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Chuen-Chau Chang, Ta-Liang Chen, Chao-Shun Lin, Chi-Li Chung, Chun-Chieh Yeh, Chaur-Jong Hu, Hsin-Long Lane, Chien-Chang Liao, Chun-Chuan Shih
BACKGROUND: Acupuncture treatment is common among stroke patients, but there is limited information available on whether acupuncture effectively prevents post-stroke pneumonia. The aim of this study was to analyze the differential risk of pneumonia after stroke between patients who did and did not receive acupuncture after discharge. METHODS: We used the Taiwan National Health Insurance Research Database to conduct a retrospective cohort study using propensity score matched-pairs of new stroke patients in 2000-2004 who did and did not receive acupuncture post-stroke...
2018: PloS One
Maja Wästfelt, Yang Cao, Jakob O Ström
BACKGROUND: Fever after stroke is common, and often caused by infections. In the current study, we aimed to test the hypothesis that pneumonia, urinary tract infection and all-cause fever (thought to include at least some proportion of endogenous fever) have different predicting factors, since they differ regarding etiology. METHODS: PubMed was searched systematically for articles describing predictors for post-stroke pneumonia, urinary tract infection and all-cause fever...
April 23, 2018: BMC Neurology
Hidetaka Wakabayashi
Sarcopenia, malnutrition, and polypharmacy are major causes of frailty in older people. Some frail older people become disabled through stroke, pneumonia, hip fracture, and other diseases. Sarcopenia, malnutrition, and polypharmacy tend to worsen disability in older people. Rehabilitation pharmacotherapy and rehabilitation nutrition are important to improve frailty and disability in older people under these circumstances.
March 2018: Journal of General and Family Medicine
Raymond Shim, Connie H Y Wong
Stroke is a leading contributor of death and disability around the world. Despite its recognised debilitating neurological deficits, a devastating clinical complication of surviving stroke patients that needs more attention is infection. Up to half of the patients develop infections after stroke, and a high proportion of them will die as a direct consequence. Major clinical trials that examined preventive antibiotic therapy in stroke patients have demonstrated this method of prevention is not effective as it does not reduce incidence of post-stroke pneumonia or improve patient outcome...
March 20, 2018: Brain, Behavior, and Immunity
Anna Therese Bjerkreim, Andrej Netland Khanevski, Solveig Bergliot Glad, Lars Thomassen, Halvor Naess, Nicola Logallo
Background: Intracerebral hemorrhage (ICH) is the most severe form of stroke, but data on readmission after ICH are sparse. We aimed to determine frequency, causes, and predictors of 30-day readmission after ICH. Materials and Methods: This retrospective cohort study includes all spontaneous ICH survivors admitted to the stroke unit at Haukeland University Hospital in Bergen in Norway from July 2007 to December 2013. Patients were followed by review of electronic medical charts, and the first unplanned readmission within 30 days after discharge was used as final outcome...
March 2018: Brain and Behavior
Lise Sproson, Sue Pownall, Pam Enderby, Jenny Freeman
BACKGROUND: Dysphagia is common after stroke, affecting up to 50% of patients initially. It can lead to post-stroke pneumonia, which causes 30% of stroke-related deaths, a longer hospital stay and poorer health outcomes. Dysphagia care post-stroke generally focuses on the management of symptoms, via modified oral intake textures and adapted posture, rather than direct physical rehabilitation of the swallowing function. Transcutaneous neuromuscular electrical stimulation (NMES) is a promising rehabilitation technology that can be used to stimulate swallowing; however, findings regarding efficacy have been conflicting...
March 2018: International Journal of Language & Communication Disorders
Yuki Inui, Yayoi Kamakura, Junko Fukada, Masahiko Yoneda, Emiko Kataoka, Yasuko Usami, Miki Sugiura, Tetsuya Nagatani, Yukio Seki, Norikazu Hatano, Keizo Yasui
Aspiration due to dysphagia is a factor associated with pneumonia during acute stroke. In such cases, it is likely that secretions in the pyriform sinuses enter the laryngeal inlet. The present study was based on the idea that it is possible to reduce aspiration pneumonia by periodically suctioning and removing such secretions (pyriform sinus suctioning), a study was conducted in a single facility. The incidence of pneumonia as a dependent variable was compared between before (control) and after (intervention group) intervention with pyriform sinus suctioning as an independent variable...
