scholarly journals Are Differences in Dysphagia Assessment, Oral Care Provision, or Nasogastric Tube Insertion Associated with Stroke-Associated Pneumonia? A Nationwide Survey Linked to National Stroke Registry Data

2021 ◽  
pp. 1-8
Author(s):  
Sabrina A. Eltringham ◽  
Benjamin D. Bray ◽  
Craig J. Smith ◽  
Sue Pownall ◽  
Karen Sage
Keyword(s):  
Nasogastric Tube ◽  
Management Practices ◽  
Oral Care ◽  
Multivariable Analysis ◽  
Nationwide Survey ◽  
Linear Regression Models ◽  
Stroke Registry ◽  
Care Protocol ◽  
Assessment Guidelines ◽  
Poor Outcomes

<b><i>Introduction:</i></b> Stroke-associated pneumonia (SAP) is a common complication associated with poor outcomes. Early dysphagia screening and specialist assessment is associated with a reduced risk of SAP. Evidence about oral care and nasogastric tube (NGT) placement is equivocal. This study aimed to expose variations in dysphagia management practices and explore their associations with SAP. <b><i>Participants and Methods:</i></b> Speech pathologists from 166 stroke units in England and Wales were surveyed about dysphagia assessment and management, oral care, and NGT placement. Survey data were then linked to the Sentinel Stroke National Audit Programme (SSNAP), the national register of stroke. Univariable and multivariable linear regression models were fitted to estimate the association between dysphagia management practices and SAP incidence. <b><i>Results:</i></b> 113 hospitals completed the survey (68%). Variation was evident in dysphagia screening protocols (DSPs), oral care, and NGT practice while specialist swallow assessment data patterns were more consistent. Multivariable analysis showed no evidence of an association in incidence of SAP when using a water-only hospital DSP compared to a multiconsistency DSP (B −0.688, 95% CI: −2.912 to 1.536), when using written swallow assessment guidelines compared to not using written guidelines (B 0.671, 95% CI: −1.567 to 2.908), when teams inserted NGTs overnight compared to teams which did not (B −0.505, 95% CI: −2.759 to 1.749), and when teams had a written oral care protocol compared to those which did not (B −1.339, 95% CI: −3.551 to 0.873). <b><i>Discussion and Conclusion:</i></b> Variation exists in dysphagia screening and management, but there was no evidence of an association between clinical practice patterns and incidence of SAP. Further research with larger sample sizes is needed to examine association with SAP.

Oral Care in the Intensive Care Unit: A Review

2007 ◽  
Vol 8 (1) ◽  
pp. 76-82 ◽  
Author(s):  
Randa F. Abidia
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Hygiene ◽  
Oral Care ◽  
Oral Intubation ◽  
Sufficient Knowledge ◽  
Oral Assessment ◽  
Care Protocol ◽  
Mouth Care ◽  
Assessment Guidelines

Abstract Oral care for patients in the hospital's Intensive Care Unit (ICU) is important, but this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow. The problems of maintaining oral care with oral intubation, performing oral assessment, guidelines for oral hygiene care, frequency of oral care needed, and suggested mouth care protocol followed by recommendations are presented and discussed in this paper. Citation Abidia RF. Oral Care in the Intensive Care Unit: A Review. J Contemp Dent Pract 2007 January;(8)1:076-082.

scholarly journals The Soil Organic Matter in Connection with Soil Properties and Soil Inputs

Agronomy ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 779
Author(s):  
Václav Voltr ◽  
Ladislav Menšík ◽  
Lukáš Hlisnikovský ◽  
Martin Hruška ◽  
Eduard Pokorný ◽  
...  
Keyword(s):  
Organic Matter ◽  
Soil Organic Matter ◽  
Soil Texture ◽  
Management Practices ◽  
Soil Depth ◽  
Operating Conditions ◽  
Hot Water ◽  
Natural Soil ◽  
Soil Productivity ◽  
Linear Regression Models

