occupational stress among Nigerian construction trade artisans in the building construction sector: An intervention study

Background:Construction work can negatively affect artisans’ mental health in the form of stress. This research investigated the effect of cognitive behavioral intervention on occupational stress among Nigerian construction trade artisans in the building construction sector.Methods:In this randomized controlled study involving 3 waves of data collection, 140 construction trade artisans who presented with high occupational stress symptoms at the study onset were assigned randomly to either a treatment condition (n = 70) or to a waitlist control condition (n = 70). The study involved pre-treatment and post-treatment assessments and a 3-months follow-up. The artisans’ occupational stress questionnaire and artisans’ dysfunctional thoughts at work scale were the data collection instruments.Results:Results revealed a significant effect of group on artisans’ occupational stress and dysfunctional thoughts at work. Also, significant effects of time on artisans’ occupational stress and dysfunctional thoughts at work were recorded. Finally, group × time interaction effects on artisans’ occupational stress and dysfunctional thoughts at work were significant.Conclusion:Cognitive behavioral intervention effectively reduced occupational stress symptoms and dysfunctional thoughts at work among Nigerian construction trade artisans compared with a waitlist control condition.     

Mild cognitive impairment in psoriatic arthritis: Prevalence and associated factors

To assess the prevalence and factors associated with mild cognitive impairment (MCI) in patients suffering from psoriatic arthritis (PsA).A cross-sectional evaluation was conducted in consecutive PsA patients. Sociodemographic data and the clinimetric variables related to PsA and psoriasis were collected for each patient. MCI was assessed through the Montreal Cognitive Assessment (MoCA). The cognitive performance of PsA patients was compared to healthy subjects using one-way analysis of variance (ANOVA). The correlations among variables were studied by the Spearman rank correlation coefficient. A multivariate logistic regression analysis was carried out to establish the predictors of MCI.The study involved 96 PsA patients and 48 healthy subjects. MCI (defined as a MoCA score < 26/30) was detected in 47 (48.9%) PsA patients. Compared to healthy subjects, the MoCA score resulted significantly lower in PsA patients (P = .015). The main differences involved the denomination and language domains. MoCA was negatively correlated with age (r = −0.354; P < .0001), HAQ-DI (r = −0.227; P = .026), and fatigue (r = −0.222; P = .029), and positively correlated with psoriasis duration (r = 0.316; P = .001) and DLQI (r = 0.226; P = .008).The multivariate logistic regression analysis revealed the duration of psoriasis (P = .0005), age (P = .0038), PASI (P = .0050), and HAQ-DI (P = .0193) as predictors of the MoCA score.MCI is present in a significant proportion of PsA patients, and is mainly determined by age, cutaneous variables, and disability.     

Effects of robot (SUBAR)-assisted gait training in patients with chronic stroke: Randomized controlled trial

Background:SUBAR is a new ground walking exoskeletal robot. The objective of this study is to investigate SUBAR-assisted gait training''s effects in patients with chronic stroke.Methods:This preliminary study is a prospective randomized controlled trial. Thirty adults were enrolled 6 months after the onset of stroke with functional ambulation category scores ≥ 3. Patients were randomly assigned to receive robot-assisted gait training (SUBAR group, n = 15) or conventional physiotherapy (control group, n = 15). All patients received a total of 10 treatment sessions of 30 minutes each for 3 weeks. Before and after the 10-treatment sessions, patients were evaluated. The primary outcome is the 10 meter walk test and the secondary outcomes were the functional ambulation category scale, the Motricity Index-Lower, Modified Ashworth Scale (MAS), timed up and go, Rivermead Mobility Index, Berg Balance Scale (BBS), and gait analysis.Results:In the SUBAR group, MAS and step length were significantly improved between pre- and posttreatment measurements (Δmean ± SD: −1.1 ± 1.6 and 5.5 ± 7.6, P = .019 and .016, respectively). The SUBAR group improved the stride length and step length of the affected limb but not significantly. The control group had significant improvements in the BBS, MAS, and stride length between pre- and posttreatment measurements (Δmean ± SD: 3.5 ± 4.6, −0.8 ± 1.5, and 6.5 ± 9.5; P = .004, .031, and .035, respectively). The BBS improved more in the control group than in the SUBAR group. There were no other differences between the SUBAR group and the control group.Conclusion:Our results suggest that SUBAR-assisted gait training improved gait parameters in patients with chronic stroke. However, there was no significant difference in most outcome measures compared to conventional physiotherapy. Further research is warranted to measure the effects of SUBAR-assisted gait training.     

