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Biomedical subjects

Lin Perry

Publications and source records attributed to Lin Perry.

11 recordsLinked to original sources
PubMed2004

Eating and dietary intake in communication-impaired stroke survivors: a cohort study from acute-stage hospital admission to 6 months post-stroke.

BACKGROUND AND AIMS: Stroke is a major cause of chronic morbidity but despite the importance of nutrition for recovery and rehabilitation, nutritional features have received limited attention, particularly amongst those with communication impairments. This study reports a group of patients followed through acute hospital admission and at 6 months post-stroke. METHODS: Subjects were survivors of a consecutive cohort admitted to a South London hospital with clinical diagnosis of acute stroke March-August 2001, with motor and communication deficits at initial assessment. Sequential assessments were undertaken from one week after admission to hospital discharge; then in normal residence at 6 months. Assessments focused on stroke-related impairments; functional abilities in activities of daily living and eating; nutritional indices; dietary intake derived from food diaries maintained by carers. Local Research Ethics Committee approval was obtained. RESULTS AND CONCLUSION: Thirty-six participants were studied in hospital; 18 at 6 months. Severely impaired and disabled at initial assessment (median Barthel Index score 1), significant improvements occurred by hospital discharge (to median score 7) despite substantial nutritional inadequacies and significant body tissue loss; mean energy intake met 60% Estimated Average Requirements. At 6 months the median Barthel Index score of survivors was 12.5 but multiple eating-related difficulties persisted, linked with dietary deficits; mean energy intake was 81% of Estimated Average Requirements. Body tissue losses continued across domiciliary settings. Closer attention to assessment and monitoring of nutrition-related aspects of stroke management is warranted across the continuum of care.

Acute Disease↗
PubMed2004

An exploration of nutrition and eating disabilities in relation to quality of life at 6 months post-stroke.

Quality of life (QoL) is increasingly recognised as an important healthcare outcome, especially for those living with enduring disability. Stroke is a major source of long-term disablement and many aspects of life after stroke have been explored. Little attention has been paid to nutritional issues despite the cultural and hedonistic importance of food and eating, and the deleterious effects of malnutrition. The present study employed an epidemiological survey to investigate the contribution of dietary and nutritional factors in relation to QoL after stroke. The participants were 206 survivors of a cohort of acute stroke patients consecutively admitted to a National Health Service trust hospital in South London, UK, between March 1998 and April 1999. They were interviewed in their homes at 6 months post-stroke. Cognitively or communication-impaired patients were precluded from interview except where a live-in carer participated as a proxy (n = 10). The participation rate for those who were eligible and could be contacted was 206 out of 218 (94%). Participants were assessed using standardised, validated tools for functional abilities in activities of daily living and eating, cognition and mood state, social support and economic indices, nutritional status, dietary intake, and QoL. Overall group scores demonstrated relatively minor degrees of physical disablement; exclusion of those with limited cognition and communication precluded assessment of a small subgroup with greater disablement at hospital discharge. Nonetheless, the overall assessment results were not dissimilar to other reported groups. Indices of poor nutritional status and substantial dietary inadequacy were revealed, linked with reduced appetite and depression. Multiple regression analyses revealed the dominant impact of mood state in relation to QoL scores; additional significant effects were identified for social support, eating-related disabilities and age. The effects of mood and social support are well-recognised, whilst nutrition-related effects have previously received little attention. Intervention in these areas might achieve improvements in survivors' perceived QoL.

Aged↗
PubMed2003

Coping and adaptation at six months after stroke: experiences with eating disabilities.

Stroke produces a range of enduring impairments and survivors' coping and adaptation styles are influential features of life after stroke. Many stroke-sequelae affect ability to eat but survivors' perceptions and responses to these have not been explored.Methods. Survivors of a cohort of patients admitted to hospital with acute stroke March 1998-April 1999 participated in semi-structured interviews in their homes at 6 months post-stroke. Interviews were tape recorded and transcribed; 113 interviews with eating-disabled subjects were entered onto QSR NUD*IST 4 for thematic analysis.Findings. Two major emergent themes of 'getting back to normal' and 'getting by' were revealed which encompassed a range of responses in relation to food and eating. A high level of congruence was demonstrated with pre-existent frameworks but with some unique features. Reportage demonstrated non-linear and inconsistent effects of impairments within patients' lives and the importance of this topic for survivors and healthcare professionals was clear.

Adaptation, Psychological↗
PubMed2003

Nutritional support in acute stroke: the impact of evidence-based guidelines.

BACKGROUND AND AIMS: Stroke patients experience multiple impairments which impair ability to eat and render them vulnerable to the deleterious sequelae of malnutrition. This study aimed to develop, implement and evaluate evidence-based guidelines for nutrition support following acute stroke using a multifaceted change management strategy. METHODS: Prospective quasi-experimental design. Documentation of two groups of 200 acute stroke patients admitted to medical and care of the elderly wards of an acute NHS Trust in South London was surveyed using a checklist before and after implementation of 24 guidelines for nutritional screening, assessment and support. Guidelines were based on systematic literature review and developed by consensus in a nurse-led multiprofessional group; implemented via a context-specific, multifaceted strategy including opinion leaders and educational programmes linked to audit and feedback. STAFF OUTCOMES: Compliance with guidelines by doctors, nurses, therapists. PATIENT OUTCOMES: Changes in Barthel Index scores and Body Mass Index in hospital, infective complications, length of stay, discharge destination. RESULTS: Statistically significant improvements in compliance with 15 guidelines occurred in the post-test group. Infective episodes showed a significant reduction in the post-test group but other patient outcomes were unaffected. CONCLUSIONS: Implementation of evidence-based guidelines for nutritional support following acute stroke using a multifaceted strategy was associated with improvements in documented practice and selected patient outcomes.

