RESUMEN
BACKGROUND: The objective of this study was to analyze the impact of two forms of secondary preventive follow-up on the association between education level and levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) after stroke/transient ischemic attack (TIA). METHODS: We included a population-based cohort of 771 stroke and TIA patients randomly assigned (1:1) to secondary preventive follow-up within primary health care (control) or nurse-led, telephone-based follow-up (intervention) between January 1, 2010, and December 31, 2013, as part of the NAILED (nurse-based age-independent intervention to limit evolution of disease) stroke risk factor trial. We compared BP and LDL-C levels 12 months after hospital discharge in relation to education level (low, ≤10 years; high, >10 years) separately for the intervention and control groups. RESULTS: Among controls, systolic BP (SBP) decreased only among the highly educated (-2.5 mm Hg, 95% confidence interval (CI) -0.2 to -4.8), whereas LDL-C increased in the low-education group (0.2 mmol/L, 95% CI 0.1 to 0.3). At 12 months, controls with low education not more than 70 years of age had higher SBP than controls of the same age with high education (5.8 mm Hg, 95% CI 1.0 to 10.6). In contrast, SBP in the intervention group decreased similarly regardless of education level, LDL-C decreased among those with low education (-0.3 mmol/L, 95% CI -0.2 to -0.4) and, in the subgroup not more than 70 years old, low-educated participants had lower LDL-C at 12 months than those with high education (0.3 mmol/L, 95% CI 0.1 to 0.5). CONCLUSIONS: Nurse-led, telephone-based secondary preventive follow-up led to comparable improvements in BP across education groups, while routine follow-up disfavored those with low education. TRIAL REGISTRATION: ISRCTN Registry ISRCTN23868518 , June 19, 2012 - Retrospectively registered.
Asunto(s)
Escolaridad , Ataque Isquémico Transitorio/enfermería , Rol de la Enfermera , Educación del Paciente como Asunto/métodos , Prevención Secundaria/métodos , Accidente Cerebrovascular/enfermería , Teléfono , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Biomarcadores/sangre , Presión Sanguínea , LDL-Colesterol/sangre , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipolipemiantes/uso terapéutico , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Ataque Isquémico Transitorio/psicología , Masculino , Persona de Mediana Edad , Factores Protectores , Factores de Riesgo , Conducta de Reducción del Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Suecia , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Among members of the health care team, nurses play a large role in actively engaging stroke survivors in secondary stroke prevention programs. This systematic review and meta-analysis examines the effectiveness of interventions in which nurses have a primary role on modification of risk factors among stroke survivors. METHODS: We systematically searched for randomized controlled trials in relevant databases investigating the role of nurses in secondary stroke prevention. Meta-analyses were conducted using Cochrane Review Manager Software. The mean pooled effect size, a 95% confidence interval (CI), and I-squared ( I2) for heterogeneity were calculated. RESULTS: Sixteen randomized controlled trials were included with a total of 3568 stroke and transient ischemic attack patients. After removing one outlier, the models demonstrated a statistically significant effect on reducing systolic blood pressure (SMD = -0.14 (95% CI = -0.23, -0.05), I2 = 0%; p = 0.002, six studies, n =1885) and diastolic blood pressure (SMD = -0.16 (95% CI = -0.27, -0.05), I2 = 0%; p = 0.003, four studies, n =1316). The interventions also significantly improved physical activity (five studies, n=1234), diet (three studies, n=425), medication adherence (two studies, n=270), and knowledge of risk factors (three studies, n=516). However, there was no effect on smoking cessation or reduction in use of alcohol. CONCLUSION: We found that interventions in which nurses had a primary role were effective on improving medical and behavioral risk factors, as well as knowledge of risk factors as part of secondary prevention of stroke.