Vagus nerve stimulation for upper limb motor impairment after ischemic stroke: A meta-analysis

Background:Upper limb motor impairment is a common complication following stroke. Although few treatments are used to enhance motor function, still approximately 60% of survivors are left with upper limb motor impairment. Several studies have investigated vagus nerve stimulation (VNS) as a potential technique for upper limb function. However, the efficacy and safety of VNS on upper limb motor function after ischemic stroke have not been systematically evaluated. Therefore, a meta-analysis based on randomized controlled trial will be conducted to determine the efficacy and safety of VNS on upper limb motor function after ischemic stroke.Method:We searched PUBMED, MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Library (CNKI), and Wan Fang Database until April 1, 2021.Results:Six studies consisting of 234 patients were included in the analysis. Compared with control group, VNS improved upper limb function via Fugl-Meyer Assessment-Upper Extremity (mean difference = 3.26, 95% confidence interval [CI] [2.79, 3.74], P < .00001) and Functional Independence Measurement (mean difference = 6.59, 95%CI [5.77, 7.41], P < .00001), but showed no significant change on Wolf motor function test (standardized mean difference = 0.31, 95%CI [–0.15, 0.77], P = .19). The number of adverse events were not significantly different between the studied groups (risk ratio = 1.05, 95%CI [0.85, 1.31], P = .64).Conclusion:VNS resulted in improvement of motor function in patients after ischemic stroke, especially in the sub-chronic stage. Moreover, compared with implanted VNS, transcutaneous VNS exhibited greater efficacy in poststroke patients. Based on this meta-analysis, VNS could be a feasible and safe therapy for upper limb motor impairment.     

A Cohort Study of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction: A Real-World Experience in Clinical Practice

Decompressive hemicraniectomy with malignant middle cerebral artery (MCA) infarction is effective but remains underutilized. The aim of this study was to observe the utilization of this intervention in mainland China.We included patients with malignant MCA infarction who admitted in West China Hospital between December 2007 to March 2011. The outcomes were death and favorable outcome (mRS < 4) at 1 month and 1 year. The multivariate logistic regression model was used to identify the independent predictors for outcomes.Ten percent (219/2174) of patients with acute ischemic stroke had malignant MCA infarction and 31.1% (68/219) patients meet the criteria that ≤60 years of age and the timing to hospital <48 hours after stroke onset. Of them, 18 patients (26.5%) underwent to decompressive hemicraniectomy. In total, 31 patients (14.2%) underwent the decompressive surgery. The average age was 53 ± 12 years; median NIHSS score was 21. The case fatality rate of patients in surgery group was significantly lower than those of in nonsurgery group at 1 month and 1 year follow-ups (32.3% and 38.7% vs. 51.1% and 61.2%, respectively, P < 0.05). Patients in surgery group had a higher proportion of good outcome at 1 year follow-up (32.2% vs. 13.3%, P = 0.006). After adjusting for confounders including age, sex, NIHSS score, and GCS score on admission, decompressive hemicraniectomy was an independent predictor of good outcome for 1 year (OR = 3.44, 95% CI, 1.27–9.31).This study shows better outcomes in the surgical group, which are consistent with findings in previous prospective randomized trials. However, this beneficial intervention remains underutilized in clinical settings.     

Predictive value of Alberta stroke program early CT score for perfusion weighted imaging - diffusion weighted imaging mismatch in stroke with middle cerebral artery occlusion

This study aimed to quantitatively assess the consistency and correlation between perfusion weighted imaging (PWI)/ diffusion weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) mismatch and PWI/DWI mismatch.Sixty-eight acute ischemic stroke with middle cerebral artery occlusion who underwent magnetic resonance imaging before thrombectomy were eligible. DWI volume, PWI volume and PWI-DWI mismatch were measured. DWI-, PWI-, PWI-DWI ASPECTS were evaluated. Statistical analysis was performed to compare the correlation between volume and ASPECTS of DWI-, PWI- and PWI-DWI mismatch. Receiver operating characteristic curve analysis was used to assess the predictive value of the PWI-DWI ASPECTS mismatch for the occurrence of PWI-DWI mismatch in acute ischemic stroke patients with middle cerebral artery occlusion.Of 68 patients, the DWI volume, PWI volume and PWI-DWI mismatch volume were (27.76 ± 17.53) mL, (167.09 ± 59.64) mL and (139.33 ± 58.18) mL respectively. DWI-ASPECTS was 6.75 ± 1.90 with the interobserver agreement was κ=0.98 (95% CI, 0.95–0.99); PWI-ASPECTS was 3.09 ± 2.11 with the interobserver agreement was κ=0.95 (95% CI, 0.91–0.99); PWI-DWI ASPECTS mismatch was 6.75 ± 1.90. Spearman''s rank correlation analysis revealed that PWI-DWI mismatch volume was negatively correlated with PWI-DWI ASPECTS mismatch (r = −0.802; P = .000). Receiver operating characteristic analysis showed that when the PWI-DWI ASPECTS mismatch cut point was ≥ 2, the under curve of PWI-DWI ASPECTS mismatch for predicting PWI-DWI mismatch was 0.954 (95%CI, 0.911–0.998), with the sensitivity and specificity were 84.00% and 100% respectively.PWI-DWI ASPECTS mismatch may represent a convenient surrogate for penumbra in clinical trials.     

