The quality of acute stroke units on a nation-wide level: the Austrian Stroke Registry for acute stroke units

Concepts for stroke units that cover the acute phase vary. Therefore, the network of acute stroke units that is being set up in Austria in a uniform way is of general interest. This nationwide network has been established in accordance to evidence-based recommendations and prespecified criteria for available resources. The location for such a unit follows a maximum of 90-min isochrones (transport time) to the hospital. The quality of the network is currently documented and the results are reported. A nationwide stroke registry was prospectively performed on 15 stroke units that were already functional in this network. The aim was to document the quality performance of Austrian stroke units, focusing on rapid admissions, ready availability of investigations and therapies performed. Outcome measures were Barthel scale, Rankin score and percentages of complications. Between August 1998 and December 2000, 2,313 patients with ischemic stroke or with primary intracerebral hemorrhage admitted to an Austrian stroke unit within 24 h after onset of symptoms were prospectively included. Forty-three percent of the patients had a moderate or severe stroke. Fifty-seven percent of all patients were admitted to the stroke unit within 3 h after the onset of symptoms. Twenty-seven percent of these patients were brought in by ambulance accompanied by an emergency physician. Two percent of patients were admitted by helicopter. Fifty-four percent of patients had their first brain imaging within 30 min after admission, another 26% within 3 h. Intravenous thrombolysis was performed in 4.1% of patients. The overall stroke-unit mortality was about 6.8% and mortality at 3 months was 12.9%. The outcome at 3 months showed a modified Rankin Scale score of 0 or 1 in 47% of patients, denoting none or mild impairment. This network of acute stroke units is highly efficient in terms of rapid admissions, short intrahospital delays, as well as rapid use of readily available investigations. Stroke units seem to be well accepted by the general public and the medical community because our data show that all types of strokes are treated in Austrian stroke units, including severe strokes. The total number of concurrently treated acute strokes in other institutions across Austria is not known and no formal comparison with other systems of hospitalized care was undertaken, therefore further research is necessary.     

急性脑梗死患者血清超敏-C反应蛋白水平变化及其与TOAST分型关系的研究

目的观察急性脑梗死(ACI)患者超敏-C反应蛋白(hs-CRP)水平变化,及其与急性卒中治疗低分子肝素试验(TOAST)病因分型的关系。方法采用免疫散射比浊法对152例住院ACI患者进行血清hs-CRP水平测定,并按照TOAST标准分为5大亚型,分析TOAST各亚型与hs-CRP水平的关系。结果本组TOAST各亚型构成比为:不明原因型41·45%,小动脉闭塞型34·87%,心源性栓塞型5·26%,大动脉粥样硬化型15·79%,其他明确病因型2·6%。心源性栓塞型hs-CRP水平(11·60±7·85)mg/L、hs-CRP阳性率(87·50%)最高,阳性者hs-CRP水平(25·14±5·12)mg/L亦最高;其余依次为大动脉粥样硬化型(10·77±4·27)mg/L、其他明确病因型(6·45±3·25)mg/L、不明原因型(4·09±5·65)mg/L,而小动脉闭塞型(3·99±0·56)mg/L最低。经Logistic回归多因素分析:年龄、收缩压、胆固醇、三酰甘油、空腹血糖、纤维蛋白原与血清hs-CRP值呈显著正相关(r=0·1640、0·2489、0·2066、0·1866、0·3029、0·2224,均P<0·05)。结论ACI患者血清hs-CRP水平随TOAST亚型的不同而变化,hs-CRP可能在ACI的发生发展中起一定作用。血清hs-CRP水平增高可作为病情评估的指标之一。     

Prevalence of spasticity following stroke and its impact on quality of life with emphasis on disability in activities of daily living. Systematic review

Spasticity is characterized by a velocity-dependent increase in muscle tone related to disturbed sensory-motor control of muscle tone following upper motor neuron damage. Spasticity and its clinical implications are still poorly described. There is no consensus concerning the number of patients developing spasticity or the relationship between spasticity and motor disabilities after stroke. Surprisingly, only a few studies have addressed the prevalence of spasticity following stroke. The present paper aims to review recent studies on prevalence of spasticity, its risk factors and on quality of life with emphasis on disability in activities of daily living and to relate collected data to situation in Poland.     

