Biomedical subjects

I Wellwood

Publications and source records attributed to I Wellwood.

4 recordsLinked to original sources

PubMed1996

Complications after acute stroke.

BACKGROUND AND PURPOSE: We sought to observe the type, timing, and frequency of complications occurring in hospitalized patients after an acute stroke. METHODS: In a single hospital, we prospectively identified a consecutive cohort of patients who were either admitted after an acute stroke or who suffered a stroke while already an inpatient (n=613). We retrieved the case notes for 607 (99%) of these strokes, and a single observer, using predefined diagnostic criteria, reviewed the notes and recorded the type, timing, and frequency of complications that occurred during the inpatient period. We also measured the reliability of complication identification from case note review by comparing two observers on a sample of records. RESULTS: Complications were recorded after 360 strokes (59%); the most common individual complications were falls (complicating 22% of all strokes), skin breaks (18%), and urinary tract (16%) or chest (12%) infections. Miscellaneous "other" complications complicated 32% of strokes. Seizures and chest infections occurred early, whereas depression and painful shoulder were later problems. Complications were more common in older patients, who were more disabled before their stroke and had suffered more severe strokes. We demonstrated moderate to good agreement between the two observers for most complications. CONCLUSIONS: Complications after acute stroke are common, confirming that stroke rehabilitation requires active and knowledgeable medical input. Knowing the nature and timing of complications, together with the identification of high-risk patients, may be useful to those planning stroke services. The differences in our results and those previously reported, most notably for skin breaks, are probably due to the different methods used, in particular patient selection and diagnostic criteria for complications. Although complications may be useful as a measure of outcome in comparative studies (eg, therapeutic trials and audit), the methodological difficulties in accurately and reliably measuring them must be addressed.

Accidental Falls↗

PubMed1995

A comparison of the Barthel Index and the OPCS disability instrument used to measure outcome after acute stroke.

The Barthel Index has been widely adopted as a measure of disability. The Office of Population Censuses and Surveys (OPCS) disability instrument was developed to provide a comprehensive measure of disability for use in the 1985 survey of disability among adults. Both measures were used on 150 patients surviving 1 year from a consecutive cohort of 246 admissions to hospital with acute stroke. The Barthel Index when summed across categories (as is commonly done), correlated reasonably well with the OPCS disability instrument [-0.73 (p < 0.001) 95% CI 0.64 to 0.80] despite its reliance on arbitrary weights and the omission of categories for communication, vision, hearing and intellectual disability. The broader scope of the OPCS instrument explained most of the floor and ceiling effects seen with the Barthel Index. The Barthel Index continues to have a useful role in stroke rehabilitation when used as a checklist for rehabilitation goals set by clinicians, as a predictor of long-term outcome and as an overall measure of disability or activities of daily living in descriptive studies, randomized controlled trials and audit. However, its floor and ceiling effects may lead to an underestimation of patients' and carers' problems in up to a third of patients. The OPCS instrument may prove to be a more useful outcome measure in randomized controlled trials and audits by virtue of its comprehensive nature.

Activities of Daily Living↗

PubMed1995

Patients' and carers' satisfaction with acute stroke management.

We set out to discover how satisfied patients and carers were with existing stroke services. We prospectively identified 164 consecutive patients admitted to a department of general medicine with acute stroke and collected data using a satisfaction questionnaire in a semi-structured interview. of the 110 (67%) survivors, 65 (59%) patients and 80 (73%) carers completed an interview. We also interviewed 34 bereaved carers. Most patients (97%), carers (92%) and bereaved carers (94%) were satisfied with care overall. However, 30 (46%) of our patients, 53 (66%) carers and 18 (53%) bereaved carers who were satisfied with care overall expressed dissatisfaction with at least one component. Carers of patients were significantly more dissatisfied than the patients themselves with the amount of information given and with social work intervention. Carers of patients who were unable to respond to the questionnaire themselves, usually because of cognitive difficulties, were the most dissatisfied group even when compared with bereaved carers. Measuring satisfaction can alert one to deficiencies within a service, aiding service development, but interpreting patients' and carers' overall satisfaction. Efforts to improve communication, discharge planning and follow-up, aimed at carers as well as the patients themselves, are likely to be rewarded with improved satisfaction with stroke services.

Acute Disease↗

PubMed1994

Perceptions and knowledge of stroke among surviving patients with stroke and their carers.

As part of a survey to collect data which would be useful in planning a district stroke service we set out to discover what the service users' (patients' and carers') perceptions and knowledge of their illness were. We prospectively identified 164 consecutive patients with acute stroke admitted to hospital. Of the 110 (67%) survivors 65 (59%) patients and 80 (73%) carers completed a semi-structured interview. Most (46, 71%) patients and (68, 85%) carers thought they understood what a stroke was but 14 (22%) patients and 12 (15%) carers did not differentiate between a 'stroke' and a 'heart attack'. Carers were significantly more likely than patients to want know all the details about the patients' condition and treatment, to discuss the risk of recurrence, to receive written information and to join information groups. They were more likely than patients to feel that they had to ask for information, yet they were better able to identify general risk factors for stroke. Many patients and carers want more information and discussion about their illness and treatment during their hospital stay, however, some do not. Therefore information giving must be considered on an individual basis. Information could be delivered by: increasing available literature, voluntary group meetings, Stroke Family Care Officers and audio-visual information packages. The most efficient way of achieving an increased understanding amongst patients and carers needs to be found.

Acute Disease↗