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Enfermería Cardiovascular/métodos , Ataque Isquémico Transitorio/enfermería , Ataque Isquémico Transitorio/prevención & control , Rol de la Enfermera , Prevención Secundaria/métodos , Accidente Cerebrovascular/enfermería , Accidente Cerebrovascular/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
BACKGROUND: Studies have shown that counseling about risk factor-related lifestyle habits can produce significantly beneficial changes in the lifestyle habits of patients with stroke. However, it is not sufficient only to provide a patient with appropriate information, but the quality of lifestyle counseling is also essential. The aim of the study was to investigate the effects of a lifestyle counseling intervention on lifestyle counseling quality in patients with stroke and transient ischemic attack. METHODS: Posttest control group design was used. Patients with stroke and transient ischemic attack (n = 98), divided into intervention and control groups, completed the Counseling Quality Questionnaire after receiving lifestyle counseling at the hospital (January 2010 to October 2011). Data were analyzed with an analysis of variance. RESULTS: The patients rated lifestyle counseling quality quite high in terms of all sum variables except patient centeredness. Counseling quality except for counseling resources was estimated to be significantly better by the intervention group. CONCLUSIONS: Lifestyle counseling quality at the hospital can be enhanced by a counseling intervention. More attention to factors that promote patient centeredness of counseling is required because patient centeredness has repeatedly been recognized as the weakest aspect of counseling by both patients with stroke and other patient groups.
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Consejo/métodos , Ataque Isquémico Transitorio/enfermería , Estilo de Vida , Accidente Cerebrovascular/enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y CuestionariosAsunto(s)
Consejo/métodos , Ataque Isquémico Transitorio/enfermería , Estilo de Vida , Enfermería en Neurociencias/métodos , Calidad de Vida/psicología , Accidente Cerebrovascular/enfermería , Femenino , Finlandia , Humanos , Ataque Isquémico Transitorio/terapia , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/terapiaRESUMEN
BACKGROUND: Acute stroke care includes cardiac rhythm monitoring in the first 24 hours. The method of monitoring varies, as do the reported findings. The nurses' role in this process can be intensive, including primary response and review of all data. Competency is critical as the acute stroke setting can be associated with life-threatening dysrhythmias as well as the detection of atrial fibrillation that affects therapy. Limited studies exist to evaluate the effectiveness of a unit-based cardiac monitoring system for which the bedside nurse has primary responsibility. OBJECTIVE: The goal was to determine if a unit-based cardiac monitoring system for which the bedside nurse was responsible detected clinically significant dysrhythmias. METHODS: Stroke unit nurses completed a mandatory education program on identifying common dysrhythmias and using the monitoring equipment along with a structured algorithm for cardiac dysrhythmia detection. The nurse was responsible for all alarms as well as review of their patients' data. Their findings were recorded and reviewed by a cardiology team after the 24-hour monitoring was completed. A total of 300 consecutive stokes, transient ischemic attack, and possible stroke patients were enrolled. RESULTS: Nurses identified 96% of all significant dysrhythmias. Twenty-eight percent of the stroke patients had a dysrhythmia, of which 79% were atrial fibrillation/atrial flutter. The bedside nurses did identify all 8 new atrial fibrillation cases. CONCLUSION: Stroke unit nurses who complete an educational program can identify dysrhythmias on their patients' unit-based cardiac monitoring systems and can improve patient outcomes.
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Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/enfermería , Ataque Isquémico Transitorio/complicaciones , Accidente Cerebrovascular/complicaciones , Telemetría , Adulto , Anciano , Anciano de 80 o más Años , Electrocardiografía , Femenino , Humanos , Ataque Isquémico Transitorio/enfermería , Masculino , Persona de Mediana Edad , Rol de la Enfermera , Accidente Cerebrovascular/enfermería , Adulto JovenRESUMEN
BACKGROUND: Enhanced cardiovascular secondary preventive follow-up is needed to improve adherence to recommended low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) levels. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of recurrent events. Secondary prevention is therefore essential in these patients. METHODS: Patients with acute coronary syndrome, stroke, or transient ischemic attack were randomized to nurse-based telephone follow-up (intervention) or usual care (control). LDL-C and BP were measured at 1 month (baseline) and 12 months post-discharge. Intervention patients with above-target values at baseline received medication titration to achieve treatment goals. Values measured for control patients were given to the patient's general practitioner for assessment. RESULTS: The final analyses included 225 intervention and 215 control patients with DM or CKD. Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26). Among patients with above-target values at baseline, 52.3 % of intervention patients reached target LDL-C values at 12 months versus 21.3 % of control patients (absolute difference of 30.9 %, 95 % CI 16.1 to 43.8 %), and there was a non-significant trend of more intervention patients reaching target SBP (49.4 % versus 36.8 %; absolute difference of 12.6 %, 95 % CI -1.7 to 26.2 %). CONCLUSIONS: Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD. TRIAL REGISTRATION: ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).