Aged↗
PubMed2003

Eating difficulties after stroke.

BACKGROUND: Stroke is a common and enduring problem, producing a wide range of effects that may impact on all aspects of life. One area that has seldom been investigated is the effects of stroke on ability to eat and, particularly, stroke survivors' subjective experiences of eating-related difficulties. AIM: To investigate stroke survivors' reports of eating-related experiences 6 months after stroke. METHODS: Participants were 206 survivors of acute stroke who were admitted to hospital between March 1998 and April 1999. Those able to communicate and who gave informed consent participated in a semi-structured interview and assessment of eating abilities in their homes 6 months after their stroke. Interviews were tape recorded and transcribed and 113 interviews with eating disabled participants were entered onto QSR NUD*IST 4 for thematic analysis. Analyses were later checked independently. FINDINGS: At 6 months, 34%, 61% and 5% had no, slight and moderate eating disablements, respectively. A range and variety of difficulties were discussed, but relationships between degrees of disablement and handicap were not straightforward; effects seemed more closely related to participants' responses than objective difficulties. Eating and related activities were clearly important aspects of life for these stroke survivors, socially and psychologically, as well as functionally. Prestroke activities were sometimes maintained, with considerable effort. CONCLUSIONS: Findings indicated issues of relevance for those involved with early rehabilitation interventions and highlighted aspects of continuing care service delivery that warrant review. The relative lack of attention paid to eating-related aspects of care is an important oversight.

Aged↗
PubMed2002

Screening for symptoms of eating disorders: reliability of the SCOFF screening tool with written compared to oral delivery.

OBJECTIVE: The validity of the SCOFF delivered orally as a screening tool for eating disorders has previously been established, but clinical screening for eating disorders also occurs via written format, for example, in occupational health settings. The objective was to compare responses to the SCOFF between verbal and written administration. METHOD: In a volunteer group of nursing and midwifery students at a South London University SCOFF was delivered orally at interview and via written questionnaire. Order was allocated randomly with repeat administration interrupted by distraction questions. RESULTS: There were 185 students who participated, providing 178 fully completed responses. Twenty subjects were male. There was overall agreement in the scores of 157 subjects (88.2%), providing a kappa coefficient of 0.811, with agreement in prediction of eating disorder for 167 (93.8%) and a kappa value of 0.824 (both p < 0.001). For 82 subjects administered the SCOFF verbally first followed by the written version, the kappa statistic was 0.752 (p < 0.001). For 96 subjects with SCOFF administered in reverse order (written form first), kappa was 0.862 (p < 0.001). DISCUSSION: Results demonstrated overall good replicability of the SCOFF administered as a written questionnaire compared to oral interview. Two trends were noted. The first was towards higher scores with written versus oral delivery irrespective of order, possibly indicating enhanced disclosure via written format. The second was of less consistency where verbal preceded written responses. Altogether findings support use of the SCOFF where a concise, valid and reliable screening for eating disorders is required in written form.

Anorexia Nervosa↗
PubMedDate not supplied

Exploring nurses perspectives of stroke care.

In recent years stroke has been recognised as a national clinical, research and policy priority. Stroke nurses and stroke nursing are important contributors, but previous studies have highlighted lack of clarity and contradictions in the nursing role. A stroke nursing conference in 2002 offered the opportunity to explore nurses' vision for the future through a series of focus group meetings. Many examples of good practice were identified, for example, nursing contributions to risk factor management and secondary prevention, service co-ordination and development, follow-up and support of stroke patients and their families. However, areas for further development include realigning services to a patient focus and ensuring equitable access, integrating services, supporting development of the nursing research evidence base and providing career and educational frameworks for nurses in stroke care. Nurses set out a vision for stroke nursing in which current strengths and developments are consolidated and disseminated in a dynamic, multiprofessional, integrated patient-focused service.

Focus Groups↗
PubMedDate not supplied

Promoting evidence-based practice in stroke care in Australia.

AIM: To explore approaches to the promotion of evidence-based practice from academic and clinical perspectives by visiting acute stroke units and collaborating centres of the Joanna Briggs Institute, an international network of academic centres. METHOD: A semi-structured interview schedule was developed, piloted and used to guide interviews with academic and clinical staff in five state capital cities in Australia. Data were analysed and findings reviewed by clinical and academic participants. FINDINGS: Four distinct but not mutually exclusive models and common but variously applied pathways for translation of evidence into clinical practice were identified. Key influential factors included context and local culture, the nature of evidence and role of clinical expertise. Implementation and change management strategies were recognised as emerging priorities. CONCLUSION: A range of methods to advance research synthesis, dissemination and knowledge transfer into clinical practice were demonstrated and may warrant consideration for the UK.

Attitude of Health Personnel↗