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https://www.readbyqxmd.com/read/27823836/acdd-4-score-a-simple-tool-for-assessing-risk-of-pneumonia-after-stroke
#1
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...
November 1, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27731885/transfusion-thresholds-and-other-strategies-for-guiding-allogeneic-red-blood-cell-transfusion
#2
REVIEW
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
https://www.readbyqxmd.com/read/27694934/translocation-and-dissemination-of-commensal-bacteria-in-post-stroke-infection
#3
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...
October 3, 2016: Nature Medicine
https://www.readbyqxmd.com/read/27686545/-correlation-between-post-stroke-pneumonia-and-outcome-in-patients-with-acute-brain-infarction
#4
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]
https://www.readbyqxmd.com/read/27682744/insurance-type-and-major-complications-after-hysterectomy
#5
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...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/27526267/hospital-contributions-to-variability-in-the-use-of-icus-among-elderly-medicare-recipients
#6
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...
August 12, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27430328/post-stroke-pneumonia-at-the-stroke-unit-a-registry-based-analysis-of-contributing-and-protective-factors
#7
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...
2016: BMC Neurology
https://www.readbyqxmd.com/read/27021357/the-big-five-hypothesis-generation-a-multidisciplinary-intervention-package-reduces-disease-specific-hospitalisations-from-long-term-care-a-post-hoc-analysis-of-the-archus-cluster-randomised-controlled-trial
#8
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
https://www.readbyqxmd.com/read/26937636/early-diagnosis-of-pneumonia-in-severe-stroke-clinical-features-and-the-diagnostic-role-of-c-reactive-protein
#9
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
https://www.readbyqxmd.com/read/26430748/variations-in-the-quality-of-care-at-large-public-hospitals-in-beijing-china-a-condition-based-outcome-approach
#10
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
https://www.readbyqxmd.com/read/26343840/prophylactic-antibiotics-after-acute-stroke-for-reducing-pneumonia-in-patients-with-dysphagia-stroke-inf-a-prospective-cluster-randomised-open-label-masked-endpoint-controlled-clinical-trial
#11
RANDOMIZED CONTROLLED TRIAL
Lalit Kalra, Saddif Irshad, John Hodsoll, Matthew Simpson, Martin Gulliford, David Smithard, Anita Patel, Irene Rebollo-Mesa
BACKGROUND: Post-stroke pneumonia is associated with increased mortality and poor functional outcomes. This study assessed the effectiveness of antibiotic prophylaxis for reducing pneumonia in patients with dysphagia after acute stroke. METHODS: We did a prospective, multicentre, cluster-randomised, open-label controlled trial with masked endpoint assessment of patients older than 18 years with dysphagia after new stroke recruited from 48 stroke units in the UK, accredited and included in the UK National Stroke Audit...
November 7, 2015: Lancet
https://www.readbyqxmd.com/read/25782324/-infectious-inflammatory-complications-of-cerebral-insulitis
#12
M A Kutlubaev
Pneumonia and urinary tract infections develop in roughly 1/3 of the survivors of cerebral stroke. Post-stroke pneumonia results from aspiration and uroinfection from neurogenic disturbances of urination and bladder catheterization. Post-stroke immune deficiency increases the risk of infectious and inflammatory complications. These conditions are treated in accordance with the general principles of management of these diseases. Prophylaxis of pneumonia is reduced to the principle of "nothing orally" before the swallowing capacity is tested, early mobilization, and oral cavity hygiene...
2014: Klinicheskaia Meditsina
https://www.readbyqxmd.com/read/25643360/effect-of-beta-blocker-therapy-on-the-risk-of-infections-and-death-after-acute-stroke-a-historical-cohort-study
#13
Ilko L Maier, André Karch, Rafael Mikolajczyk, Mathias Bähr, Jan Liman
BACKGROUND: Infections are a frequent cause for prolonged hospitalization and increased mortality after stroke. Recent studies revealed a stroke-induced depression of the peripheral immune system associated with an increased susceptibility for infections. In a mice model for stroke, this immunosuppressive effect was reversible after beta-blocker administration. The aim of our study was to investigate the effect of beta-blocker therapy on the risk of infections and death after stroke in humans...
2015: PloS One
https://www.readbyqxmd.com/read/25194786/bipolar-disorder-and-comorbidity-increased-prevalence-and-increased-relevance-of-comorbidity-for-hospital-based-mortality-during-a-12-5-year-observation-period-in-general-hospital-admissions
#14
Dieter Schoepf, Reinhard Heun
BACKGROUND: Bipolar disorder (BD) is associated with an increase of psychiatric and physical comorbidities, but the effects of these disorders on general hospital-based mortality are unclear. Consequently, we investigated whether the burden of comorbidity and its relevance on hospital-based mortality differed between individuals with and without BD during a 12.5-year observation period in general hospital admissions. METHODS: During 1 January 2000 and 30 June 2012, 621 individuals with BD were admitted to three General Manchester Hospitals...
