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- Brizzi, Marco, et al.
(författare)
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Early do-not-resuscitate orders in intracerebral haemorrhage; frequency and predictive value for death and functional outcome. A retrospective cohort study
- 2012
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: In former studies from North America early Do-Not-Resuscitate orders (DNR orders) in patients with intracerebral haemorrhage (ICH) had negative prognostic impact on mortality. The influence of DNR orders on functional outcome and whether DNR orders are grounded on relevant patient characteristics is unknown. We aimed to determine the frequency and predictive factors of DNR-orders and its association to prognosis, in ICH patients, in Scandinavia. Methods: In 197 consecutive ICH patients admitted to Skane University Hospital, Malmo, Sweden, between January 2007 and June 2009, information of the presence of DNR orders within 48 hours, clinical and radiological characteristics was retrieved by review of patient medical journal and computed tomography scans. Determinants of DNR-orders, one-month case fatality and bad functional outcome (modified Rankin Scale, grade 4-6) were assessed by logistic regression analysis. Results: DNR orders were made in 41% of the cases. After adjustment for confounding factors, age >= 75 years (Odds Ratio (95% confidence interval) 4.2(1.8-9.6)), former stroke (5.1(1.9-3.1)), Reaction Level Scale grade 2-3 and 4 (7.0(2.8-17.5) and (4.1(1.2-13.5), respectively) and intraventricular haemorrhage (3.8(1.6-9.4)) were independent determinants of early DNR orders. Independent predictors of one-month case fatality was age >= 75 years (3.7(1.4-9.6)) volume >= 30 ml (3.5(1.3-9.6)) and DNR orders (3.5(1.5-8.6)). Seizure (6.0(1.04-34.2) and brain stem hemorrhage (8.0(1.1-58.4)) were related to bad functional outcome, whereas early DNR order was not (3.5(0.99-12.7)). Conclusions: Well known prognostic factors are determinants for DNR orders, however DNR orders are independently related to one-month case fatality. In addition to improvements of the local routines, we welcome a change of attitude with an enhanced awareness of the definition of, and a more careful approach with respect to DNR orders.
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| 2. |
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| 3. |
- Jönsson, Ann-Cathrin, et al.
(författare)
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Secondary Prevention and Health Promotion after Stroke: Can It Be Enhanced?
- 2014
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1532-8511 .- 1052-3057. ; 23:9, s. 2287-2295
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to study if health outcome and secondary prevention were satisfactory 1 year after stroke and if nurse-led interventions 3 months after stroke could have impact. Design was a randomized controlled open trial in a 1-year population. Primary outcome was health status 1 year after stroke. One month after stroke, survivors were randomized into intervention group (IG) with follow-up by a specialist nurse (SN) after 3 months (n = 232), and control group (CG) with standard care (n = 227), all to be followed up 1 year after stroke. At the first follow-up, patients graded their health, replied to the EuroQol-5 Dimensions (EQ-5D) health outcome questions, health problems were assessed, and supportive counseling was provided in the IG. Health problems requiring medical interventions were primarily referred to a general practitioner (GP). One year after stroke, 391 survivors were followed up. Systolic blood pressure (BP) had decreased in IG (n = 194) from median 140 to 135 (P = .05), but about half were above the limit 139 in both groups. A larger proportion (22%) had systolic BP >155 in the CG (n = 197) than in the IG (14%; P = .05). In the IG, 62% needed referrals compared with the 75% in the CG (P = .009). Forty percent in the IG and 52.5% in the CG (P = .04) reported anxiety/depression. In the IG, 75% and 67% in the CG rated their general health as fairly good or very good (P = .05). Although nurse-led interventions could have some effect, the results were not optimal. A more powerful strategy could be closer collaboration between the SN and a stroke clinician, before referring to primary care.
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| 4. |
- Oudin, Anna, et al.
(författare)
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Hospital admissions for ischemic stroke : does long-term exposure to air pollution interact with major risk factors?
- 2011
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Ingår i: Cerebrovascular Diseases. - : S. Karger. - 1015-9770 .- 1421-9786. ; 31:3, s. 284-293
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim was to investigate whether the effects of major risk factors for ischemic stroke were modified by long-term exposure to air pollution in Scania, southern Sweden.Methods: Cases were defined as first-ever ischemic strokes in patients born between 1923 and 1965 during 2001-2006 (n = 7,244). Data were collected from The Swedish National Stroke Register (Riks-stroke) and the Malmö and Lund Stroke Registers. Population controls were matched on age and sex. Modeled outdoor annual mean NO(x) concentrations were used as proxy for long-term exposure to air pollution. Heterogeneity across NO(x) categories was tested for smoking, hypertension, diabetes mellitus, atrial fibrillation and physical inactivity. Data were analyzed as case-control data and to some extent as case-only data, with logistic regression analysis.Results: The case-control odds ratios for ischemic stroke in association with diabetes were 1.3 [95% confidence interval (CI): 1.1-1.6] and 2.0 (95% CI: 1.2-3.4) in the lowest and highest NO(x) category, respectively (p value for testing heterogeneity across the categories = 0.056). The case-only approach gave further support for the risk associated with diabetes to increase with NO(x) (p for trend = 0.033). We observed no main effect of mean NO(x) or any conclusive effect modifications between NO(x) and smoking, hypertension, atrial fibrillation or physical inactivity.Conclusions: In a low-level air pollution area, the risk for ischemic stroke associated with diabetes seemed to increase with long-term exposure to air pollution.
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| 5. |
- Wendel, Kerstin, et al.
(författare)
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Post-stroke functional limitations and changes in use of mode of transport
- 2010
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1651-2014 .- 1103-8128. ; 17:2, s. 162-174
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate the use of different modes of transport and long-term changes among stroke survivors with cognitive functional limitations (CFLs), and to study differences among sub-groups (decreased/ceased vs. unchanged and increased public transport use) regarding physical functional limitations (PFLs), CFLs, depression, and social activity outside home. Method: Survey of 79 individuals living in the community with CFLs post-stroke (mean 26 months). Well-established and study-specific instruments were used capturing the mode of transport use, CFLs (professionally assessed and self-reported), depression symptoms, and PFLs. Results: Over one third of the participants reported decreased/ceased use of bus and train, among whom more PFLs were found in comparison with those reporting unchanged use and more depression was found in comparison with those showing increased use. There were no sub-group differences concerning occurrence of CFLs and decrease in social activity. The use of own car or motorbike had largely ceased, most often replaced by Special Transportation Service or travelling by private car or taxi. Yet 27% were still frequent car drivers. Conclusion: The results indicate considerably affected use of modes of transport after stroke, and higher frequencies of PFLs and symptoms of depression among those with decreased/ceased public transport use.
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