December 2017: Dysphagia
Iryna I Delva, Mykhaylo Y Delva, Volodymyr A Poltorapavlov
INTRODUCTION: Post-stroke fatigue (PSF) is a common stroke complication with long-term negative consequences. AIM: Assess the rates of certain PSF domains within first 3 months after different acute cerebrovascular events (ACE) and identify clinical factors associated with each PSF domain. MATERIAL AND METHODS: There were examined 285 patients (195 with ischemic strokes, 39 with hemorrhagic strokes and 51 with transient ischemic attacks (TIA)) consequently at hospital stay, in 1 month and in 3 months after ACE...
2017: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Anika L Hines, Susan O Raetzman, Marguerite L Barrett, Ernest Moy, Roxanne M Andrews
BACKGROUND: Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor...
February 8, 2017: BMC Health Services Research
Eva Mracsko, Sabine Stegemann-Koniszewski, Shin-Young Na, Alexander Dalpke, Dunja Bruder, Felix Lasitschka, Roland Veltkamp
BACKGROUND: Stroke-induced immunodeficiency increases the risk of infectious complications, which adversely affects neurological outcome. Among those, pneumonia affects as many as one third of stroke patients and is the main contributor to mortality in the post-acute phase of stroke. Experimental findings on post-stroke susceptibility to spontaneous pneumonia in mice are contradictory. Here, we established a mouse model inducing standardized bacterial pneumonia and characterized the impaired pulmonary cellular and humoral immune responses after experimental stroke...
2017: Cerebrovascular Diseases
Sandeep Kumar, Sarah Marchina, Joseph Massaro, Wayne Feng, Sourabh Lahoti, Magdy Selim, Shoshana J Herzig
BACKGROUND: Pneumonia is a serious but a preventable stroke complication. Prediction scales for post-stroke pneumonia have been proposed with an intent to improve surveillance and prevention but they remain under-utilized in clinical practice. Most existing scales were developed using both ventilated and non-ventilated patients which may affect their accuracy. We derived and validated a novel, pragmatic scale to predict hospital-acquired pneumonia (HAP) after stroke employing only a non-ventilated stroke cohort...
January 15, 2017: Journal of the Neurological Sciences
Jeffrey L Carson, Simon J Stanworth, Nareg Roubinian, Dean A Fergusson, Darrell Triulzi, Carolyn Doree, Paul C Hebert
BACKGROUND: There is considerable uncertainty regarding the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients. Blood is a scarce resource, and in some countries, transfusions are less safe than others because of a lack of testing for viral pathogens. Therefore, reducing the number and volume of transfusions would benefit patients. OBJECTIVES: The aim of this review was to compare 30-day mortality and other clinical outcomes in participants randomized to restrictive versus liberal red blood cell (RBC) transfusion thresholds (triggers) for all conditions...
October 12, 2016: Cochrane Database of Systematic Reviews
Dragana Stanley, Linda J Mason, Kate E Mackin, Yogitha N Srikhanta, Dena Lyras, Monica D Prakash, Kulmira Nurgali, Andres Venegas, Michael D Hill, Robert J Moore, Connie H Y Wong
Bacterial infection is highly prevalent in patients who have had a stroke. Despite the potential contribution of micro-aspiration in post-stroke pneumonia, we found that the majority of the microorganisms detected in the patients who developed infections after having a stroke were common commensal bacteria that normally reside in the intestinal tracts. In a mouse model of ischemic stroke, post-stroke infection was only observed in mice that were born and raised in specific-pathogen-free facilities; this was not seen in mice that were born and raised in germ-free facilities...
