Where and How Should Elderly Stroke Patients Be Treated?

Kaste, Markku; Palomäki, Heikki; Sarna, Seppo

doi:10.1161/01.str.26.2.249

Cited by 167 publications

(115 citation statements)

References 16 publications

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“…[1][2][3][4][5][6][7][8][9] Meta-analysis of all available randomized controlled trials has shown that care of stroke patients in an SU reduces mortality, institutionalization, and dependency. 10,11 Why SU treatment works is still under discussion.…”

mentioning

confidence: 99%

Treatment in a Combined Acute and Rehabilitation Stroke Unit

Indredavik¹,

Bakke²,

Slørdahl³

et al. 1999

Stroke

321

250

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Background and Purpose-We have previously shown that treatment of acute stroke patients in our stroke unit (SU) compared with treatment in general ward (GWs) improves short-and long-term survival and functional outcome and increases the possibility of earlier discharge to home. The aim of the present study was to identify the differences in treatment between the SU and the GW and to assess which aspects of the SU care which were most responsible for the better outcome. Methods-Of the 220 patients included in our trial, only 206 were actually treated (SU, 102 patients; GW, 104 patients).For these patients, we identified the differences in the treatment and the consequences of the treatment. We analyzed the factors that we were able to measure and their association with the outcome, discharge to home within 6 weeks. Results-Characteristic features in our SU were teamwork, staff education, functional training, and integrated physiotherapy and nursing. Other treatment factors significantly different in the SU from the GW were shorter time to start of the systematic mobilization/training and increased use of oxygen, heparin, intravenous saline solutions, and antipyretics. Consequences of the treatment seem to be less variation in diastolic and systolic blood pressure (BP), avoiding the lowest diastolic BP, and lowering the levels of glucose and temperature in the SU group compared with the GW group. Univariate analyses showed that all these factors except the level of glucose were significantly associated with discharge to home within 6 weeks. In the final multivariate Cox regression model, shorter time to start of the mobilization/training and stabilized diastolic BP were independent factors significantly associated with discharge to home within 6 weeks. Conclusions-Shorter time to start of mobilization/training was the most important factor associated with discharge to home, followed by stabilized diastolic BP, indicating that these factors probably were important in the SU treatment. The effects of characteristic features of an SU, such as a specially trained staff, teamwork, and involvement of relatives, were not possible to measure. Such factors might be more important than those actually measured. (Stroke. 1999;30:917-923.)

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mentioning

confidence: 99%

Treatment in a Combined Acute and Rehabilitation Stroke Unit

Indredavik¹,

Bakke²,

Slørdahl³

et al. 1999

Stroke

321

250

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show abstract

“…They found that patients treated in the Neurology department were discharged earlier and had better functional outcomes after one year of follow-up. 11 As stated by Chadwick and Smith, seizures are also frequently misdiagnosed or over-treated prior to neurological evaluation.…”

Section: Discussionmentioning

confidence: 99%

A Neurologist’s Hard Day’s Work: Impact of Inpatient Neurology Consultation in a Tertiary Hospital

et al. 2016

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Introduction: Consultation of hospitalized patients under the responsibility of other specialties is a very demanding work. However, it is often under-recognized and poorly documented. The aim of the present study was to assess the burden of the inpatient neurology consultation in a Portuguese hospital and to evaluate the performance of our Neurology department regarding this issue. Material and Methods: A retrospective study was conducted during 2013, reviewing clinical and demographic data. Results: Over one year, the neurologists of our department evaluated 632 inpatients. The commonest reasons for consultation were altered mental state/behavior, focal neurological deficit and seizures. Requests came mainly from medical departments but also from Intermediate and Intensive Care Units. Neurologists suggested further investigation in almost one half of patients and management changes in a similar proportion of patients. A new diagnosis could be established in 63% of cases and the most frequent diagnosis were neurological manifestations of systemic disorders, epilepsy and cerebrovascular disease. Our intervention had impact on the care of 68% of patients. Discussion and Conclusion: Different studies in the literature support our findings and highlight the economic and patient care benefits of this activity. Our results suggest that neurological inpatient observation generates useful interventions for the clinical management of these patients.

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“…Research has found that comprehensive coordinated care, as provided by the VA system, can improve functional outcomes and reduce the length of hospital or nursing home stays more than care in a traditional stroke unit [7][8][9][10][14][15][16][17][18][19]. The VA and the Department of Defense (DOD) recognized the need for care coordination for stroke patients in their publication of the Clinical Practice Guidelines for the Management of Stroke Rehabilitation 2003 (http://www.oqp.med.va.gov), as did the Commission on Accreditation of Rehabilitation Facilities, which introduced stroke specialty program standards for medical rehabilitation in 2005.…”

Section: Discussionmentioning

confidence: 99%

Department of Veterans Affairs-Medicare dual beneficiaries with stroke: Where do they get care?

Shen¹

2008

JRRD

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Abstract-This study examined care patterns among stroke patients with diabetes who were dually eligible for Department of Veterans Affairs (VA) and Medicare services. We investigated the location (VA hospital or community-based hospital reimbursed by Medicare) of initial and postacute stroke care during a 1-year follow-up period. We used logistic regression to identify the factors associated with the locations of initial and subsequent stroke care. Of the 6,699 patients studied, 76% received their initial care at a Medicare-reimbursed hospital ("Medicare-first" patients) and 24% at a VA hospital ("VAfirst" patients). Patients who were white, married, female, or living farther from the VA were more likely to be Medicarefirst patients. During the follow-up period, Medicare-first patients were more likely not only to seek further care but also to use the dual systems than were VA-first patients (71% vs 49%, respectively). The high rates of dual-system use highlight the need for care coordination across systems to address issues of care duplication and continuity.

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Where and How Should Elderly Stroke Patients Be Treated?

Abstract: Well-organized management of elderly stroke patients was associated with a better outcome. It was also the more economical alternative.

Cited by 167 publications

References 16 publications

Treatment in a Combined Acute and Rehabilitation Stroke Unit

Treatment in a Combined Acute and Rehabilitation Stroke Unit

A Neurologist’s Hard Day’s Work: Impact of Inpatient Neurology Consultation in a Tertiary Hospital

Department of Veterans Affairs-Medicare dual beneficiaries with stroke: Where do they get care?

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