Learning From Peers: A Survey of Perception and Utilization of Online Peer Support Among Informal Dementia Caregivers

Informal dementia caregivers are those who care for a person living with dementia (PLWD) without receiving payment (e.g., family members, friends, or other unpaid caregivers). These informal caregivers are subject to substantial mental, physical, and financial burdens. Online communities enable these caregivers to exchange caregiving strategies and communicate experiences with other caregivers whom they generally do not know in real life. Research has demonstrated the benefits of peer support in online communities, but they are limited in focusing merely on caregivers who are already online users. In this paper, we designed and administered a survey to investigate the perception and utilization of online peer support from 140 informal dementia caregivers (with 100 online-community caregivers). Our findings show that the behavior to access any online community is only significantly associated with their belief in the value of online peer support (p = 0.006). Moreover, 33 (83%) of the 40 non-online-community caregivers had a belief score above 24, a score assigned when a neutral option is selected for each belief question. The reasons most articulated for not accessing any online community were no time to do so (14; 10%), and insufficient online information searching skills (9; 6%). Our findings suggest that online peer support is valuable, but practical strategies are needed to assist informal dementia caregivers who have limited time or searching skills

Abstract 55: An Integrated Stroke Practice Unit Model Can Impact Blood Pressure Management Post-Stroke

Introduction: Stroke care involves multiple mechanisms and high risk and cost. Even when initial acute events are managed successfully, patient risk remains high for stroke recurrence and readmission for stroke-related causes that negatively impact recovery. Hypertension, the main modifiable risk factor for stroke, accounts for ≤50% of recurrent strokes. Blood pressure (BP) management for stroke post-discharge often combines risk education, lifestyle modification, and medication compliance, but insufficient evidence has complicated provider response. Methods: An Integrated Stroke Practice Unit (ISPU) Model was implemented in New Orleans (2012-2015) that combines integrated technology and real time response to improve care coordination from symptom onset through 12-months post-discharge. Stroke Central included patients hospitalized with suspected stroke symptoms, and Stroke Mobile included patients discharged with a stroke diagnosis residing in St. Tammany or Jefferson Parishes. Stroke Mobile patients were followed at home monthly to assess recovery, manage comorbidities, and provide risk/recovery/recurrence education and caregiver/family support; comprehensive BP management and education were key goals. BP at goal was defined as 140/90 and was measured at each visit (12 total); BP issues were proactively followed and resolved. Results: From February 2013-December 2015, 558 patients were seen at least one time in Stroke Mobile, and 192 patients completed 12 visits. Of those who completed the program, patients whose blood pressure was controlled at each visit ranged from 78.2%-93.2%, which is higher than in previously reported studies. Overall, increased control was seen overtime from visits 1-12; additional analyses will examine this in more detail. Conclusions: A comprehensive ISPU approach, combined with targeted education and caregiver/family focus, can be effective for managing BP post-stroke. </jats:p

Stroke: the critically neglected first year post-stroke

PurposeStroke is a leading cause of death and disability in the USA and worldwide. While stroke care has evolved dramatically, many new acute approaches to therapy focus only on the first 3-12 hours. Significant treatment opportunities beyond the first 12 hours can play a major role in improving outcomes for stroke patients. The purpose of this paper is to highlight the issues that affect stroke care delivery for patients and caregivers and describe an integrated care model that can improve care across the continuum.Design/methodology/approachThis paper details evidence-based research that documents current stroke care and efforts to improve care delivery. Further, an innovative integrated care model is described, and its novel application to stroke care is highlighted.FindingsStroke patients and caregivers face fragmented and poorly coordinated care systems as they move through specific stroke nodes of care, from acute emergency and in-hospital stay through recovery post-discharge at a care facility or at home, and can be addressed by applying a comprehensive, technology-enabled Integrated Stroke Practice Unit (ISPU) Model of Care.Originality/valueThis paper documents specific issues that impact stroke care and the utilization of integrated care delivery models to address them. Evidence-based research results document difficulties of current care delivery methods for stroke and the impact of that care delivery on patients and caregivers across each node of care. It offers an innovative ISPU model and highlights specific tenets of that model for readers.</jats:sec

Absolute Scotoma in Young Man With Recent Epstein-Barr Virus

We report a case of nasal optic disc hypoplasia (NODH) in a patient who noticed a visual field defect (VFD) after an unrelated EBV infection. Distinguishing NODH from other optic neuropathies is important for sparing patients from unnecessary testing and interventions

Iatrogenic PVD Following Dilated Fundus Examination: A New Diagnosis or Fluke?

