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Aims: Dehydration is one of the common complications of dysphagia and poses significant risks including hospitalization and mortality, but the relationship between dysphagia and dehydration has received little attention. This study aims to determine the prevalence and risk factors for dehydration of patients with dysphagia in eastern China, and to provide reference for early identification and prevention of dehydration. Methods: A descriptive, cross‐sectional design was conducted. Three hundred and thirty‐seven (n = 337) patients with dysphagia participated in the study between August and December 2022. Information relating to participants' demographic variables, nutrition, cognition, functional, hydration status and fluid intake was collected. Univariate analysis was used to examine related impact factors, and then binary logistic regression analysis was conducted to determine reliable impact factors. Results: Among 337 patients with dysphagia, the average age was 63.47 ± 16.96, most participants were male (72.1%) and married (91.7%). The prevalence of dehydration was calculated to be 43.9%, the mean plasma osmolality score was 293.53 mmol/L. Diseases with the highest prevalence were stroke (78.3%), followed by hypertension (63.5%). The risk for dehydration increased with older age, usage of more medicines such as diuretics and beta‐blockers, worse functional status and lower fluid intake. Conclusion: This study found a high percentage of dehydration in patients with dysphagia. Findings can provide a basis for targeted nursing interventions for clinical prevention and treatment of dehydration. Summary statement: What is already known about this topic? Dehydration is one of the adverse consequences of dysphagia, and it causes physical stress to sufferers and enormous costs to the health care system.Previous studies have identified that personal factors (age, gender, health condition etc.), living environment, and social support may affect dehydration What this paper adds? Results showed high percentages of dehydration among patients with dysphagia; older age, greater use of medicines such as diuretics and beta‐blockers, worse functional status and lower fluid intake played a crucial role in hospital patients with dysphagia, leading to dehydration. The implications of this paper: This paper reveals prevalence and risk factors associated with dehydration of patients with dysphagia in hospital.Findings could provide reference data for development of nursing preventive interventions, to reduce the incidence of dehydration and improve the health level of patients. [ABSTRACT FROM AUTHOR]

Accessible SummaryWhat is known on the subject?Functioning is one of the most affected areas in schizophrenia. Social, occupational and personal domains are affected, and these deficits are responsible for a major part of the disability associated with the disorder.There are several instruments to measure functioning, but the HoNOS provides a wide assessment of impairment in 12 areas of functioning.What does the paper add to existing knowledge?The Spanish version of the HoNOS shows good properties in terms of reliability and validity for use in schizophrenia patients.Although some authors divide the scale according to proposed underlying dimensions, in schizophrenia this division may not be appropriate.What are the implications for practice?A reliable and easy‐to‐use measure of impairment in different areas of functioning is useful for optimizing the treatment and rehabilitation of patients with schizophrenia. Introduction: The HoNOS scale was designed for the assessment of psychosocial impairment in various domains. While it is widely used in psychiatric settings, it has not been validated in Spanish for use in patients with schizophrenia. Aim: To examine the psychometric properties of the Spanish version of the HoNOS scale in a sample of schizophrenia patients. Method: A total of 194 individuals aged 18 to 65 with schizophrenia spectrum diagnoses were evaluated using the HoNOS. Illness severity and level of functioning were also assessed. Results: The HoNOS showed moderate internal consistency, good inter‐observer reliability and good test‐retest reliability. Factor analysis revealed an internal structure consisting of four factors, with item distribution differing from the theoretical dimensions proposed for the original scale. Discussion: The Spanish version of the HoNOS scale is a reliable and valid instrument for assessing psychosocial impairment in individuals diagnosed with schizophrenia spectrum disorders. However, further research is needed to determine its internal structure more accurately. Implications for Practice: The HoNOS scale provides researchers and clinicians with a valid measure of impairment in twelve different domains, which can facilitate and guide the treatment of schizophrenia patients. [ABSTRACT FROM AUTHOR]

Aims: To assess the effects of COVID‐19 pandemic on clinical variables as part of the routine clinical monitoring of patients with chronic diseases in primary care. Design: A prospective longitudinal study was conducted in primary care centres of the Andalusian Health Service. Methods: Data were recorded before the pandemic (T1), during the declaration of the state of emergency (T2) and in the transition phase (T3). The Barthel index and the Short Portable Mental Status Questionnaire (SPMSQ) were used to analyse functional and cognitive changes at the three time points. HbA1c, systolic and diastolic blood pressure, heart rate, BMI and lipid levels were assessed as clinical variables. Descriptive statistics and non‐parametric chi‐square test were used for analysis. STROBE checklist was used for the preparation of this paper. Results: A total fo148 patients with chronic conditions were included in the analysis. Data analysis revealed in T2 only significant reductions in BMI, total levels of cholesterol and HDL during the onset of the pandemic. Barthel Index, SPMSQ, blood pressure and triglycerides and LDL levels worsened in T2, and the negative effects were maintained in T3. Compared to pre‐pandemic values, HbA1c levels improved in T3, but HDL levels worsened. Conclusions: COVID‐19 has drastically disrupted several functional, cognitive and biological variables. These results may be useful in identifying clinical parameters that deserve closer attention in the case of a new health crisis. Further studies are needed to assess the potential impacts of each specific chronic condition. Impact: Cognitive and functional status, blood pressure and triglycerides and LDL levels worsen in short term, maintaining the negative effects in medium‐term. [ABSTRACT FROM AUTHOR]