The content of organic matter in the soil, its labile (hot water extractable carbon–HWEC) and stable (soil organic carbon–SOC) form is a fundamental factor affecting soil productivity and health. The current research in soil organic matter (SOM) is focused on individual fragmented approaches and comprehensive evaluation of HWEC and SOC changes. The present state of the soil together with soil’s management practices are usually monitoring today but there has not been any common model for both that has been published. Our approach should help to assess the changes in HWEC and SOC content depending on the physico-chemical properties and soil´s management practices (e.g., digestate application, livestock and mineral fertilisers, post-harvest residues, etc.). The one- and multidimensional linear regressions were used. Data were obtained from the various soil´s climatic conditions (68 localities) of the Czech Republic. The Czech farms in operating conditions were observed during the period 2008–2018. The obtained results of ll monitored experimental sites showed increasing in the SOC content, while the HWEC content has decreased. Furthermore, a decline in pH and soil´s saturation was documented by regression modelling. Mainly digestate application was responsible for this negative consequence across all soils in studied climatic regions. The multivariate linear regression models (MLR) also showed that HWEC content is significantly affected by natural soil fertility (soil type), phosphorus content (−30%), digestate application (+29%), saturation of the soil sorption complex (SEBCT, 21%) and the dose of total nitrogen (N) applied into the soil (−20%). Here we report that the labile forms (HWEC) are affected by the application of digestate (15%), the soil saturation (37%), the application of mineral potassium (−7%), soil pH (−14%) and the overall condition of the soil (−27%). The stable components (SOM) are affected by the content of HWEC (17%), soil texture 0.01–0.001mm (10%), and input of organic matter and nutrients from animal production (10%). Results also showed that the mineral fertilization has a negative effect (−14%), together with the soil depth (−11%), and the soil texture 0.25–2 mm (−21%) on SOM. Using modern statistical procedures (MRLs) it was confirmed that SOM plays an important role in maintaining resp. improving soil physical, biochemical and biological properties, which is particularly important to ensure the productivity of agroecosystems (soil quality and health) and to future food security.

Abstract P256: Association Between Antidepressants Use and Intracerebral Hemorrhage: Florida Stroke Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mithilesh Siddu ◽  
Antonio Bustillo ◽  
Carolina M Gutierrez ◽  
Kefeng Wang ◽  
Hannah Gardener ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Oral Anticoagulants ◽  
Large Population ◽  
Multivariable Analysis ◽  
Population Based ◽  
Prior History ◽  
Stroke Registry ◽  
The Us ◽  
History Of ◽  
Antidepressant Use

Introduction: SSRIs, the most commonly prescribed antidepressants (AD) in the US, are linked to an increased intracerebral hemorrhage (ICH) risk possibly related to impaired platelet function. In the Florida Stroke Registry (FSR), we studied the proportion of cases presenting with ICH amongst AD users and the rate of SSRI prescription amongst stroke patients discharged on AD. Methods: From Jan 2010 to Dec 2019 we included 127,915 cases from FSR in whom information on AD use was available. Multivariable logistic regression was used to evaluate ICH proportions amongst AD and non-AD users and rates of prescribed SSRIs at discharge. Results: The rate of ICH amongst prior AD users (n=17,009, median age 74, IQR=19) and non-AD users (n=110,906, median age 72, IQR=21) were 11% and 14% respectively. Prior AD users were more likely to be female (17% vs. 10% male), non-Hispanic White (16% vs. 8% non-Hispanic Black vs. 12% Florida Hispanic vs. 6% Puerto Rican Hispanic), have hypertension (HTN) (14.% vs. 10%), diabetes mellitus (DM) (16% vs.12%), use oral anticoagulants (OAC) (17 % vs. 13%), antiplatelets (AP; 17% vs. 11%), and statins (17% vs. 10%) prior to hospital presentation. In multivariable analysis adjusting for age, race, prior history of HTN, DM, prior OAC, AP and statin use, AD users just as likely to present with spontaneous ICH as compared to non-AD users (OR=0.92, 95% CI 0.85, 1.01). A total of 3.4% of all ICH patients and 9% of those in whom AD information was available were discharged home on an AD (74 % SSRI, 24% other AD). Conclusion: In this large population-based study, we did not find an association between prior AD use and an increased rate of ICH. Importantly AD (mostly SSRIs) are commonly prescribed to patients with ICH in routine clinical practice. The association between types, duration, and safety of antidepressant use in ICH patients deserves further studies.

