Stoma management.

BACKGROUND: Although recent advances have been made in the treatment of acute stroke, patients often arrive at the hospital too late to receive the maximum benefit from these new therapies. OBJECTIVE: To investigate characteristics that influence the time from symptom onset to hospital arrival (delay time) for patients with acute stroke. DESIGN: Retrospective medical record review. SETTING: Minneapolis-St. Paul metropolitan hospitals. PATIENTS: A 50% random sample of all patients 30 to 79 years of age who were hospitalized with acute stroke from 1991 to 1993. MEASUREMENTS: Patients were identified through discharge diagnosis lists by using the International Classification of Diseases, 9th Revision. Trained nurses abstracted the medical records. Stroke events were validated by using neuroimaging reports and additional clinical criteria (1895 patients). An accelerated failure time model was used to identify patient characteristics that independently predicted delay time. For 70% of patients (n = 1334), delay time was calculated from the medical record by subtracting the recorded time of symptom onset from the admission time. For the remaining 30% of patients (n = 561), the time of symptom onset was not recorded, and an approximate delay time was estimated from all available information. RESULTS: Among patients with a calculated delay time, half arrived within 3 hours of symptom onset and 90% arrived within 24 hours. Patients with approximated delay times tended to have longer delays, and less than 40% of these patients arrived within 24 hours of symptom onset. Some characteristics associated (P < 0.05) with longer delay included Asian/Pacific Islander ethnicity, dependence in any activities of daily living before stroke, and several symptoms at stroke onset. Characteristics associated (P < 0.05) with shorter delay included admission through the emergency department, presence of syncope or seizures at stroke onset, previous myocardial infarction, abnormal mental status, and greater disability at presentation (measured by the Rankin scale). CONCLUSIONS: Most patients arrive at the hospital too late to receive the maximum benefit from emerging stroke therapies. Efforts to reduce delays in hospital arrival after acute stroke can maximize the effectiveness of these therapies by specifically targeting persons at risk for longer delay.

Activities of Daily Living↗

PubMed1998

Profile of residents in unlicensed homes for the aged in the eastern townships of Quebec.

BACKGROUND: The number of unlicensed homes for the aged in Quebec has increased rapidly over the last decade. Because these homes are not linked in any formal way to the Quebec Ministry of Health and Social Services, little is known about their residents. The objective of this study was to describe the sociodemographic characteristics and disability profile of elderly residents in unlicensed homes for the aged. Comparisons were made to a sample of residents drawn from licensed long-term facilities. METHODS: The target population was restricted to residents aged 65 years and over in facilities in the Eastern Townships of Quebec who had some difficulties with at least 2 activities of daily living. This population included 94% of elderly people in licensed facilities and 64% of those in unlicensed homes. The study population comprised 301 impaired people in 88 residential care facilities (36 licensed, 52 unlicensed). They were selected using a 2-stage sampling scheme: stratified sampling of the primary units (homes) and simple random sampling of the secondary units (residents). Facility managers were interviewed to collect descriptive information about themselves and their facilities. Residents were assessed with regard to their cognitive abilities (using the Modified Mini-Mental State [3MS] Examination) and their functional autonomy (using the Functional Autonomy Measurement System [Système de mesure de láutonomie fonctionnelle (SMAF)]. RESULTS: Although residents without impairment were excluded from the study, the unlicensed facilities were found to house people who were, on average, less cognitively and physically impaired than their counterparts in the licensed facilities (p < 0.001). Nonetheless, a substantial proportion of the residents in the unlicensed homes had severe cognitive disabilities (38.5% had 3MS score of less than 60) and functional disabilities (17.0% had an SMAF score of more than 40). The corresponding figures for residents in the licensed facilities with these scores were 65.3% and 66.7%. Of the managers of the unlicensed facilities 31.9% had no training and 58.8% had no previous experience in caring for the elderly people. The staff-resident ratio was lower among the unlicensed homes than among the licensed facilities (mean 0.05 [standard error of the mean (SEM) 0.01] v. 0.39 [SEM 0.03], p < 0.001). In addition, only 26.0% of the unlicensed homes employed qualified staff, as compared with 63.0% of the licensed facilities (p < 0.001). INTERPRETATION: This study provides evidence that many residents of unlicensed homes have considerable care needs. These homes appear ill-equipped to address their needs, which raises doubts about their ability to deliver high-quality care.

Activities of Daily Living↗