BACKGROUND: Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care. OBJECTIVE: This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia. METHODS: The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed. RESULTS: The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group. CONCLUSION: HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization. [ABSTRACT FROM AUTHOR]

Background: Many caregivers are insufficiently prepared, and little is known about measures that can be employed to enhance their preparedness. Aim: The aim of this study was to explore the factors associated with caregiver preparedness and establish a predictive model including the relationship between preparedness, burden, resilience and anxiety. Design: A cross‐sectional design was used. Methods: The sample included 172 family caregivers who were selected from one private hospital and daytime nursing centres. Caregivers were recruited from 2018 to 2019; they completed assessments for caregiver preparedness, anxiety, resilience and burden. A multiple linear regression analysis was performed to identify the factors associated with preparedness. Results: Preparedness was significantly associated with high levels of resilience and a low level of burden, while it was not associated with anxiety. Caregivers' gender, experience and cohabitation status were the main predictors. Resilience is an explanatory factor for caregiver preparedness in the predictive model. Conclusion: The demographic variables related to preparedness can be used to guide efforts to meet the needs of vulnerable caregivers. A caregiver's preparedness depends on their level of burden and resilience. Nursing interventions focused on these aspects could make the caregiver's role easier and improve the quality of care provided. Summary statement: What is already known about this topic? Many caregivers are inadequately prepared for this role, and ensuring adequate preparedness is important for family caregivers.Preparedness and factors predictive of this in Spanish family caregivers have not been well‐documented.Resilience, burden and anxiety affect caregivers, but the degree to which they influence caregivers' preparation levels is unknown. What is the contribution of this paper? Specific factors influence the preparedness of family caregivers. Men and caregivers who do not cohabit in the same household with the care‐dependent person may present greater deficits in preparedness. Moreover, poor health and lack of experience in caring can result in inadequate caregiving performance.Readiness, resilience and burden are significantly related, and the best predictor of family caregivers' preparedness is resilience.Resilience leads to greater preparedness in caregivers, and better‐prepared caregivers experience a lighter burden. What are the implications of this paper? Knowing the factors associated with preparedness in advance will allow health‐care professionals to prevent deficits in vulnerable family caregivers.Resilience is a decisive factor which prevents negative consequences such as low preparedness. A resilient coping style can diminish the burden and promote successful adaptation in caregivers. [ABSTRACT FROM AUTHOR]

Objectives: To assess the psychometric characteristics of the Spanish Post-COVID-19 Functional Status (PCFS) scale (web-based and paper-based forms) and the test-retest reliability of the web-based form. Study design and setting: Cross-sectional study of 125 COVID-19 survivors. The test-retest reliability of the web-based form was assessed at 7 days after the first evaluation. We collected symptoms, functional status (PCFS scale), health-related quality of life (EuroQol-5D questionnaire, EQ-5D-5L), activities of daily living limitations [Barthel Index and Global Activity Limitation Index, GALI] and psychological state (Hospital Anxiety and Depression Scale, HADS). Results: The paper- and web-based forms of the Spanish PCFS scale showed adequate construct validity, and the web-based form provided substantial test-retest reliability (kappa = 0.63). The percentage of agreement between the web-based and paper-based forms was high (88%). Functional status showed a high correlation with EQ-5D-5L (inverse) and GALI (direct) (both; Rho ≥.743), a moderate correlation with HADS (Rho ≥.409) and a low correlation with the Barthel Index (Rho <.30). The Kruskal–Wallis test showed statistically significant differences in EQ-5D-5L, GALI and HADS according to the degree of functional status. Conclusion: The Spanish version of the PCFS scale (web-based and paper-based forms) showed adequate construct validity, and the web-based form provided substantial test-retest reliability in COVID-19 survivors. [ABSTRACT FROM AUTHOR]

Aims: To investigate the change and associated factors of care needs within 6 months post‐discharge in older people with hospital‐associated disability, and the relationship between time‐varying care needs and physical function. Background: Older people with hospital‐associated disability will have various care needs post‐discharge. Understanding their care needs will help to improve their health. However, studies on this population are still limited. Design: A longitudinal study. Methods: The older people who met the inclusion and exclusion criteria were selected in 2 tertiary hospitals in Zhejiang Province, China. The questionnaire survey method was used to collect data about socio‐demographic characteristics, physical function and care needs. The data of 375 older people who completed follow‐up were analysed using logistic regression analysis, generalised estimating equations and generalised additive mixed model. We followed STROBE checklist for reporting the study. Results: The care needs of the older people with hospital‐associated disability declined unevenly, it decreased rapidly in the first three months, and then flattening out. The percentage of people with care needs in each dimension decreased over time, but daily care and rehabilitation needs were consistently more important. Socio‐demographic factors and physical function had different effects on need at different time points, the physical function was the main factor among them. There were non‐linear relationships between the physical function and different care needs with different inflection points. Conclusion: This research revealed change patterns of the care needs of older people with hospital‐associated disability post‐discharge and the non‐linear relationship between physical function and care needs. These findings may help healthcare professionals and caregivers to provide accurate care. Relevance to clinical practice: The findings can be used to identify effective approaches to address the care needs of older people with hospital‐associated disability based on the time of discharge, in conjunction with age, education, and especially physical function, which will promote the justify allocation of nursing resources. What does this paper contribute to the wider global clinical community? [ABSTRACT FROM AUTHOR]