Asunto(s)
Síndrome Coronario Agudo/prevención & control , Ataque Isquémico Transitorio/prevención & control , Prevención Secundaria/métodos , Accidente Cerebrovascular/prevención & control , Síndrome Coronario Agudo/tratamiento farmacológico , Síndrome Coronario Agudo/enfermería , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , LDL-Colesterol/sangre , Diabetes Mellitus , Angiopatías Diabéticas/complicaciones , Femenino , Humanos , Ataque Isquémico Transitorio/tratamiento farmacológico , Ataque Isquémico Transitorio/enfermería , Masculino , Recurrencia , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/enfermería , TeléfonoRESUMEN
A unique extant database to explain heterogeneity in peripheral immune response (PIR) over time in response to stroke/transient ischemic attack (TIA) was used to compare changes in PIR between first-time and recurrent stroke/TIA and to identify distinct and common trajectories of change in the PIR in stroke/TIA. Associations between risk factors for stroke (hypertension, smoking, diabetes, hypercholesterolemia, infection) and PIR trajectory were quantified using multivariate random effects modeling. With comparable admission values, patients with recurrent stroke/TIA had a persistent elevation in lymphocyte percentage as opposed to the significant decline in lymphocyte percentages over time observed in those with first-time stroke/TIA. Two naturally occurring trajectories of the PIR to stroke/TIA were observed, one indicative of a primed PIR and one indicative of an unprimed PIR. A large proportion of the sample, 80%, was classified as having persistently higher lymphocyte percentages and lower neutrophil percentages over time compared with the remainder of the sample. When controlling for risk factors for stroke, adults admitted with recurrent stroke/TIA without infection were more than three times as likely to have a primed PIR (i.e., the high lymphocyte-low neutrophil trajectory) than those with first-time stroke with infection. Interventions for reduction of neurological deficits require tight implementation windows early after stroke occurs. The outlined classification of cases in these primed and unprimed trajectories of the PIR adds to the knowledge of optimal clinical timing for de novo immune-based interventions.
Asunto(s)
Ataque Isquémico Transitorio/inmunología , Ataque Isquémico Transitorio/enfermería , Recuento de Leucocitos , Recuento de Linfocitos , Neutrófilos/inmunología , Accidente Cerebrovascular/inmunología , Accidente Cerebrovascular/enfermería , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Examen Neurológico/enfermería , Pronóstico , Recurrencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
AIMS AND OBJECTIVES: To describe and explain the lifestyle habits of hospital-admitted stroke patients by identifying relationships between the different lifestyle habits and by examining associations between them and clinical measurements. BACKGROUND: Stroke is associated with several risk factors that are closely intertwined. However, lifestyle factors have profound effects on its incidence. It has been shown that healthy lifestyle habits are associated with a reduced stroke risk both in combination and independently. DESIGN: A cross-sectional, exploratory study. METHODS: Data were collected from stroke and transient ischemic attack (TIA) patients (n = 150) in an acute neurology unit in Finland between January 2010 and October 2011 using the Lifestyle Instrument. Data analysis was performed by cross-tabulation of variables, factor analysis, analysis of variance and logistic regression. RESULTS: Patients with a mean age of 56·5 participated. Based on their body mass index, most were overweight (43·2%) or obese (31·8%). Their waist circumference levels indicated significant health problems in most cases (70%). Their mean glucose (5·6 mmol/l) and blood pressure (149·9/86·7 mmHg) levels were also above the guideline values. The participants had diverse risk factor-related lifestyle habits. There were several statistically significant differences between the different lifestyle habits and most of the clinical data were at least partly explained by the lifestyle habits. CONCLUSIONS: The participants in this study had many lifestyle habits that are associated with stroke risk factors, exposing them to an elevated risk of a new stroke in the future. RELEVANCE TO CLINICAL PRACTICE: It is an important obligation for nursing staff courageously to bring up the lifestyle habits at the hospital phase and point out that there is a relationship between them and stroke incidence and that secondary stroke can be prevented or made less likely by adopting a healthy lifestyle.
