Stroke services

Dennis, MS

doi:10.1016/0140-6736(92)91907-p

Cited by 9 publications

(3 citation statements)

References 12 publications

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“…In the United Kingdom, general practitioners and general medical, geriatric, neu rological, and rehabilitation services care for patients with stroke. Conversely, in Italy almost all stroke patients are managed by neurologists [22], In the Oxfordshire commu nity stroke project, 55% of the patients were admitted to the hospital, whereas in a community-based study in Italy this number was 85% [23,24], The average time of arrival of stroke patients in a population-based study in Scandi navia was 4.8 h [25], whereas this was 17 h in a recent American study [8], and 16 h in a study from Norway [21]. In central Rome.…”

Section: Discussionmentioning

confidence: 99%

Physician Attitudes towards Acute Stroke – A Comparison of Primary Care Physicians in Iowa and The Netherlands

Kappelle

Adams²,

Torner

et al. 1993

Cerebrovasc Dis

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Randomly selected primary care physicians in Iowa (n = 250) or The Netherlands (n = 250) received a questionnaire asking their opinions about management of patients with ischemic stroke of recent onset (ISRO). Responses were received from 64% of the Dutch and 58% of the Iowa physicians. More physicians in Iowa (81 %) considered ISRO a medical emergency similar to myocardial infarction than their Dutch colleagues (51 %) (difference: 30%; 95% confidence limits (CL): 20–40%). More Iowa physicians also thought ISRO was a treatable condition (72 vs. 48%; difference: 24%; CL: 13–35%), but only if management began within a few hours of onset of symptoms (76 vs. 45%; difference: 31 %; CL: 21–41 %). When asked about potentially useful drugs for ISRO, Dutch physicians favored thrombolytic drugs (45 vs. 33%; difference: 12%; CL: 1–23%) or steroids (33 vs. 18%; difference: 15%; CL: 5–25%), whereas the Iowa physicians more often considered heparin potentially useful (76 vs. 30%; difference: 46%; CL: 36–56%). Admission to the hospital for most patients with ISRO was thought to be appropriate by 97% of the Iowa and 48% of the Dutch physicians (difference 49%; CL: 41–57%). More physicians in Iowa refer patients with ISRO to hospitals with special expertise in stroke (46 vs. 10%; difference: 36%; CL: 27–45%). Also, more Iowa physicians refer to hospitals where promising treatments are being tested (35 vs. 7%; difference: 28%; CL: 19–37%). In planning of multicenter clinical trials attention should be paid to the consequences of variations in the organization of health care systems in different countries. Primary care physicians should be regularly informed about their key role in the early management of patients with ISRO, particularly in situations which involve testing of new or promising therapies. Our results indicate that primary care physicians in The Netherlands should be stimulated to collaborate in such efforts similar to that reported by their Iowa colleagues.

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Section: Discussionmentioning

confidence: 99%

Physician Attitudes towards Acute Stroke – A Comparison of Primary Care Physicians in Iowa and The Netherlands

Kappelle

Adams²,

Torner

et al. 1993

Cerebrovasc Dis

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“…Our projections of hospital admission rates and bed requirements for acute stroke should be treated with rela tive confidence, given no radical changes to the pre vention of stroke [35] and data indicating that acute treat ments for stroke are likely to have only a very small impact on the burden of stroke [36], There are several fea tures to the structure and function of services that need to be explored [7], Although few randomised trials of reha bilitation after stroke have been conducted, there is evi dence that well-organized care, by either a 'stroke unit' or a 'stroke service', can achieve better survival, more rapid improvement in function, and reduced long-term institu tional care than standard hospital care [37], A major chal lenge for researchers is to identify which components of the 'rehabilitation package' are the most beneficial to patients, and how these should best be delivered to con sumers.…”

Section: Discussionmentioning

confidence: 99%

“…The few attempts to estimate the direct cost of stroke have shown that it is dominated by charges resulting from care in acute hopsitals [2,3], with a considerable proportion of resources used to provide rehabilitation of patients who tients achieve their full potential for recovery and resettle ment [7]. Currently, however, much of our effort in managing patients with stroke and their care-givers is unfocussed and inefficient [8].…”

Section: Introductionmentioning

confidence: 99%

Patterns of Acute Hospital Care, Rehabilitation, and Discharge Disposition after Acute Stroke: The Perth Community Stroke Study 1989–1990

Anderson¹,

Jamrozik

Stewart-Wynne

1994

Cerebrovasc Dis

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There have been few attempts to determine, for a defined population, the total number of patients admitted to hospital and requiring rehabilitation after acute stroke. In a population-based stroke register (the Perth Community Stroke Study) of 492 patients with acute stroke, 70% were admitted to hospital immediately after onset while another 10% were already in-patients for other reasons. The independent predictors of acute management outside hospital were residence in a nursing home [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.8, 13.5], and age 85 years and over (OR 3.1; 95% CI 1.0, 9.0). The average length of stay in hospital was 32 days, (median 18, range 1–212 days), 23 days for acute beds and 55 days for rehabilitation beds. The in-hospital case fatality was 28% (95% CI 24%, 32%). Of the 302 patients discharged from hospital, 248 (82%) returned to their pre-morbid living arrangements. Failure to return home was related to the severity of the stroke (loss of consciousness and severe paresis) and social factors (living alone and pre-morbid disability). We estimate that patients with stroke, one third of whom are aged over 75 years, account for approximately 4% of the total acute bed capacity in metropolitan Perth. The data emphasise the need for hospital-based stroke services to be well organised and to have strong links with community services.

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