Objective. To develop a deep learning-assisted recovery and nursing system after total hip arthroplasty and to conduct clinical trials in order to verify its accuracy. Methods. In our study, based on manual labeling, the human hip X-ray image library was established, and the deep neural network based on Mask R-CNN was built. The labeled medical images were used to train the model, providing reference for nursing decision after hip replacement. A total of 80 patients with hip injury from 2016 to 2019 were selected for the study. In our paper, the patients were divided into experimental group and control group. The pertinence and effectiveness of the model for postoperative care were evaluated by comparing the hip pain (VAS index), recovery (Harris score), self-care ability (Barthel index), and postoperative complication rate between the two groups. Results. The pain and complications in the experimental group were significantly lower than those in the control group, the difference being statistically significant (P < 0.05); the recovery of hip joint and self-care ability were higher than those in the control group, the difference being statistically significant (P < 0.05); the other differences were not statistically significant (P > 0.05). Conclusion. The application of deep learning method in the rapid nursing after total hip replacement can significantly improve the nursing ability. Compared with the traditional method, it has stronger pertinence, faster postoperative recovery, lower incidence of complications, and greatly improves the postoperative quality of life of patients with hip injury. [ABSTRACT FROM AUTHOR]

Purpose: Prescriptive and predictive analytics and artificial intelligence (AI) provide tools to analyze data with objectivity. In this paper, we provide an overview of how these techniques can improve nursing care, and we detail a quantitative model to afford managerial insights about care management in a Hospital in Colombia. Our main purpose is to provide tools to improve key performance indicators for the care management of inpatients which includes the nurse workload. Methods: The optimal nurse‐to‐patient assignment problem is addressed using analytics, lean health care, and AI. Also, we propose a new mathematical model to optimize the nurse‐to‐patient assignment decisions considering several variables about the patient state such as the Barthel index, their risks, the complexity of the care, and the mental state. Findings: Our results show that there are several processes inherent to compassionate nursing care that can be improved using technology. By using data analytics, we can also provide insights about the high variability of the care requirements and, by using models, find nurse‐to‐patient assignments that are nearly perfectly balanced. Conclusions: We illustrated this improvement with a pilot test that makes the equitable distribution of nursing workload the functionality of this strategy. The findings can be useful in highly complex hospitals in Latin America. Clinical Relevance: The proposed model presents an opportunity to make near perfectly balanced nurse‐to‐patient assignments according to the number of patients and their health conditions using technology. [ABSTRACT FROM AUTHOR]

Background: The obstacle of limb motor caused by stroke, especially the decline of motor function of upper limbs, can directly affect the activities of daily living of stroke patients with hemiplegia. Based on long-term clinical practice, the treatment effect of electrical stimulation methods for stroke limb dysfunction has been widely recognized and supported by authoritative guidelines and systematic reviews. However, which electrical stimulation method is the optimum in the treatment of stroke limb dysfunction is still a controversial issue. Objective: In this paper, we adopted Network Meta-Analysis (NMA) to rank the priorities of various electrical stimulation methods, so as to select the optimal electrical stimulation method and discuss its rationality in guiding clinical practice. Methods: We carried out a systematic review by searching a total of 6806 studies from 8 databases and 2 clinical trial registries, and finally screened out 34 studies for further investigation. Then, pairwise meta-analysis and Bayesian network meta-analysis were employed to evaluate the effectiveness and ranking of various interventions. The primary outcome measure was Fugl-Meyer Assessment Upper Extremity (FMA-UE), and the secondary outcome measures were Modified Barthel Index (MBI) and Modified Ashworth Scale (MAS). Finally, the risk of bias, publication bias and sensitivity of the Randomized Controlled Trials (RCTs) were evaluated. Results: On the basis of comprehensive rehabilitation treatment (RT), the Functional Electrical Stimulation (FES) was superior than other electrical stimulation methods in improving both FMA-UE and MBI. Meanwhile, the results indicated that the Transcutaneous Electrical Acupoint Stimulation (TEAS) was the only electrical stimulation method that showed treatment advantages in reducing MAS. Conclusion: The study showed that FES had the optimal overall rehabilitation effect on upper limb dysfunction of stroke patients based on the comprehensive RT, while the treatment effect of TEAS on upper limb spasticity after stroke was the most significant. [ABSTRACT FROM AUTHOR]

This purpose of this study is to correlate a new shear-wave elastography (SWE) parameter, mass characteristic frequency (fmass) and other elasticity measure with the prognostic histological factors and immunohistochemical (IHC) biomarkers for the evaluation of heterogeneous breast carcinomas. The new parameter, fmass, first introduced in this paper, is defined as the ratio of the averaged minimum shear wave speed taken spatially within regions of interest to the largest mass dimension. 264 biopsy-proven breast cancerous masses were included in this study. Mean (Emean), maximum (Emax), minimum (Emin) shear wave elasticity and standard deviation (Esd) of shear wave elasticity were found significantly correlated with tumor size, axillary lymph node (ALN) status, histological subtypes and IHC subtypes. The areas under the curve for the ALN prediction are 0.73 (95% confidence interval [CI]: 0.67-0.80) and 0.75 (95% CI: 0.69-0.81) for the combination of Emean with Breast Imaging Reporting and Data System (BI-RADS) score and Emax with BI-RADS score, respectively. fmass was significantly correlated with the presence of calcifications, ALN status, histological grade, the expressions of IHC biomarkers and IHC subtypes. To conclude, poor prognostic factors were associated with high shear wave elasticity values and low mass characteristic frequency value. Therefore, SWE provides valuable information that may help with prediction of breast cancer invasiveness. [ABSTRACT FROM AUTHOR]