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Admisión del Paciente , Asunción de Riesgos , Accidente Cerebrovascular/epidemiología , Índice de Masa Corporal , Estudios Transversales , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/enfermería , Modelos Logísticos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/enfermeríaAsunto(s)
Enfermería de Urgencia , Ataque Isquémico Transitorio/enfermería , Evaluación en Enfermería , Enfermería Basada en la Evidencia , Humanos , Ataque Isquémico Transitorio/complicaciones , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Accidente Cerebrovascular/etiologíaAsunto(s)
Diagnóstico Precoz , Conocimientos, Actitudes y Práctica en Salud , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/enfermería , Personal de Enfermería en Hospital/psicología , Evaluación de Síntomas/enfermería , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Factores de RiesgoRESUMEN
GOALS: The aims of this study were to determine if the infection rate differs between the first and recurrent ischemic stroke/transient ischemic attack (TIA), if the pattern of the peripheral immune response (PIR) differs between the first and recurrent ischemic stroke/TIA and if infection further influenced the pattern of the PIR. METHODS: Retrospective review of 500 stroke cases with strict exclusion criteria (e.g., hemorrhagic stroke, subarachnoid hemorrhage, or spontaneous intracerebral hemorrhage; history of cancer; on steroids or immune suppressive drugs; recent invasive procedure) resulted in inclusion of 198 cases. Independent variables were first stroke or recurrent stroke and not infected or infected cases. Main-effect dependent variables were the white blood cell (WBC) and differential leukocyte counts (percentages of 100 cell counts for neutrophils, lymphocytes, and monocytes and absolute counts of neutrophils, lymphocytes, and monocytes). FINDINGS: Infection rate was not different between the first versus recurrent stroke (p = .279). The pattern of WBC and differential counts were not different between groups, but addition of the covariate of infection showed group differences (p = .05). A four-group comparison of the dependent variables with the laboratory normal ranges showed lymphocyte percentages below the lower range limit in all four groups. Generalized linear modeling showed a modest rise (15%) in WBC counts in both groups with concomitant infection, a modestly low (-18%) lymphocyte percentage in recurrent stroke with infection, and a more substantial rise (22%-26%) in absolute neutrophil count in both groups with concomitant infection. CONCLUSIONS: Infection influences the pattern of the PIR in the first and recurrent stroke/TIA, and this difference can be quantified.
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Isquemia Encefálica/inmunología , Isquemia Encefálica/enfermería , Infección Hospitalaria/inmunología , Infección Hospitalaria/enfermería , Inmunidad Celular/inmunología , Ataque Isquémico Transitorio/inmunología , Ataque Isquémico Transitorio/enfermería , Recuento de Leucocitos , Accidente Cerebrovascular/inmunología , Accidente Cerebrovascular/enfermería , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Neutrófilos/inmunología , Recurrencia , Valores de Referencia , Factores de RiesgoRESUMEN
The speech-language pathologist (SLP) standardized a Nursing Bedside Swallowing Screen (NBSS) tool for all patients admitted to the hospital. The adults engaged in the NBSS before oral intake (i.e., medication included) as part of the Brain Attack Pathway for patients with neurological symptoms. If the patient failed the NBSS in the emergency department (ED), then the screen was repeated again after the patient had been admitted before the SLP dysphagia evaluation. Fifty-three male and female patients ranging from 34 to 96 years old with an initial diagnosis of stroke or transient ischemic attack (TIA) admitted during an 8-week time period from April 25, 2010, to June 19, 2010, were included in this study. There were 32 women and 17 men including 27 strokes and 22 TIAs tested. As a whole, the NBSS and SLP dysphagia evaluation results were consistent with each other for 40 of 46 patients (86.96% perfect agreement). The NBSS had 74% of sensitivity (34 of 46) with the nursing and the speech pathologist in agreement with the patients passing the swallow screen. Accurate identification of aspiration with the patients failing the NBSS was evident with the nursing and speech pathology assessment, which resulted in 83% of sensitivity (10 of 12). The positive predictive value with the corresponding identification of aspiration with the staff was 96% (44 of 46). The naturalistic observation of the patients exhibited internal consistency reliability between the two disciplines. Extraneous variables affecting the results included spontaneous resolution of stroke or TIA symptoms or the patient's decline in neurological status. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/JNN/A9.
