The effectiveness of problem solving therapy for stroke patients: Study protocol for a pragmatic randomized controlled trial

Background: Coping style is one of the determinants of health-related quality of life after stroke. Stroke patients make less use of active problem-oriented coping styles than other brain damaged patients. Coping styles can be influenced by means of intervention. The primary aim of this study is to investigate if Problem Solving Therapy is an effective group intervention for improving coping style and health-related quality of life in stroke patients. The secondary aim is to determine the effect of Problem Solving Therapy on depression, social participation, health care consumption, and to determine the cost-effectiveness of the intervention.Methods/design: We strive to include 200 stroke patients in the outpatient phase of rehabilitation treatment, using a multicenter pragmatic randomized controlled trial with one year follow-up. Patients in the intervention group will receive Problem Solving Therapy in addition to the standard rehabilitation program. The intervention will be provided in an open group design, with a continuous flow of patients. Primary outcome measures are coping style and health-related quality of life. Secondary outcome measures are depression, social participation, health care consumption, and the cost-effectiveness of the intervention.Discussion: We designed our study as close to the implementation in practice as possible, using a pragmatic randomized trial and open group design, to represent a realistic estimate of the effectiveness of the intervention. If effective, Problem Solving Therapy is an inexpensive, deliverable and sustainable group intervention for stroke rehabilitation programs.Trial registration: Nederlands Trial Register, NTR2509

Perceived Participation in Discharge Planning and Health Related Quality of Life after Stroke

The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients. Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge. The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke

Counterfeiting and piracy from a rightholders perspective

This essay focuses on the increasing problems for companies and right-holders with counterfeited and pirated goods in the European Union and the problems for right holders to enforce their IPR rights. Will IPRED1 make a difference and is there really a need for the new Directive of Enforcement 2004/48/EG, or do the sanctions according to the TRIPS Agreement suffice. Further, IPRED2 is a follow up of IPRED1, with criminal sanctions to be implemented. Also the Council regulation (EC) No 1383/2004 concerning customs actions against goods suspected of infringing certain intellectual property rights and the measures to be taken against goods to have infringed such rights will be discussed. The second question to ask is&semic are IPRED1 and The Council regulation effective enough to protect IP rights. Will the intention of harmonizing criminal measures be what is necessary to improve enforcement of intellectual property rights in the Member States. Problems can arise when it comes to parallel import of goods, since there are no international directives for the customs to use against this kind of trade over the borderlines. The thesis will focus on infringement of intellectual property rights, mainly trademarks and design rights from a right-holders perspective and not the problems related to parallel import. The European Union has seen a 900% increase in the amount of different counterfeit products coming into the European Union in the last five years Statistics taken from EU institutions press release''Customs Counterfeiting and piracy in 2001'', issued from Brussels, 26 July 2002..Losses to U.S. business from the counterfeiting of trademarked consumer products is estimated at $200 billion a year according to the Department of Commerce. Often organized crime lies behind the trade of counterfeited goods and piracy. In 1998, the EU commission presented the Green Paper in an attempt to fight piracy and counterfeiting within the common market. This has resulted in a new directive, called IPRED1 in which the protection of intellectual property rights are secured

Use of a New International Classification of Health Interventions for Capturing Information on Health Interventions Relevant to People with Disabilities

Development of the World Health Organization's International Classification of Health Interventions (ICHI) is currently underway. Once finalised, ICHI will provide a standard basis for collecting, aggregating, analysing, and comparing data on health interventions across all sectors of the health system. In this paper, we introduce the classification, describing its underlying tri-axial structure, organisation and content. We then discuss the potential value of ICHI for capturing information on met and unmet need for health interventions relevant to people with a disability, with a particular focus on interventions to support functioning and health promotion interventions. Early experiences of use of the Swedish National Classification of Social Care Interventions and Activities, which is based closely on ICHI, illustrate the value of a standard classification to support practice and collect statistical data. Testing of the ICHI beta version in a wide range of countries and contexts is now needed so that improvements can be made before it is finalised. Input from those with an interest in the health of people with disabilities and health promotion more broadly is welcomed

Post-stroke depression and functional independence: a conundrum.

Brown C, Hasson H, Thyselius V, Almborg A-H. Post-stroke depression and functional independence: a conundrum. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2011.01595.x. © 2011 John Wiley & Sons A/S. Objectives - People who suffer a stroke are at risk of developing post-stroke depression (PSD). Not only does this lower their quality of life but it also increases their risk of another stroke or death. This study aimed to investigate the factors associated with PSD in order to better direct rehabilitation efforts aimed at cutting the incidence of PSD. Material and methods - This study was based on all patients admitted to the stroke unit of a hospital in southern Sweden from 1 October 2003 to 30 November 2005. The total number of patients involved was 181. Measures were collected at 2 ± 1 weeks after discharge from hospital, 3 ± 0.5 months after the occurrence of the stroke and 12 ± 1 months after the occurrence of the stroke. Information collected was results from the Center of Epidemiologic Studies Depression Scale and the Barthel Index together with demographic data including age, sex, time since stroke and relationship status. Results - Those patients involved in the study were mainly men (58-59%) and generally those either married or cohabiting (53-57%). The age of respondents ranged from 32 to 92 years with a mean age of 74.0 (95%CI 72.37-75.63) at 2 ± 1 weeks after discharge. The Barthel Index scores ranged from 15 to 100 with means of between 88.7 and 91.7. Between 15% and 19% of the group were clinically depressed during the time frame of the study. The Barthel Index, measuring functional independence in terms of need for assistance with personal activities of daily living (P-ADL), was consistently associated with PSD. Conclusions - The differences found in levels of depression between those with lower functional independence after a stroke compared to those more independent in P-ADL, raise the possibility that attention should be paid to therapeutic rehabilitation for stroke patients to help them recover as much functional independence as possible in order to improve their quality of life and lower their chances of developing PSD

Working draft: Classifications of interventions in mental health care. An expert review

Background and objectives Specific classifications of mental health interventions have encountered many issues in their integration into a general classification of interventions. Nonetheless, there has not been any previous review on the content and structure of current classifications in relation to mental health care. This expert review aimed to compare the mental health interventions provided in a series of reference classification systems for the incorporation of mental health care into the International Classification of Health Interventions (ICHI). Methods Twelve classifications are described with regards to the structure of the classification (unit of analysis, sections, multiaxiality, granularity) and context of utilization (purpose, descriptors, neutrality, interoperability and implementation). Results Major problems identified include a granularity unbalance (i.e. differences in the number of codes and its specificity with other areas such as rehabilitation), unclear units of analysis (i.e. differences between procedures, interventions, packages of care and care programs), lack of clearly stated evidence-based interventions in a mental health context; and lack of a well-defined taxonomical tree. An ontology approach to the definition of the different entities involved in the throughput of mental care, including their hierarchical relationships and conceptual map, may have contributed to the failure of previous systems together with the development of systems to classify mental health interventions separate from generic health interventions. Conclusions The present review provides additional ground for the development of the ICHI knowledge-base and highlights the importance of taxonomical disambiguation and international comparability in the development and implementation of classifications of mental care interventions