Assessment of long‐term functional outcomes after meningioma surgery is important. We systematically reviewed the literature on health‐related quality of life (HrQoL) and functional disability (FD) of patients after surgery for intracranial meningiomas. Using PRISMA 2015 guidelines, we screened 289 abstracts and 43 titles were retained for full‐paper screening. 15 articles did not present enough data to meet the inclusion criteria and 7 articles failed to assess functional assessment and HrQoL. Twenty‐two articles were included in our review. HrQol was assessed in N = 18 publications, most frequently using SF‐36 (N = 10), followed by EQ5D‐5L (N = 4), EORTC‐QLQ (N = 4), and the FACT questionnaire (N = 2). The assessment of FD was reported in N = 11 publications, mostly using the KPS (N = 8). The Barthel index was used in N = 2 publications. Follow‐up was reported in N = 12 publications, ranging from 6 months to 9 years. Scientific publications assessing long‐term postoperative HrQol and FD in patients undergoing meningioma surgery are scarce and the data are heterogeneously reported, using various scales and follow‐up protocols. Efforts should be undertaken to uniformly assess long‐term post‐operative functional outcomes in meningioma patients. [ABSTRACT FROM AUTHOR]

Purpose: Stroke-related hemiplegia is an important factor influencing parameters of gait. So far, limited papers have assessed temporo-spatial capabilities and their correlations with gait parameters in the early post-stroke stage. This pilot study evaluated the temporo-spatial parameters of gait and assessed the maximal isometric and isokinetic torque production of the plantar flexor and dorsiflexor muscles. Methods: 15 patients with lower limb spasticity and 15 healthy controls were included. Stroke severity was assessed using the Modified Ashworth Scale and the Barthel Index. Gait cadence, gait speed, and gait cycle were assessed using inertial sensors during a Timed Up and Go test. Maximal isometric and isokinetic torque production of the ankle plantar flexor and dorsiflexor muscles were assessed using an isokinetic dynamometer device. Results: Post-stroke patients had statistically significantly lower gait cadence than healthy participants (17%, p<0.05). Statistically significantly lower values of vertical acceleration were also noted during a sit-to-stand movement task (42%, p<0.05). Plantar flexion torque of the affected limb was significantly different during isometric (63%, p≤0.01) and isokinetic work for 30°/s (49%, p=0.04), 60°/s (58%, p=0.01) and 120°/s (53%, p=0.01). Dorsiflexor muscles' torque production was significantly different in isometric activity (38%, p=0.04). A statistically significant positive correlation occurred between the absolute peak torque of the dorsiflexor muscles in both static and speed phases of gait (rs=0.65, p=0.04). Conclusions: Despite the low intensity of spasticity and early phase after stroke, differences in the muscle torque production and temporo-spatial parameters, as well as the correlations between them, were noticeable. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to demonstrate the advantages of using local resources in the coverage of such defects. Our approach in fingers' defects is the use of local perforator flaps, both as propeller flaps or bi-lobed pedicled flaps.Patients and Methods: After performing an anatomical study on cadaver segments injected with latex followed by transparentation, 81 local perforator flaps in 80 patients during a period of 10 years (2007-2016), i.e. 47 digital artery propeller perforator flaps (DAPP), 10 island transposition perforator flaps (DATP), and 24 bi-lobed pedicled perforator flaps (BLP) were performed in our department. The patients were evaluated regarding finger mobility (ROM), two-points discrimination (TPD), and degree of satisfaction (DS) from cosmetic point of view.Results: The mean interval for social and professional reintegration was 12 days. As complications, we registered only venous congestion in 7 cases followed by epidermolysis in 4 cases and superficial necrosis in 3 cases, which healed by reepithelialization. The range of motion (ROM) of the reconstructed fingers was normal in all the patients. All the flaps regain a satisfactory degree of sensibility (TPD between 4 mm and 14 mm). The DS was relatively high, with 67 patients very satisfied, 11 satisfied, and 2 unsatisfied.Conclusions: This fast and less invasive method, which replaces like-with-like, allows an early and good reinervation and a rapid social and professional reintegration, proves to be a very reliable alternative in digital defects coverage. [ABSTRACT FROM AUTHOR]

Background:There is a lack of evidence-based knowledge about the effectiveness of home-based OT for older adults aimed at improving occupational performance by practicing activities and tasks. Aim:This review synthesizes and discusses evidence for the effectiveness of occupation-focused and occupation-based OT for older adults at home. Material and methods:Peer-reviewed quantitative papers were included. Participants: ≥ 60-year-old adults with functional limitations. Intervention: OT aiming at improving occupational performance, primarily through the practice of activities and tasks. Outcome: Occupational performance. Context: Home. Three reviewers critically appraised 13 of 995 detected papers. Extracted data were presented and summarized descriptively. Results:Eight high-quality papers showed that occupation-focused and occupation-based OT using cognitive, behavioral and environmental strategies may significantly improve occupational performance in older, home-dwelling adults with physical health problems. Maintaining achieved improvements was a consistent challenge. Conclusions and significance:Evidence suggests that older adults’ occupational performance can be significantly improved through low-intensity occupation-focused and occupation-based intervention. It is recommended to develop and test high-intensity OT programs and maintenance programs. [ABSTRACT FROM PUBLISHER]