Effects of a food preparation program on dietary well-being for stroke patients with dysphagia: A pilot study

Background:Dysphagia is one of the common issues observed in patients with stroke. Stroke patients with dysphagia have to eat blended food or similar types of food for each meal, resulting in dietary dissatisfaction. The purpose of this study was to investigate the effects of a food preparation program on dietary well-being for stroke patients with dysphagia.Methods:This study was a pilot randomized clinical trial. Twenty-two patients were assigned randomly into the food preparation group (n = 11) and control group (n = 11). The food preparation group received oral motor exercises, recognition of food texture and thickener, and hands-on food preparation for 6 weeks. Outcome measures included the Dietary Well-Being Scale, brief version of the World Health Organization Quality of life, Swallowing Quality of Life Questionnaire, and Mini Nutritional Assessment.Results:Patients in the food preparation group showed significant improvements in the Dietary Well-Being Scale, psychological and environmental domains of the brief version of the World Health Organization Quality of life (P = .001–.024) with small to large effect sizes (success rate difference = 0.23–0.46). The Swallowing Quality of Life Questionnaire and Mini Nutritional Assessment displayed non-significant differences (P = .053–.092) and revealed small to moderate effect sizes (success rate difference = 0.23–0.32).Conclusions:The food preparation program showed a positive impact on dietary well-being and a potential improvement in the health-related quality of life, quality of life related to the process of swallowing, and nutritional status for stroke patients with dysphagia. We recommend that stroke patients with dysphagia receive adequate knowledge and hands-on food preparation training to increase their dietary intake and well-being.     

Attentional abilities and functional outcomes following stroke

Although stroke affects cognitive functioning as well as motor functioning, research on cognitive consequences has lagged behind that focused on motor function. The evidence that is accruing suggests that cognitive function is importantly related to successful rehabilitation. The present study examined two aspects of attentional functioning (divided attention and switching attention) in older adult stroke survivors and healthy older adults. In addition, the authors investigated the relation between attention and functional outcomes following stroke. Results revealed stroke-related deficits in both of the types of attention as well as significant associations between attentional functioning and both physical and social outcome measures. Poorer attentional performance was associated with a more negative impact of stroke on daily functioning. These findings suggest an important role for attention in post-stroke function and provide information that can contribute to improving outcomes following stroke.     

The validation of oxygen uptake efficiency slope in patients with stroke

To evaluate the real aerobic capacity is difficult due to impaired limbs function in stroke patients. Oxygen uptake efficiency slope (OUES) could represent the aerobic capacity in submaximal exercise test. Hence, we designed this observational study to investigate the application of the OUES for evaluating aerobic capacity in these patients.Thirty-seven stroke patients were classified into 2 groups according to their Brunnstrom stage of affected lower limbs. Patients underwent cardiopulmonary exercise testing to assess cardiorespiratory fitness. Minute ventilation and oxygen consumption were measured, and OUES was calculated, compared with healthy reference values, and correlated with the peak oxygen consumption. The predictive validity of submaximal OUES was derived.Study participants’ OUES (median 566.2 [IQR, 470.0-711.6]) was 60% of healthy reference values and correlated positively with the peak oxygen consumption (r = 0.835) (P < .01). The predictive validity of oxygen uptake efficiency slope at 50% of maximal exercise duration (OUES₅₀) and oxygen uptake efficiency slope at 75% of maximal exercise duration (OUES₇₅) for oxygen uptake efficiency slope at 100% of maximal exercise duration (OUES₁₀₀) was 0.877 and 0.973, respectively (P < .01). The OUES₅₀, OUES₇₅, and OUES₁₀₀ groups were not significantly different; agreement of submaximal and maximal OUES values was strong.OUES is a valuable submaximal index for evaluating cardiorespiratory fitness in stroke patients. Moderate-to-high concurrent validity of this parameter with peak oxygen consumption and the high predictive validity of OUES₅₀ and OUES₇₅ for OUES₁₀₀ suggest maximal exercise testing in stroke patients who cannot reach maximal exercise is unnecessary.     

Road towards promoting patient safety practices among hospital pharmacists: Hospital-based baseline patient safety culture assessment cross-sectional survey

Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor''s degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%–74%). The highest PRR was observed in teamwork (74.4%), followed by ‘staff, training and skills’ (68%), and ‘organizational learning continuous improvement’ (66%). The lowest PRR was observed in ‘staffing, work pressure, and pace’ (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents’ demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.