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Trastornos de Deglución/diagnóstico , Trastornos de Deglución/enfermería , Especialidades de Enfermería/métodos , Especialidades de Enfermería/normas , Agua , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/etiología , Femenino , Humanos , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/enfermería , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Persona de Mediana Edad , Evaluación en Enfermería/métodos , Evaluación en Enfermería/normas , Reproducibilidad de los Resultados , Patología del Habla y Lenguaje/métodos , Patología del Habla y Lenguaje/normas , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/enfermeríaRESUMEN
When someone has a stroke it can cause death or severe disability. However, advances in treatment have changed the way professionals need to respond. Nurses must recognise the signs of stroke and understand why prompt action can save more of the brain. They also need to recognise and respond appropriately to transient ischaemic attacks, which can warn of impending stroke, and to support people in reducing their individual risk.
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Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/enfermería , Accidente Cerebrovascular/enfermería , Accidente Cerebrovascular/prevención & control , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Rol de la Enfermera , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Reduction of blood pressure (BP) after stroke or TIA decreases stroke recurrence and is a major goal ofsecondary Stroke Prevention Clinics (SPCs). Health care providers need effective screening processes to identify those clients at highest risk of not achieving BP targets and those clients at highest risk ofnon-adherence to medication. METHODS: This multicentred, randomized controlled study used a screening process to identify SPC patients with psychosocial/cognitive deficits (e.g., lack of confidence in the utility of medications, poor memory, mild cognitive impairment) who were experiencing difficulty managing their BP to target values and evaluated whether a model of nurse-led case management program (monthly telephone calls, motivational interviewingfor lifestyle change, plus home BP monitoring and use ofdosettes for medication administration) would improve BP measures and adherence to medications. RESULTS: Both intervention (n=29) and usual care groups (n=27) showed a trend-for'reduced BP at six months (Median ql-q3, Systolic BR p=0.46; Diastolic BR p=0.37). Diabetic patients, irrespective of the group to which they were randomized, were less likely to meet Best Practice Guideline targets than those without diabetes (Chi Square test, p=0.0001). CONCLUSION: Stroke and TIA patients with diabetes may require additional resources and support in order to reach BP target values.
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Antihipertensivos/uso terapéutico , Manejo de Caso , Hipertensión/tratamiento farmacológico , Hipertensión/enfermería , Ataque Isquémico Transitorio/enfermería , Accidente Cerebrovascular/enfermería , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , AutoeficaciaRESUMEN
PURPOSE: To identify the incidence of adverse events (AE) that occurred in stroke survivors during the first year following discharge from inpatient rehabilitation and to determine the type and patterns of AE. METHODS: Data were collected for 12 months on events resulting in admissions to the emergency department, hospital, long-term care facility, or death. Descriptive statistics were used to depict the patterns of AE and univariate comparisons were made of the differences between survivors who did or did not experience one or more AE. RESULTS: Of the 159 participants, 50% reported a total of 163 AE. Most AE (82.2%) were unexpected and the majority occurred during the first 6 months; 12 recurrent strokes and 6 transient ischemic attacks occcurred. CONCLUSIONS: Education on prevention and treatment of common AE is important prior to discharge. Anticipatory guidance may help survivors and caregivers modify their lifestyle and prevent common AE.
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Alta del Paciente , Enfermería en Rehabilitación , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/enfermería , Sobrevivientes , Anciano , Femenino , Humanos , Incidencia , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/enfermería , Ataque Isquémico Transitorio/rehabilitación , Masculino , Persona de Mediana Edad , Recurrencia , Accidente Cerebrovascular/epidemiologíaRESUMEN
BACKGROUND: Secondary prevention after stroke and transient ischemic attack (TIA) is essential in order to reduce morbidity and mortality. Secondary stroke prevention studies have, however, been fairly small, or performed as clinical trials with non-representative patient selection. Long-term follow-up data is also limited. A nurse-led follow-up for risk factor improvement may be effective but the evidence is limited. The aims of this study are to perform an adequately sized, nurse-led, long-term secondary preventive follow-up with a population-based inclusion of stroke and TIA patients. The focus will be on blood pressure and lipid control as well as tobacco use and physical activity. METHODS: A randomized, controlled, long-term, population-based trial with two parallel groups. The patients will be included during the initial hospital stay. Important outcome variables are sitting systolic and diastolic blood pressure, LDL cholesterol and total cholesterol. Outcomes will be measured after 12, 24 and 36 months of follow-up. Trained nurses will manage the intervention group with a focus on reaching set treatment goals as soon as possible. The control group will receive usual care. At least 200 patients will be included in each group, in order to reliably detect a difference in mean systolic blood pressure of 5 mmHg. This sample size is also adequate for detection of clinically meaningful group differences in the other outcomes. DISCUSSION: This study will test the hypothesis that a nurse-led, long-term follow-up after stroke with a focus on reaching set treatment goals as soon as possible, is an effective secondary preventive method. If proven effective, this method could be implemented in general practice at a low cost. TRIAL REGISTRATION: Current Controlled Trials ISRCTN23868518.