November 2016: Nature Medicine
S J Li, H Q Hu, X L Wang, B Z Cao
Objective: To investigate the correlation between post-stroke pneumonia and outcome in patients with acute brain infarction. Methods: Consecutive acute cerebral infarction patients who were hospitalized in Department of Neurology, Jinan Military General Hospital were prospectively recruited from August 2010 to August 2014. The baseline data including age, sex, the National Institute of Health Stroke Scale (NIHSS) scores, type of Oxfordshire Community Stroke Project (OCSP: total anterior circulation infarct, partial anterior circulation infarct, posterior circulation infarct and lacunar infarct), fasting blood glucose etc...
September 20, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Carolyn Weaver Swenson, Neil S Kamdar, Helen Levy, Darrell A Campbell, Daniel M Morgan
OBJECTIVES: The aim of this study was to investigate the relationship between primary insurance type and major complications after hysterectomy. METHODS: A retrospective analysis was performed on women with Medicaid, Medicare, and private insurance who underwent hysterectomy from January 1, 2012, to July 1, 2014, and were included in the Michigan Surgical Quality Collaborative. Major complications within 30 days of surgery included the following: deep/organ space surgical site infection, deep venous and pulmonary thromboembolism, myocardial infarction or stroke, pneumonia or sepsis, blood transfusion, readmission, and death...
January 2017: Female Pelvic Medicine & Reconstructive Surgery
Andrew J Admon, Hannah Wunsch, Theodore J Iwashyna, Colin R Cooke
OBJECTIVE: Hospitals vary widely in ICU admission rates across numerous medical diagnoses. The extent to which variability in ICU use is specific to individual diagnoses or is a function of the hospital, regardless of disease, is unknown. DESIGN: Retrospective cohort study. SETTING: A total of 1,120 acute care hospitals with ICU capabilities. PATIENTS: Medicare beneficiaries 65 years old or older admitted for five medical diagnoses (acute myocardial infarction, congestive heart failure, stroke, pneumonia, and chronic obstructive pulmonary disease) and a surgical diagnosis (hip fracture treated with arthroplasty) in 2010...
January 2017: Critical Care Medicine
Karl Matz, Leonhard Seyfang, Alexandra Dachenhausen, Yvonne Teuschl, Jaakko Tuomilehto, Michael Brainin
BACKGROUND: To investigate prevalence and risk factors for post stroke pneumonia (PSP) in patients with acute ischemic stroke treated at stroke units (SU). METHOD: We analysed data from the Austrian Stroke Unit registry concerning admissions from January 2003 to December 2013 and assessed the prevalence of PSP at the stroke unit. Patients with and without PSP were compared in univariate and multivariate models searching for factors associated with the occurrence of PSP at the SU...
July 18, 2016: BMC Neurology
Martin J Connolly, Joanna B Broad, Michal Boyd, Tony Xian Zhang, Ngaire Kerse, Susan Foster, Thomas Lumley, Noeline Whitehead
INTRODUCTION: long-term care (LTC) residents have higher hospitalisation rates than non-LTC residents. Rapid decline may follow hospitalisations, hence the importance of preventing unnecessary hospitalisations. Literature describes diagnosis-specific interventions (for cardiac failure, ischaemic heart disease, chronic obstructive pulmonary disease, stroke, pneumonia-termed 'big five' diagnoses), impacting on hospitalisations of older community-dwellers, but few RCTs show reductions in acute admissions from LTC...
May 2016: Age and Ageing
Anushka Warusevitane, Dumin Karunatilake, Julius Sim, Craig Smith, Christine Roffe
BACKGROUND: Accurate diagnosis of pneumonia complicating severe stroke is challenging due to difficulties in physical examination, altered immune responses and delayed manifestations of radiological changes. The aims of this study were to describe early clinical features and to examine C-reactive protein (CRP) as a diagnostic marker of post-stroke pneumonia. METHODS: Patients who required nasogastric feeding and had no evidence of pneumonia within 7 days of stroke onset were included in the study and followed-up for 21 days with a daily clinical examination...
2016: PloS One
Ye Xu, Yuanli Liu, Ting Shu, Wei Yang, Minghui Liang
BACKGROUND: Public hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C) largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms. METHODS: We compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing...
2015: PloS One
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