Reablement – or restorative care – is a central feature of many western governments' approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority – to develop an evidence base on models of delivery – is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare‐ and social care–related quality of life, functioning, mental health and resource use (service costs, informal carer time, out‐of‐pocket costs). In contrast with the majority of other studies, self‐report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow‐up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self‐report outcome and resource use measures in evaluations of reablement. [ABSTRACT FROM AUTHOR]

An operational ability assessment system for older adults is of great help to address health and social challenges for ageing. In this paper, the main problems in currently available ADL and ability evaluation systems have been analyzed. The basic principles to build an index system for disability elders evaluation have been put forwarded. Then, an improved Barthel index system for ADL evaluation and a new older adults ability evaluation system consisted of 4 first-level indexes and 14 secondary indexes based on experts' opinion and the ability assessment system for older adults by Ministiy of Civil Affairs of China have been built. The grey clustering model based on end-point mixed triangular possibility function has been introduced. And three living examples of adults' disability evaluation have been conducted. It is confirmed clearly that the three older adults belong to different categories of "severe disability", "mild disability", and "ability passable" respectively. The research results can be used as reference for government to formulate the elderly-care policies, to run and allocate the elderly-care resources, as well as reference for various nursing or elderly-care institutions. [ABSTRACT FROM AUTHOR]

Background Pendlebury and Rothwell's recent paper reports the incidence of cognitive impairment and dementia post stroke as 5% for TIA, 8% for minor stroke and 34% for severe stroke. 1We wanted to explore if these trends were reproducible in an Irish cohort. Methods We conducted a retrospective review of a random sample of 100 discharges from a dedicated stroke rehabilitation unit between 2017 and 2018. Diagnosis of cognitive impairment or dementia was extracted from MDT discharge documentation, along with results of cognitive assessments. This cohort required inpatient rehabilitation post stroke, so we can infer that these were severe strokes. As a surrogate marker of disability, the average Barthel Index of this sample on admission to rehabilitation was 13, indicating moderate functional dependency. Results Complete information was available for 94/100 patients. The average age was 67 years (age range 33-95 years) 37 of 94 (39%) were judged to have cognitive impairment on discharge. Demonstration of functional impairment was central to this assessment. 30 (81%) of these diagnoses were supported by abnormal cognitive tests. 3 of those judged to have cognitive impairment, were unable to complete cognitive assessment. 2 of those judged to have cognitive impairment had cognitive scores which were within the normal range. None of the discharge letters mentioned a diagnosis of post stroke or vascular dementia. Conclusion This study replicates Pendlebury and Rothwell's findings that over a third of people suffering from severe strokes will develop cognitive impairment. This is of critical importance to stroke clinicians as it should prompt frank discussions with stroke patients and their families about prognosis, recovery and future planning. [ABSTRACT FROM AUTHOR]

Background: Recently we defined a user-friendly tool to assess complexity of patients hospitalized in medical wards. FCS-1 is an average between the Barthel Index and the Exton-Smith score, while FCS-2 is obtained by using the Charlson score. The aim of this paper is to assess the ability of the FCS to predict mortality in-hospital and after 1-3-6-12-months. In this perspective, we performed comparisons with the validated Multidimensional Prognostic Index (MPI). Methods: It is a multicenter, prospective observational study, enrolling patients aged over 40, suffering from at least two chronic diseases and consecutively admitted to Internal Medicine departments. For each patient, data from 13 questionnaires were collected. Survival follow-up was conducted at 1-3-6-12 months after discharge. The relationships between cumulative incidences of death with FCS were investigated with logistic regression analyses. ROC curve analyses were performed in order to compare the predictiveness of the logistic models based on FCS with respect to those with MPI taken as reference. Results: A cohort of 541 patients was evaluated. A 10-point higher value for FCS-1 and FCS-2 leads to an increased risk of 1-year death equal to 25.0% and 27.1%, respectively. In case of in-hospital mortality, the relevant percentages were 63.1% and 15.3%. The logistic model based on FCS is significantly more predictive than the model based on MPI (which requires an almost doubled number of items) for all the time-points considered. Conclusions: Assessment of prognosis of patients has the potential to guide clinical decision-making and lead to better care. We propose a new, efficient and easy-to-use instrument based on FCS, which demonstrated a good predictive power for mortality in patients hospitalized in medical wards. This tool may be of interest for clinical practice, since it well balances feasibility (requiring the compilation of 34 items, taking around 10 minutes) and performance. [ABSTRACT FROM AUTHOR]

