Prediction of hospital disposition after thrombolysis for acute ischemic stroke using the National Institutes of Health Stroke Scale

BACKGROUND: Early determination of discharge destination after acute stroke may promote earlier rehabilitation and reduce costs by shortening the duration of hospitalization. OBJECTIVE: To determine whether the National Institutes of Health Stroke Scale (NIHSS) score predicts disposition in stroke patients treated with thrombolysis. DESIGN: Cohort study. SETTING: Academic and community hospitals from 3 countries. PATIENTS: Five hundred forty-six patients with acute ischemic stroke treated with recombinant tissue plasminogen activator (rt-PA). INTERVENTIONS: Medical records were reviewed for demographic information, vascular risk factors, location of stroke, initial NIHSS score, acute hospital disposition, and complications of symptomatic or asymptomatic intracerebral hemorrhage (ICH). MAIN OUTCOME MEASURE: Discharge destination to home, acute rehabilitation, or nursing facility. RESULTS: In multinomial regression analysis, increasing NIHSS score was a robust and independent predictor of discharge to rehabilitation or nursing facilities, roughly doubling for each 5-point increment. Patients who developed symptomatic ICH were never discharged to home, but asymptomatic ICH had no significant independent effect on disposition. CONCLUSIONS: Stroke severity as determined by the admission NIHSS score is the major independent predictor of disposition after hospitalization and treatment with rt-PA for acute stroke in a broad-based population. However, symptomatic ICH after rt-PA is a catastrophic event that may preclude discharge to home.     

Management of optic neuritis and impact of clinical trials: an international survey

OBJECTIVE: 1) To evaluate the management of acute isolated optic neuritis (ON) by ophthalmologists and neurologists; 2) to evaluate the impact of clinical trials; 3) to compare these practices among 7 countries. METHODS: A survey on diagnosis and treatment of acute isolated ON was sent to 5,443 neurologists and 6,099 ophthalmologists in the southeast-USA, Canada, Australia/New Zealand, Denmark, France, and Thailand. USA data were compared to those of other countries. RESULTS: We collected 3,142 surveys (1,449 neurologists/1,693 ophthalmologists) (29.8% response rate). In all countries, ON patients more frequently presented to ophthalmologists, and were subsequently referred to neurologists or subspecialists. Evaluation and management of ON varied among countries, mostly because of variations in healthcare systems, imaging access, and local guidelines. A brain MRI was obtained for 70-80% of ON patients; lumbar punctures were obtained mostly in Europe and Thailand. Although most patients received acute treatment with intravenous steroids, between 14% and 65% of neurologists and ophthalmologists still recommended oral prednisone (1 mg/kg/day) for the treatment of acute isolated ON. In all countries, steroids were often prescribed to improve visual outcome or to decrease the long-term risk of multiple sclerosis. INTERPRETATION: Although recent clinical trials have changed the management of acute ON around the world, many neurologists and ophthalmologists do not evaluate and treat acute ON patients according to the best evidence from clinical research. This confirms that evaluation of the impact of major clinical trials ("translational T2 clinical research") is essential when assessing the effects of interventions designed to improve quality of care.     

中国卒中营养标准化管理专家共识

正脑血管病是世界范围内致残率、致死率最高的疾病之一,也是疾病负担最重的疾病之一~([1-4])。根据最新流行病学研究报道,我国脑血管病的患病率、发病率和死亡率分别为1114.8/10万、246.8/10万和114.8/10万~([5])。脑血管病的发生给患者、家属、社会带来巨大的躯体、精神和经济负担~([3,6])。     

American Society for Parenteral and Enteral Nutrition and American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Nutrition Support

The Standards of Practice for Registered Dietitians in Nutrition Support and the Standards of Professional Performance for the Registered Dietitian in Nutrition Support are key resources for RDs at all knowledge and performance levels. These standards can and should be used by RDs in daily practice to consistently improve and appropriately demonstrate competency and value as providers of safe and effective nutrition support therapy. The standards development and evaluation process is dynamic—these standards will be reviewed at least every 5 years for applicability to practice. Current and future initiatives of A.S.P.E.N. and ADA will provide information that will be used in these updates and in further clarifying and documenting the specific roles and responsibilities of practitioners at each level. As a quality initiative of A.S.P.E.N., its Dietetics Practice Section, ADA, and their DNS DPG, the standards themselves are an application of continuous quality improvement concepts and represent another very important collaborative endeavor.     

Growth and catch-up growth of Australian infants of low birthweight

Abstract The growth of 90 infants of low birthweight (1500–2499 g) has been studied longitudinally from birth to 2 years of age. Seventy-five per cent of those infants were of birthweight that was appropriate-for-gestational age (AGA) and of mean gestational age 33.6 weeks (boys) and 34.5 weeks (girls). Twenty-four per cent were small-for-gestational age (SGA) and of mean gestational age 39.4 weeks (boys) and 38.5 weeks (girls). The data showed that, when gestational age was considered, the growth of AGA infants was similar to that of full-term infants of normal birthweight; SGA infants displayed accelerated growth ('catch-up'), particularly in the first months of life with upward percentile crossing from below the 5th toward the 50th. These results provide further evidence of the need to consider gestational age and whether AGA or SGA when assessing the growth of low birthweight infants.     

Relation of bronchial responsiveness to body mass index in the ECRHS. European Community Respiratory Health Survey

BACKGROUND: There is substantial evidence for an association between symptoms of asthma and overweight or obesity. However, a study that reported no association between bronchial responsiveness (BHR) and body mass index (BMI) suggested that the relation of symptoms to obesity was due to increased diagnosis of asthma. The relation of BHR to BMI was therefore investigated in a large multicentre study. METHODS: Data were obtained for 11,277 participants in stage II of the European Community Respiratory Health Survey (ECRHS). BHR to methacholine was analysed in relation to BMI adjusted for a number of factors known to be associated with BHR, including baseline lung function and allergen sensitisation, and combined across 34 centres using random effects meta-analysis. RESULTS: BHR increased with increasing BMI in men (ECRHS slope changed by -0.027 for each unit increase in BMI, 95% confidence interval -0.044 to -0.010, p=0.002), but the relation in women was weak (-0.014, 95% CI -0.033 to 0.005, p=0.14). There was no evidence for an interaction of sex with BMI (p=0.41). CONCLUSIONS: BHR is related to BMI in the ECRHS. This suggests that the association is not due to greater diagnosis or perception of symptoms in obese people compared with those of normal weight. The data do not support the finding by some studies of a relation between asthma and obesity in women but not in men.