Asunto(s)
Ataque Isquémico Transitorio/enfermería , Proyectos de Investigación , Conducta de Reducción del Riesgo , Prevención Secundaria/métodos , Accidente Cerebrovascular/enfermería , Factores de Edad , Antihipertensivos/uso terapéutico , Protocolos Clínicos , Progresión de la Enfermedad , Ejercicio Físico , Humanos , Hipolipemiantes/uso terapéutico , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/etiología , Medición de Riesgo , Factores de Riesgo , Cese del Hábito de Fumar , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Suecia , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIMS AND OBJECTIVES: To explore how a stroke or a transient ischemic attack affects quality of life and to identify gender differences. BACKGROUND: The negative effect of a stroke on the patients' quality of life has previously been studied, while the effect on patients with transient ischemic attack (TIA) is more unknown, especially in relation to gender. As poor quality of life may have a negative effect on rehabilitation it is important to investigate quality of life in this group. DESIGN: A descriptive cross-sectional survey. METHODS: All stroke and transient ischemic attack patients appointed to the out-patient stroke clinic between May 2008-August 2009 were asked to complete the Nottingham Health Profile. RESULTS: Of 1048 patients, 379 (50%) of the stroke patients and 117 (40%) of the patients with transient ischemic attack completed the form within the first months after onset. Female stroke patients were significantly more negatively affected in all domains except the social domain than were male stroke patients. Female transient ischemic attack patients were significantly more negatively affected in all domains than were male transient ischemic attack patients. Male stroke patients had a significantly more negatively affected quality of life than male transient ischemic attack patients in the emotional, energy, social and total domains, while female stroke patients and female transient ischemic attack patients were equally negatively affected. CONCLUSIONS: This study shows that female stroke patients are more negatively affected in their quality of life than male stroke patients and that female transient ischemic attack patients are as affected as female stroke patients. This indicates that female patients with both stroke and TIA need more attention concerning their life situation. RELEVANCE TO CLINICAL PRACTICE: Increased knowledge about how transient ischemic attack patients are affected, indicate that this group need support postdischarge to the same extension as stroke patients.
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Ataque Isquémico Transitorio/psicología , Ataque Isquémico Transitorio/rehabilitación , Pacientes Ambulatorios/psicología , Calidad de Vida , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/psicología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Ataque Isquémico Transitorio/enfermería , Masculino , Persona de Mediana Edad , Factores Sexuales , Accidente Cerebrovascular/enfermeríaRESUMEN
INTRODUCTION: Ankle brachial index (ABI) is not widespread in clinical practice because the need for specific equipment and training. Doing it without these requirements, quicker and with a cheaper method would facilitate their routine use. AIMS: To evaluate sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90, when technique is performed by nurses. To evaluate agreement between two techniques for the ABI determination. PATIENTS AND METHODS. Diagnostic accuracy study in 30 ischemic stroke patients. For each patient, three measurements were performed with the automatic device, and one with the reference method. RESULTS: The automatic blood pressure device performance detecting ABI < 0.90 was acceptable for each of the three measurements (sensitivity: 78%, 87% and 100%; specificity: 95%, 100% and 100%; positive predictive value: 87%, 100% and 100%; negative predictive value: 91%, 96% y 100%; accuracy: 90%, 97% y 100%). The intraclass correlation coefficients for intra-observer, inter-observer and inter-method variability showed acceptable levels, with results of 0.64, 0.83 and 0.75, respectively. In the Bland Altman test only inter-method comparison had less than 5% of its values out of range. CONCLUSIONS: Sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90 shows acceptable levels when technique is performed by nurses. This suggests its potential as screening tool in transient ischemic attack/ischemic stroke patients.