This article is a Photo Essay. Please download the PDF or view the article HTML.</jats:p

Abstract T P380: Blood Pressure Management among Stroke Patients: The Impact of a Comprehensive Post-Stroke Model in Louisiana

Background and Purpose: Stroke is the 4 th leading cause of death in the United States, and 38.4% of Louisiana residents report being told they have high blood pressure or hypertension in 2011. The American Stroke Association estimates that 80% of stroke can be prevented through effective blood pressure management, particularly for patients who have already had a stroke. Stroke Mobile, a novel, outpatient care program provides targeted follow-up care and patient/caregiver education for 12 months as part of Ochsner's Comprehensive Stroke Care Model. Stroke Mobile Care Teams, consisting of a Registered Nurse and Lay Health Educator, visit patients and their caregivers in their homes monthly to assess overall health, existing co morbidities, including blood pressure, and provide comprehensive patient/caregiver education and support. Stroke Mobile Care Teams can link back to providers to provide real-time intervention for patients whose blood pressure is elevated. This study will describe ongoing monitoring and intervention for participants in this innovative post-stroke care model. Methods: The study sample includes patients discharged with a final discharge of stroke who reside in St. Tammany or Jefferson Parishes in Louisiana and have completed 12 Stroke Mobile visits in 2013-2014 (n=33). Demographic characteristics and blood pressure management at hospital discharge and upon completion of the Stroke Mobile program was analyzed. Results: Of those who completed 12 visits (n=33), 60.6% had uncontrolled blood pressure levels when starting the Stroke Mobile program. Following monthly monitoring and intervention (as needed) for blood pressure control, 93% of patients who had uncontrolled blood pressure levels post-discharge were at or below their blood pressure goal. All patients were educated across multiple visits on stroke risk factors and blood pressure management and reduction strategies. Conclusions: These results suggest clear benefit from monthly post-stroke follow-up that includes consistent blood pressure assessment and maintenance strategies combined with targeted blood pressure education on management strategies post stroke </jats:p

Abstract T P259: Study of Factors Contributing to Reduce Cost in an Innovative Post-Stroke Program

Background and Purpose: Stroke is the 4 th leading cause of death in the United States. Stroke-related medical costs and disability in the US cost approximately $73.7 billion in 2010 and is projected to cost$185 billion by 2030. Decreasing costs of care among post-stroke patients requires a combination of follow-up care and monitoring and targeted risk factor reduction. Ochsner Neuroscience Institute (ONI) has implemented a Comprehensive Stroke Care Model designed to increase quality and decrease costs of stroke across the continuum from symptom onset through 12 months post-discharge. This Model combines evidence-based, streamlined in-hospital care with monthly post-discharge follow-up and education in the home for patients and caregivers. Innovative technology that connects patients and caregivers with ONI stroke and internal medicine providers to address issues real-time during outpatient visits. This research will describe this innovative Stroke Care Model, including its impact on mortality, length of stay, stroke reoccurrence rate, and cost of care. Methods: This research will include patients seen as part of this Model from 1/3/2013-7/31/2014. Stroke Central, the in-hospital component, coordinated patients who presented at Ochsner’s Emergency Department via transfer, EMS, or personal transportation (n=1,711). Stroke Mobile, the outpatient component, includes a subsample of patients and their caregivers who were discharged with a stroke diagnosis and who reside in St. Tammany and Jefferson Parishes in Louisiana (n=288). Results: Stroke Mobile includes patients discharged from Ochsner’s Stroke Program with a final diagnosis of stroke who reside in St. Tammany or Jefferson Parishes in Louisiana from 2013-2014 (n=288 as of 7/31/2014). Patients that participated in stroke mobile reported a stroke reoccurrence rate 40% lower than patients not participating in stroke mobile. Conclusions: These results suggest a significant cost reduction in post stroke care through personalized patient visits that resulted in reduced readmissions rates, reduced stroke reoccurrence rates, and decreased clinic visits. </jats:p

Iatrogenic PVD Following Dilated Fundus Examination: A New Diagnosis or Fluke?

This article is a Photo Essay. Please download the PDF or view the article HTML

Bilateral, chronic, bacterial conjunctivitis in giant fornix syndrome

Giant fornix syndrome (GFS) results in chronic, relapsing conjunctivitis in elderly patients with enophthalmos and enlarged fornices, in which infectious material collects and perpetuates inflammation. A 98-year-old woman presented with persistent, bilateral, purulent conjunctivitis; corneal epithelial defects and progressive blepharospasm that did not respond to artificial tears, topical antibiotics and steroids and amniotic membrane grafts. Additional findings of deep-set orbits with enlarged upper fornices were diagnostic of GFS. Over the next 2 months, she responded to a combination of topical and systemic antibiotics, autologous serum eye drops, povidone-iodine forniceal rinses, and hypochlorous acid treatment of the eyelashes. GFS is an important diagnostic consideration in elderly patients with chronic conjunctivitis and deep-set orbits.</jats:p