This paper examines the healthcare needs of community‐dwelling older people living in Porto, Portugal, diagnosed with moderate or severe dementia, linked to functional dependency, cognitive decline, limitations in the activities of daily life, and frailty levels. A sample of 83 participants was recruited. Data were collected between 2013 and 2017. A sociodemographic questionnaire, the Clinical Dementia Rating (CDR), the Barthel Index (BI), the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and the Edmonton Frail Scale (EFS) were used. A set of 26 healthcare needs was defined to support the assessment. The Pearson chi‐square or Fisher's exact test (as appropriate) was used to examine the association of the needs (unmet and met) with the levels of dementia and frailty. Participants were diagnosed previously with moderate or severe dementia and benefited from a structured home‐care program. There was a high number rated as "severe dementia," "fully dependent," "severely or fully dependent in the activities of daily living (ADL)," and "severe frailty." There were statistically significant differences among needs identified in people with moderate or severe dementia and moderate or severe frailty. The most prevalent healthcare needs in the sample were food preparation, medication/taking pills, looking after their home, toilet use, sensory problems, communication/interaction, bladder, bowels, eating and drinking, memory, sleeping, and falls prevention. In particular, the study identifies a set of needs that are present simultaneously in both frailty and dementia stages. This study underlines that despite well‐structured home‐care programs for people with dementia, unmet health needs remain. Timely healthcare needs assessment may help professionals to avoid fragmented care and to tailor quality‐integrated interventions, including the emotional and psychological balance of the caregiver. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the role of gender in the impact of urinary continence (UI) on the quality of life and physical functioning in stroke patients with UI. Methods: This study included 128 stroke patients (64 male, 64 female) with UI and was conducted in the inpatient and outpatient clinics of a public rehabilitation hospital in June,July, and August 2018. Patients were asked to fill a structured questionnaire for colllection of demographic data and incontinence properties, SF-36 for evaluation of quality of life, and Barthel Index for evaluation of functional capacity. Results: Mean ages of the male and female patients included in the study were 62±15.33 and 58.77±16.10 years, respectively. There was no statistically significant difference between genders for UI frequency, urine quantity, materials used for UI, and application to an healthcare institute for UI (p>0.05). Use of sanitary pads for UI was associated with decreased quality of life (p<0.05). There was a statistically significant difference between UI frequency and the "Physical Health" and "Mental Health" subdimension scores of SF-36 (p<0.05). Conclusion: Independent of gender, UI negatively affects the quality of life and social, work, and family life in stroke patients. [ABSTRACT FROM AUTHOR]

Within medical applications there are two main types of information design; paper-based and digital information [1]. As technology is constantly changing, information within healthcare management and delivery is continually being transitioned from traditional paper documents to digital and online resources. Activity of Daily Living (ADL) charts are still predominantly paper based and are therefore prone to 'human error' [2]. In light of this, an investigation has taken place into the design for reducing the amount of human error, between a paper based ADL, specifically the Barthel Index, and the same ADL created digitally. The digital ADL was developed as an online platform as this offers the best method of data capture for a large group of participants all together [3]. The aim of the study was to evaluate the usability of the Barthel Index ADL in paper format and then reproduce the same ADL digitally. This paper presents the findings of a study involving 26 participants who were familiar with ADL charts, and used three scenarios requiring them to complete both a paper ADL and a digital ADL. An evaluation was undertaken to ascertain if there were any 'human errors' in completing the paper ADL and also to find similarities/differences through using the digital ADL. The results from the study indicated that 22/26 participants agreed that the digital ADL was better, if not the same as a paper based ADL. Further results indicated that participants rate highly the added benefit of the digital ADL being easy to use and also that calculation of assessment scores were performed automatically. Statistically the digital BI offered a 100 % correction rate in the total calculation, in comparison to the paper based BI where it is more common for users to make mathematical calculation errors. Therefore in order to minimise handwriting and calculation errors, the digital BI proved superior than the traditional paper based method. [ABSTRACT FROM AUTHOR]

Background: Upper limb recovery is one of the main goals of post-stroke rehabilitation due to its importance for autonomy in Activities of Daily Living (ADL). Although the efficacy of upper limb Robot-assisted Therapy (RT) is well established in literature, the impact of the initial status of the patient on the effects of RT is still understudied. This paper aims to identify whether demographic, clinical and motor characteristics of stroke patients may influence the ability to independently perform ADL after RT. Methods: A retrospective study was conducted on sixty stroke patients who conducted planar upper limb goal-directed tasks with the InMotion 2.0 robot. The RT was administered 5 days/week for 4 weeks and each session lasted 45 minutes. The primary outcome measure was the Modified Barthel Index (BI), dichotomized into favourable (BI ≥75) and unfavourable (BI<75) outcomes. The potential predictors were the demographic and clinical records, and the following clinical assessment scores: Modified Ashworth Scale-Shoulder (MAS-S); Modified Ashworth Scale-Elbow (MAS-E); Fugl-Meyer Assessment Upper Extremity (FMA-UE); upper limb section of the Motricity Index (MIul); total passive Range Of Motion (pROM); and Box and Block Test (BBT). Results: Statistical analysis showed that the BBT, FMA-UE and MIul scores were significant predictors of a favourable outcome in ADL. The cut-off scores of the independent variables were calculated (FMA-UE = 32; MIul = 48; BBT = 3) with respect to the dichotomic BI outcome. Their robustness was assessed with the Fragility Index (FMA-UE = 2; MIul = 3; BBT = 7), showing that BBT is the most robust predictor of favourable BI outcome. Moreover, subjects with all predictors higher than the cut-off scores had higher probability to increase their independence in ADL at the end of the therapy. Demographic records, spasticity and pROM were not identified as predictors. Conclusion: Stroke patients with greater manual dexterity and less impairment appear to have a higher probability of achieving clinically significant ADL outcomes after upper limb RT. The obtained results can help to optimise the management of RT treatment planning. Further studies on a larger number of patients with a long-term follow up are recommended in order to evaluate other potential predictors and to validate the results. [ABSTRACT FROM AUTHOR]

