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Healthcare-associated infections (HCAIs) in patients admitted with acute conditions pose a serious risk to patients and a major challenge to healthcare services. However, there is a lack of consistency in reporting aetiological risk factors, particularly in acute stroke patients. Here, we determined independent risk factors of two common HCAIs (urinary tract infection and pneumonia) acquired within 7-days of admission after an acute stroke. Data were prospectively collected (2014–2016) from the Sentinel Stroke National Audit Programme for 3,309 patients (mean age=76.2yr, SD=13.5) admitted to four UK hyperacute stroke units. Associations between variables were assessed by forward stepwise multivariable logistic regression (odds ratios, 95 % confidence intervals). The rate of urinary tract infection and/or pneumonia occurring within 7-days of admission was 15.0 %. The risk of urinary tract infection and/or pneumonia was increased amongst women: OR = 1.35 (1.08–1.68); patients from ethnic minority backgrounds: OR = 1.77 (1.01–3.10); patients aged 70–79 years: OR = 2.08 (1.42–3.06), and ≥80 years: OR = 3.20 (2.26–4.55); history of hypertension: OR = 1.59 (1.27–1.98); history of atrial fibrillation: OR = 1.67 (1.32–2.12); pre-stroke disability: OR = 2.08 (1.44–3.00); intracranial haemorrhage: OR = 1.41 (1.07–1.86); severe stroke: OR = 3.21 (2.32–4.45); swallow screening within 4–72 h: OR = 1.42 (1.08–1.86); swallow screening beyond 72 h: OR = 1.70 (1.08–2.70). History of congestive heart failure, diabetes and previous stroke did not significantly associate with HCAIs. A profile of independent risk factors for two common HCAIs in acute stroke was identified. These findings provide valuable information for timely intervention to reduce HCAIs, and the ability to minimise subsequent adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: Indicators for outcomes following acute stroke are lacking. We have developed novel evidence-based criteria for identifying outcomes of acute stroke using the presence of clusters of coexisting cardiovascular disease (CVD).Materials and Methods: Analysis of prospectively collected data from the Sentinel Stroke National Audit Programme (SSNAP). A total of 1656 men (mean age ±SD=73.1yrs±13.2) and 1653 women (79.3yrs±13.0) were admitted with acute stroke (83.3% ischaemic, 15.7% intracranial haemorrhagic), 1.0% unspecified) in four major UK hyperacute stroke units (HASU) between 2014 and 2016. Four categories from cardiovascular disease Congestive heart failure, Atrial fibrillation, pre-existing Stroke and Hypertension (CASH).were constructed: CASH-0 (no coexisting CVD); CASH-1 (any one coexisting CVD); CASH-2 (any two coexisting CVD); CASH-3 (any three or all four coexisting CVD). These were tested against outcomes, adjusted for age and sex.Results: Compared to CASH-0, individuals with CASH-3 had greatest risks of in-hospital mortality (11.1% vs 24.5%, OR=1.8, 95%CI=1.3-2.7) and disability (modified Rankin Scale score ≥4) at discharge (24.2% vs 46.2%, OR=1.9, 95%CI=1.4-2.7), urinary tract infection (3.8% vs 14.6%, OR= 3.3, 95%CI= 1.9-5.5), and pneumonia (7.1% vs 20.6%, OR= 2.6, 95%CI= 1.7-4.0); length of stay on HASU >14 days (29.8% vs 39.3%, OR=1.8, 95%CI=1.3-2.6); and joint-care planning (20.9% vs 29.8%, OR=1.4, 95%CI=1.0-2.0).Conclusions: We present a simple tool for estimating the risk of adverse outcomes of acute stroke including death, disability at discharge, nosocomial infections, prolonged length of stay, as well as any joint care planning. CASH-0 indicates a low level and CASH-3 indicates a high level of risk of such complications after stroke. [ABSTRACT FROM AUTHOR]

Abstract: The need to consider myocarditis as one cause of flu-like symptoms in patients taking Clozapine should be well entrenched. Suspicion should be heightened if the symptoms develop during the first 6–8 weeks of therapy. The FDA and the drug''s manufacturer have strengthened warnings to include that a potentially fatal myocarditis may occur when taking Clozapine. We aim to highlight the side effects of Clozapine and increase awareness of this condition associated with the usage of the drug. [Copyright &y& Elsevier]