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Biomedical subjects

Keith V Kuhlemeier

Publications and source records attributed to Keith V Kuhlemeier.

4 recordsLinked to original sources
PubMed2006

Do racial disparities exist in access to inpatient stroke rehabilitation in the state of Maryland?

OBJECTIVE: Black patients tend to have a greater number and severity of stroke cases. The literature on access to rehabilitative services shows mixed results ranging from no disparities to limited access among minority populations. This study evaluated the association of race and acute discharge to inpatient stroke rehabilitation in Maryland, a diagnostic related group-and postacute care prospective payment system-exempt state. DESIGN: Data from the Maryland Health Services and Cost Review Commission database for 2000 was used to conduct a cross sectional retrospective review to determine the rate of disposition to inpatient rehabilitation facilities (IRF). Multiple logistic regression analyses evaluated factors associated with discharge to IRF in this population. RESULTS: There were a total of 12,208 patients hospitalized with stroke in the year 2000. Compared with urban-dwelling white patients, black patients who lived in urban dwellings were more likely to be discharged to IRF, OR 1.42, 95% CI (1.06, 1.91). CONCLUSION: In the state of Maryland, urban-dwelling black stroke patients were more likely to be discharged to IRF acutely after stroke. Future studies should assess whether this trend persists in states that have larger rural populations.

Activities of Daily Living↗
PubMed2003

Prevalence of venous thromboembolism in acute hemorrhagic and thromboembolic stroke.

OBJECTIVE: Deep venous thromboembolism (DVT) is an important health issue in the hospitalized geriatric population that leads to increased length of stay, morbidity, and mortality. Patients with hemorrhagic strokes are usually not placed on prophylactic therapy because of the risk of hemorrhagic extension of the stroke. The purpose of this study was to evaluate the prevalence of DVTs in hospitalized patients with hemorrhagic vs. thromboembolic strokes. DESIGN: Retrospective chart review of data obtained from the Maryland Health Services Cost Review Commission data base for 1999 to determine the prevalence of DVTs in both hemorrhagic and thromboembolic stroke patients hospitalized acutely. Multiple logistic regression was performed to evaluate possible risk factors. RESULTS: There were 1926 patients hospitalized with a primary diagnosis of hemorrhagic stroke and 15599 with thromboembolic stroke. Women in general had more strokes than men did. Older patients were more likely to have strokes as evidenced by the mean ages of 66 and 71 yr for hemorrhagic and thromboembolic strokes, respectively. A total of 37 patients (1.9%) with hemorrhagic strokes had DVTs, whereas 74 patients (0.5%) with thromboembolic strokes had DVTs. Hemorrhagic stroke was an independent risk factor for DVT (odds ratio, 2.60; 95% confidence interval, 1.49-4.55; P = 0.0008). CONCLUSIONS: DVT prevalence and risk was higher among patients with hemorrhagic strokes in comparison with patients with thromboembolic strokes.

Age Factors↗
PubMed2003

[Dysphagia severity scale].

A simple, broadly applicable, standardized dysphagia severity scale would be useful to standardize dysphagia evaluations, to monitor recovery and efficacy of treatment and to study the consequences of dysphagia. We developed a global Dysphagia Severity Scale (DSS) from videofluorographic swallowing studies which included subjective clinical ratings of functional swallowing. We rated laryngeal penetration/aspiration (P/A) and pharyngeal retention (PR), and then assessed methods for scoring severity of P/A and PR and for combining them in a global scale. Each method was tested by correlation with overall clinical severity ratings. The highest correlations were found by: 1) scoring P/A based on which foods were aspirated (no aspiration or penetration; penetration only; thin liquid aspiration; thick liquid, pudding, or chewed solid food aspiration; 2) scoring PR based on how much food was retained (none; minimal; moderate; severe); and 3) combining P/A and PR by taking the higher of the two scores as the final DSS rating. The final global DSS score and the clinical severity rating correlated well (r = 0.71). This proposed scale shows promise for rating global dysphagia severity.

Adult↗