Dysphagia screening after intracerebral hemorrhage

2017 ◽  
Vol 13 (5) ◽  
pp. 503-510 ◽  
Author(s):  
Raed A Joundi ◽  
Rosemary Martino ◽  
Gustavo Saposnik ◽  
Vasily Giannakeas ◽  
Jiming Fang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Clinical Severity ◽  
Stroke Severity ◽  
Stroke Registry ◽  
Patients At Risk ◽  
Poor Outcomes ◽  
Risk Of Aspiration ◽  
To Receive

Background Dysphagia screening is recommended after acute stroke to identify patients at risk of aspiration and implement appropriate care. However, little is known about the frequency and outcomes of patients undergoing dysphagia screening after intracerebral hemorrhage (ICH). Methods We used the Ontario Stroke Registry from 1 April 2010 to 31 March 2013 to identify patients hospitalized with acute stroke and to compare dysphagia screening rates in those with ICH and ischemic stroke. In patients with ICH we assessed predictors of receiving dysphagia screening, predictors of failing screening, and outcomes after failing screening. Results Among 1091 eligible patients with ICH, 354 (32.4%) patients did not have documented dysphagia screening. Patients with mild ICH were less likely to receive screening (40.4% of patients were omitted, adjusted odds ratio (aOR) 0.40, 95% confidence interval (CI) 0.26–0.63). Older age, greater stroke severity, speech deficits, lower initial level of consciousness, and admission to intensive care unit were predictive of failing the screening test. Failing screening was associated with poor outcomes, including pneumonia (aOR 5.3, 95% CI 2.36–11.88), severe disability (aOR 4.78, 95% CI 3.08–7.41), and 1-year mortality (adjusted hazard ratio 2.1, 95% CI 1.38–3.17). When compared to patients with ischemic stroke, patients with ICH were less likely to receive dysphagia screening (aOR 0.64, 95% CI 0.54–0.76) and more likely to fail screening (aOR 1.98, 95% 1.62–2.42). Conclusion One-third of patients with ICH did not have documented dysphagia screening, increasing to 40% in patients with mild clinical severity. Failing screening was associated with poor outcomes. Patients with ICH were less like to receive screening and twice as likely to fail compared to patients with ischemic stroke, and thus efforts should be made to include ICH patients in dysphagia screening protocols whenever possible.

scholarly journals Efficacy of a multidisciplinary care protocol for the treatment of operated hip fracture patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jorge Salvador-Marín ◽  
Francisco Javier Ferrández-Martínez ◽  
Cort D. Lawton ◽  
Domingo Orozco-Beltrán ◽  
Jose Fernando Martínez-López ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hospital Mortality ◽  
Multivariable Analysis ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Multidisciplinary Care ◽  
Exposed Group ◽  
Composite Outcome ◽  
Surgical Delay ◽  
Care Protocol

AbstractTo assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. Prospective cohort study between 2011 and 2017. The unexposed group comprised patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. Variables analyzed were demographics, medical comorbidities, treatment, blood parameters, surgical delay, LOS, re-admissions, mortality, and a composite outcome considering in-hospital mortality and/or LOS > 10 days. We performed a Poisson regression and cost analysis. The cohort included 681 patients: 310 unexposed and 371, exposed. The exposed group showed a shorter surgical delay (3.0 vs. 3.6 days; p < 0.001), and a higher proportion received surgery within 48 h (46.1% vs. 34.2%, p = 0.002). They also showed lower rates of 30-day readmission (9.4% vs. 15.8%, p = 0.012), 30-day mortality (4.9% vs. 9.4%, p = 0.021), in-hospital mortality (3.5% vs. 7.7%; p = 0.015), and LOS (8.4 vs. 9.1 days, p < 0.001). Multivariable analysis showed a protective effect of the protocol on the composite outcome (risk ratio 0.62, 95% CI 0.48–0.80, p < 0.001). Hospital costs were reduced by EUR 112,153.3. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients.

scholarly journals Association of Level and Increase in D‐Dimer With All‐Cause Death and Poor Functional Outcome After Ischemic Stroke or Transient Ischemic Attack

2021 ◽  
Author(s):  
Huiqing Hou ◽  
Xianglong Xiang ◽  
Yuesong Pan ◽  
Hao Li ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Transient Ischemic Attack ◽  
Cox Regression ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Poor Outcomes ◽  
Ischemic Attack ◽  
High Level ◽  
D Dimer