Spatial neglect is a characterized by a failure to attend or make movements towards left-sided stimuli. Common paper-and-pencil tasks to diagnose spatial neglect are sensitive to perseverative errors, including additional marks over already cancelled targets and "scribbling" out a target. Here, we examine whether functionally distinct perseverative behaviors are related to spatial neglect. Line cancellation tasks of 45 healthy controls and 220 right-hemisphere stroke survivors were examined for recurrent marks (RM) and continuous marks (CM) perseverations. We found that RM perseveration correlated with neglect severity, while CM perseveration did not. Examination of lesion profiles for the two groups indicated distinct anatomical correlates, with RM lesions overlapping regions implicated in spatial neglect including the rolandic operculum, superior temporal gyrus, and inferior parietal lobule. [ABSTRACT FROM AUTHOR]

Background: Evaluation of functional status is difficult in neurological and neurosurgical early rehabilitation patients. The Early Rehabilitation Index (ERI) was introduced in Germany over 20 years ago, but since then validation studies are lacking. The ERI (range −325 to 0 points) includes highly relevant items including the necessity of intermittent mechanical ventilation or tracheostomy. Methods: The present paper analyzed data from a German multi-center study, enrolling 754 neurological early rehabilitation patients. Together with ERI, Barthel Index (BI), Glasgow Coma Scale (GCS), Glasgow Outcome Score Extended, Coma Remission Scale (CRS), Functional Ambulation Categories and length of stay were obtained. Results: ERI showed significant improvements from admission to discharge (p < 0.001). In addition, there were significant correlations of the ERI upon admission and at discharge with BI, CRS and GCS. Conclusions: Evaluation of our study data suggest that the ERI may be used as a valid assessment instrument for neurological and neurosurgical early rehabilitation patients. [ABSTRACT FROM AUTHOR]

The main aim of this paper is to assess the effects of an occupational therapy home programme in Spain on 23 people who had had stroke (mean age 61.17 years). The programme was made up of a set of activities and techniques of physical, cognitive, social and functional nature aimed at preventing, maintaining and/or rehabilitating the abilities affected of people who had had stroke. A multiple-baseline intrasubject design and replication with a treatment withdrawal period to check whether the effects of the programme remained was applied. The results show a significant statistical improvement, concerning not only the participants' cognitive skills through Loewenstein Occupational Therapy Cognitive Assessment Battery - Second Edition but also their functional independence as assessed by the Barthel Index. Despite the low number of participants, being one of the limitations of our study, the results support the need to carry out research about the effectiveness of rehabilitation treatments in the home with the goal to plan how public healthcare systems should tackle them and how to improve those already being used. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: Sexual dysfunction is common after stroke, but is frequently not addressed by healthcare providers. The aim of this study was to examine patient preferences for counseling related to sexuality post-stroke. Method: Two hundred and sixty-eight patients from a stroke registry were provided an anonymous paper or online survey. Thirty-eight patients responded and completed the survey. The survey included demographic information, and scales of sexual dysfunction, fatigue, depression and functional independence. In addition, we queried subjects about stroke-related sexual dysfunction and their preferences for counseling and education materials. Results: Most respondents (71%) identified sexuality as a moderately to very important issue in their post-stroke rehabilitation. Sexual dysfunction was common, with 47% of respondents indicating that their sexual function had declined since the stroke. Eighty-one percent reported receiving insufficient information about sexuality post-stroke, and the majority (60%) expressed a preference for receiving counseling regarding sexuality from a physician. A substantial portion (26.5%) of patients wanted to receive counseling prior to discharge from a hospital or rehabilitation center, with 71% wishing to receive counseling within 1 year post-stroke. Conclusions: Many stroke survivors experience sexual dysfunction and indicate a desire for additional information and counseling from healthcare providers. Preferences regarding the timing of such counseling vary, creating challenges for optimizing the delivery of this care. [ABSTRACT FROM AUTHOR]

Background: Fragility fractures are a major health care problem worldwide. The proportion of the geriatric population and the overall life expectancy will increase. Hip fractures are the most common fragility fractures needing surgery and nowadays treatment concepts are changing. We studied the long-term functional outcome and their influencing factors in patients treated without any interdisciplinary aspects. Design and setting: A retrospective cohort study with functional long-term follow-up examination was carried out in a level one trauma centre on hip fracture patients 80 years old and above treated without any formalized interdisciplinary aspects ('usual care'). Patients: Of 281 consecutive patients who were treated 2005 and 2006 with usual care, 246 patients with a mean age of 86.8 years met our inclusion criteria. 69.1% died within the study period of 4.9 years. On the remaining patients, the residential status, the Barthel Index and the Parker Score were assessed. Results: The mean Barthel Index was 49.6 and the mean Parker Score was 2.7. More than one-fourth of the survivors were found to be bedridden and 45% were not able to walk outside. 88% are bound to one floor and only 8% are able to walk unaided. Patients with more comorbidities and patients with subsequent fractures had significant higher mortality rates. Patients with trochanteric fractures had significant better functional outcome scores compared to patients with femoral neck fractures. Nursing home residents showed significant higher mortality rates and lower functional outcome scores. Patients who were transferred to a nearby acute geriatric hospital for further treatment had significantly higher functional outcome scores. Conclusion: This paper shows the frustrating long-term outcome of geriatric hip fracture patients but it also suggests that an early geriatric intervention may lead to better function. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study evaluating whether expanding a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery. BACKGROUND: Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation, although this is limited by the constraints of service organization. METHODS: A pragmatic randomized controlled trial was undertaken. Patients with a diagnosis of stroke were randomized to receive continued support from a stroke nurse (n = 87) or usual care and follow-up (n = 89) after discharge from hospital. Patients were recruited from two hospitals in the north-west of England from November 1999 to April 2001. Patient dependence (Barthel Index), general health (Nottingham Health Profile), activities of living (Frenchay Activity of Living Index), depression (Beck Depression Inventory) and carer strain (Carer Strain Index) were assessed at 3 and 12 months after stroke. RESULTS: The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months (median difference 42.6, P = 0.012), and in particular reduced negative emotional reaction (P = 0.037) and perceived social isolation (P = 0.002). In addition, the intervention reduced carer strain at 3 months (P = 0.045), and reduced deterioration in physical dependence from 3 to 12 months (P = 0.049). CONCLUSION: The provision of continued intervention from a stroke nurse after discharge from hospital, focusing on education and support, has tangible benefits for patients and carers. [ABSTRACT FROM AUTHOR]