Outcome on quality of life in a Canadian national sample of patients with schizophrenia and related psychotic disorders

OBJECTIVE: To examine changes in subjective and objective dimensions of quality of life (QoL) in a large Canadian sample of patients with diagnosis of schizophrenia or schizoaffective disorder treated in academic and non-academic settings over a 2-year period. METHOD: Patients recruited in the study across the country were assessed for QoL and functioning using the Client and Provider versions of the Wisconsin Quality of Life Questionnaire (WQoL) and the Short Form-36 (SF-36) at baseline (n = 448), 1 year (n = 308-353) and 2 years (188-297). Data were analyzed to examine change across time using multivariate analyses controlling for potential influence of variables such as age, regional variation, gender, duration of illness, type of treatment taken and baseline measures of symptoms and QoL. RESULTS: The weighted quality of life index (W-QoL-I) showed a significant change on both the client and the provider versions of the WQoL while the physical and mental composites of the SF-36 showed change only at 2 years. These changes were influenced significantly by baseline scores on W-QoL-I and in the case of provider version of the WQoL by baseline Brief Psychiatric Rating Scale (BPRS) scores. Regional variation or type of medication had no impact on improvement in QoL. CONCLUSION: Within a naturalistic sample of schizophrenia patients treated and followed in routine care the overall QoL showed an improvement over time but this improvement was not influenced by the type of medication prescribed.     

Influence of 100% and 40% oxygen on penumbral blood flow,oxygen level,and T2*-weighted MRI in a rat stroke model

Accurate imaging of the ischemic penumbra is a prerequisite for acute clinical stroke research. T₂^* magnetic resonance imaging (MRI) combined with an oxygen challenge (OC) is being developed to detect penumbra based on changes in blood deoxyhemoglobin. However, inducing OC with 100% O₂ induces sinus artefacts on human scans and influences cerebral blood flow (CBF), which can affect T₂^* signal. Therefore, we investigated replacing 100% O₂ OC with 40% O₂ OC (5 minutes 40% O₂ versus 100% O₂) and determined the effects on blood pressure (BP), CBF, tissue p₂, and T₂^* signal change in presumed penumbra in a rat stroke model. Probes implanted into penumbra and contralateral cortex simultaneously recorded p₂ and CBF during 40% O₂ (n=6) or 100% O₂ (n=8) OC. In a separate MRI study, T₂^* signal change to 40% O₂ (n=6) and 100% O₂ (n=5) OC was compared. Oxygen challenge (40% and 100% O₂) increased BP by 8.2% and 18.1%, penumbra CBF by 5% and 15%, and penumbra p₂ levels by 80% and 144%, respectively. T₂^* signal significantly increased by 4.56%±1.61% and 8.65%±3.66% in penumbra compared with 2.98%±1.56% and 2.79%±0.66% in contralateral cortex and 1.09%±0.82% and −0.32%±0.67% in ischemic core, respectively. For diagnostic imaging, 40% O₂ OC could provide sufficient T₂^* signal change to detect penumbra with limited influence in BP and CBF.     

The effects of Nintendo WiiTM-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study

Objective: The aim of this study was to investigate the effects of Nintendo Wii^TM-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. Methods: 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (～8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45–60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. Results: There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). Conclusion: These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.     

Evaluation of an upper limb robotic rehabilitation program on motor functions,quality of life,cognition, and emotional status in patients with stroke: a randomized controlled study

Neurological Sciences - This study aims to find out whether including robotic therapy in addition to a conventional rehabilitation program affects the quality of life, motor function, cognition,...