Background D‐dimer is involved in poor outcomes of stroke as a coagulation biomarker. We aimed to investigate the associations of the level and increase in D‐dimer between baseline and 90 days with all‐cause death or poor functional outcome in patients after ischemic stroke or transient ischemic attack. Methods and Results We collected data from the CNSRIII (Third China National Stroke Registry) study. The present substudy included 10 518 patients within 7 days (baseline) of ischemic stroke or transient ischemic attack and 6268 patients at 90 days. Poor functional outcome at 1 year was assessed on the basis of the modified Rankin Scale (≥3). Multivariable Cox regression or logistic regression was used to assess the association of D‐dimer levels with all‐cause death or poor functional outcome. D‐dimer levels at 90 days were lower than those at baseline (1.4 µg/mL versus 1.7 µg/mL; P <0.001). Higher baseline D‐dimer level was associated with all‐cause death (adjusted hazard ratio [HR], 1.77; 95% CI, 1.25–2.52; P =0.001) and poor functional outcome (adjusted odds ratio [OR], 1.49; 95% CI, 1.23–1.80; P <0.001) during 1‐year follow‐up. Higher D‐dimer level at 90 days was also associated with poor outcomes independently. Furthermore, an increase in D‐dimer levels between baseline and 90 days was associated with all‐cause death (since 90 days to 1 year after index event) (adjusted HR, 1.99; 95% CI, 1.12–3.53; P =0.019) but not with poor functional outcome (adjusted OR, 1.08; 95% CI, 0.82–1.41). Conclusions Our study shows that high level and an increase in D‐dimer between baseline and 90 days are associated with poor outcomes in patients after ischemic stroke or transient ischemic attack.

Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II

2017 ◽  
Vol 12 (3) ◽  
pp. 254-263 ◽  
Author(s):  
Janet Prvu Bettger ◽  
Zixiao Li ◽  
Ying Xian ◽  
Liping Liu ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multivariable Analysis ◽  
Thrombosis Prophylaxis ◽  
Stroke Patients ◽  
Multivariable Logistic Regression Model ◽  
Recommended Care ◽  
Stroke Registry ◽  
Factors Associated ◽  
Rehabilitation Assessment

Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

Abstract 160: Paradoxical Effect of Smoking on Mortality in the patients Admitted with Acute Ischemic Stroke

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Lee H Schwamm
Keyword(s):  
Ischemic Stroke ◽  
Myocardial Ischemia ◽  
Acute Ischemic Stroke ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Oral Intake ◽  
Lower Mortality ◽  
Paradoxical Effect ◽  
Multicenter Studies ◽  
Stroke Registry

Introduction: Compared to those who never smoked, a paradoxical effect of smoking on reducing mortality in patients admitted with myocardial ischemia has been reported. We sought to determine if this effect was present in patients hospitalized with ischemic stroke. Methods: Using the local Get with the Guidelines-Stroke registry, we analyzed 4,305 consecutively admitted ischemic stroke patients (Mar 2002-Dec 2011). The sample was divided into smokers vs. ex or non-smokers. The main outcome of interest was the overall inpatient mortality. Multivariable analysis included factors significant at p<0.05 in univariate analysis. Results: Compared to non-smokers, tobacco smokers were younger, more frequently male and presented with fewer stroke risk factors such as hypertension, hyperlipidemia, diabetes, coronary artery disease and atrial fibrillation. Smokers also had a lower median NIHSS and fewer received tPA. Patients in both groups had similar adherence to early antithrombotics, dysphagia screening prior to oral intake and DVT prophylaxis (Table 1). Smoking was associated with lower all cause in-hospital mortality (6.6% vs. 12.4%; unadjusted OR 0.46; CI [0.34 - 0.63]; p < 0.05). In multivariable analysis, adjusted for age, gender, ethnicity, HTN, DM, HL, CAD, A.fib, NIHSS and tPA at an outside hospital, smoking remained independently associated with lower mortality (adjusted OR 0.66; CI [0.44-0.98]; p < 0.05). (Table 2) Conclusion: Similar to myocardial ischemia, smoking was independently associated with lower mortality in acute ischemic stroke. This effect may be due to tobacco induced changes in cerebrovascular resting tone or vasoreactivity, or may be due in part to residual confounding (e.g., differences in predicted outcome from stroke subtypes, or wishes regarding life sustaining therapies). Larger, multicenter studies are needed to confirm the finding and determine the role of in hospital complications and the effect on 30 day and 1 year mortality.

Nurses’ Implementation of Guidelines for Ventilator-Associated Pneumonia From the Centers for Disease Control and Prevention

2007 ◽  
Vol 16 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Carolyn L. Cason ◽  
Tracy Tyner ◽  
Sue Saunders ◽  
Lisa Broome
Keyword(s):  
Intensive Care ◽  
Disease Control ◽  
Intensive Care Units ◽  
Oral Care ◽  
The United States ◽  
Hand Washing ◽  
Ventilator Associated Pneumonia ◽  
Care Protocol ◽  
Control And Prevention ◽  
Centers For Disease Control

• Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

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