Objective: the Barthel Index (BI) has been recommended for the functional assessment of older people but the reliability of the measure for this patient group is uncertain. To investigate this issue we undertook a systematic review to identify relevant studies from which an overview is presented. Method: studies investigating the reliability of the BI were obtained by searching Medline, Cinahl and Embase to January 2003. Screening for potentially relevant papers and data extraction of the studies meeting the inclusion criteria were carried out independently by two researchers. Results: the scope of the 12 studies identified included all the common clinical settings relevant to older people. No study investigated test-retest reliability. Inter-rater reliability was reported as 'fair' to 'moderate' agreement for individual BI items, and a high percentage agreement for the total BI score. However, these findings were difficult to interpret as few studies reported the prevalence of the disability categories for the study populations. There may be considerable inter-observer disagreement (95% CI of ±4 points). There was evidence that the BI might be less reliable in patients with cognitive impairment and when scores obtained by patient interview are compared with patient testing. The role of assessor training and/or guidelines on the reliability of the BI has not been investigated. Conclusions: although the BI is highly recommended, there remain important uncertainties concerning its reliability when used with older people. Further studies are justified to investigate this issue. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the caregiver burden over time of patients with haemorrhagic stroke and the determinants of this. Background: Identification of the predictors for caregiver burden can be used to improve the outcomes of stroke survivors and caregivers. Few studies focus on the caregiver burden of patients with haemorrhagic stroke and how this changes over time. Design This was a prospective longitudinal study. Methods: A convenience sample of 202 stroke survivor/caregiver pairs were recruited in the neurosurgery unit from March 2015 to March 2016. The participants were assessed at three different times by face to face or telephone interview. Caregiver burden was assessed using the Bakas Caregiver Outcomes Scale. Sociodemographic data and other characteristics of the pairs were also collected. Multiple linear regression was performed to identify the determinants. Results: Caregiver burden decreased from T1 to T3 significantly. The physical function, depression of stroke survivors, and self‐rated burden of caregivers were the most important determinants for overall caregiver burden. The factors identified explained 41.6% to 67.4% of overall burden. Conclusion: Caregiver burden decreased over time, affected by factors from patients and caregivers. More professional caregivers are needed to support informal carers. SUMMARY STATEMENT: What is already known about this topic? Stoke survivors usually contribute much of the perceived burden of caregivers, especially for family caregivers.Perceived caregiver burden can have adverse effects on both caregivers and patients.Caregiver burden is affected by multiple factors from both caregivers and patients, which vary in different cultures. What this paper adds? Caregivers of patients with haemorrhagic stroke experience burden even during the patients' hospital stay.The factors identified for caregiver burden in China differ from what has been identified in western countries.The self‐rated burden of caregivers is a predictor for overall burden, suggesting this may be used as a screening function. The implications of this paper: The study suggests the early screen of caregiver burden via self‐rated burden could help to detect long‐term burden.There is a need for nurses and other professions to provide psychological nursing and functional rehabilitation to patients postdischarge from health care services.More professional care providers are needed to support informal carers. [ABSTRACT FROM AUTHOR]

(1) Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = −0.791), WGS (r = −0.646) and FIM (r = −0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = −0.847), FIM (r = −0.810) and BI (r = −0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months). [ABSTRACT FROM AUTHOR]

Conservative practices, such as manual registry have limited scope regarding preoperative, intraoperative and postoperative decision making, knowledge discovery, analytical techniques and knowledge integration into patient care. To maximize quality and value, perioperative care is changing through new technological developments. In this context, knowledge management practices will enable future transformation and enhancements in healthcare services. By performing a data science and knowledge management research in the perioperative department at Hospital Dr. Nélio Mendonça between 2013 and 2015, this paper describes its principal results. This study showed perioperative decision-making improvement by integrating data science tools on the perioperative electronic system (PES). Before the PES implementation only 1,2% of the nurses registered the preoperative visit and after 87,6% registered it. Regarding the patient features it was possible to assess anxiety and pain levels. A future conceptual model for perioperative decision support systems grounded on data science should be considered as a knowledge management tool. [ABSTRACT FROM AUTHOR]