December 2014: Journal of Affective Disorders
https://www.readbyqxmd.com/read/25179968/should-left-ventricular-assist-devices-be-implanted-in-patients-seventy-years-of-age-and-older-a-comparative-analysis
#15
Jeffrey A Morgan, Hassan W Nemeh, Gaetano Paone
BACKGROUND: We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age. METHODS: From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded...
August 2014: Heart Surgery Forum
https://www.readbyqxmd.com/read/25162640/contaminated-heparin-and-outcomes-after-cardiac-surgery-a-retrospective-propensity-matched-cohort-study
#16
Heiko A Kaiser, Arbi Ben Abdallah, Nan Lin, Bethany R Tellor, Mohammad Helwani, Jennifer R Smith, Marc R Moon, Michael S Avidan
BACKGROUND: During 2007 and 2008 it is likely that millions of patients in the US received heparin contaminated (CH) with oversulfated chondroitin sulfate, which was associated with anaphylactoid reactions. We tested the hypothesis that CH was associated with serious morbidity, mortality, intensive care unit (ICU) stay and heparin-induced thrombocytopenia following adult cardiac surgery. METHODS AND FINDINGS: We conducted a single center, retrospective, propensity-matched cohort study during the period of CH and the equivalent time frame in the three preceding or the two following years...
2014: PloS One
https://www.readbyqxmd.com/read/24725276/a-pilot-study-of-respiratory-muscle-training-to-improve-cough-effectiveness-and-reduce-the-incidence-of-pneumonia-in-acute-stroke-study-protocol-for-a-randomized-controlled-trial
#17
RANDOMIZED CONTROLLED TRIAL
Stefan Tino Kulnik, Gerrard Francis Rafferty, Surinder S Birring, John Moxham, Lalit Kalra
BACKGROUND: After stroke, pneumonia is a relevant medical complication that can be precipitated by aspiration of saliva, liquids, or solid food. Swallowing difficulty and aspiration occur in a significant proportion of stroke survivors. Cough, an important mechanism protecting the lungs from inhaled materials, can be impaired in stroke survivors, and the likely cause for this impairment is central weakness of the respiratory musculature. Thus, respiratory muscle training in acute stroke may be useful in the recovery of respiratory muscle and cough function, and may thereby reduce the risk of pneumonia...
2014: Trials
https://www.readbyqxmd.com/read/24273263/-application-of-a-2-ds-2-score-for-predicting-post-stroke-pneumonia-in-elderly-patients
#18
Yanchang Shang, Shuhui Wang, Xiujuan Bai, Zhongbao Gao, Jimei Li, Weiping Wu
OBJECTIVE: To investigate the risk factors for post-stroke pneumonia and assess the value of A(2)DS(2) score in predicting post-stroke pneumonia in elderly stroke patients. METHODS: The clinical data were retrospectively collected from elderly stroke patients from January, 2007 to December, 2012. A(2)DS(2) score was then assigned using the clinical information from the medical record. The ability of the score to discriminate between patients with post-stroke pneumonia and those without was quantified using ROC analysis...
November 2013: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/24178914/interrelationship-among-common-medical-complications-after-acute-stroke-pneumonia-plays-an-important-role
#19
Ruijun Ji, David Wang, Haipeng Shen, Yuesong Pan, Gaifen Liu, Penglian Wang, Yilong Wang, Hao Li, Yongjun Wang
BACKGROUND AND PURPOSE: Medical complications are common among patients with stroke. However, little is known about the potential interrelationship among them. In the present study, we aimed to investigate the association between common in-hospital medical complications after acute ischemic stroke (AIS) and spontaneous intracerebral hemorrhage (ICH). METHODS: We analyzed patients enrolled in the China National Stroke Registry from 2007 to 2008. The occurrence of 11 common stroke-associated medical complications during acute hospitalization was prospectively registered...
December 2013: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/24128744/reductions-in-medicare-payments-and-patient-outcomes-an-analysis-of-5-leading-medicare-conditions
#20
Yu-Chu Shen, Vivian Y Wu
BACKGROUND: The Affordable Care Act enacted significant Medicare payment reductions to providers, yet the effects of such major reductions on patients remain unclear. We used the Balanced Budget Act (BBA) of 1997 as a natural experiment to study the long-term consequence of major payment reductions on patient outcomes. OBJECTIVES: To analyze whether mortality trends diverge over the years between hospitals facing different levels of payment cuts because of the BBA for 5 leading conditions: acute myocardial infarction, congestive heart failure, stroke, pneumonia, and hip fracture...
November 2013: Medical Care
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