Perceived wellbeing of patients one year post stroke in general practice - recommendations for quality aftercare

<p>Abstract</p> <p>Background</p> <p>Annually, 41,000 people in the Netherlands have strokes. This has multiple physical and psychosocial consequences. Most patients return home after discharge from hospital. Quality aftercare by general practitioners is important to support patients at home. The purpose of this study is to examine the wellbeing of patients who returned home immediately after discharge from hospital, one year post stroke, in comparison with the general Dutch population of the same age and to determine factors that could influence wellbeing.</p> <p>Methods</p> <p>All the stroke patients from the Department of Neurology, Martini Hospital Groningen in the period November 2006 to October 2007 were included. People aged under 65 years or with haemorrhaging were excluded. All the patients (N = 57) were interviewed at home using the following questionnaires: Barthel Index, SF-36, HADS, CSI and a questionnaire about their way of life.</p> <p>Results</p> <p>31% of the patients in this study experienced a decrease in functional status after one year. Nevertheless, there was no significant difference between the median Barthel Index value at discharge from hospital and one year post stroke. ADL independence correlated with a better quality of life. The health-related quality of life was high. Stroke patients have almost the same quality of life as the 'average' Dutch elderly population. Where patients can no longer fully participate in society, their perceived quality of life is also lower. In this study there is an indication of a high prevalence of depression and anxiety disorders in stroke patients. This negatively affects the quality of life a year after stroke. Although caregiver strain was low for the partners of stroke patients, a reduced quality of life is correlated to greater burden.</p> <p>Conclusions</p> <p>This study provides valuable insight into the wellbeing of patients living at home one year post stroke. Physical functioning and quality of life are comparable to the general population of the same age, but improvements in mental functioning can be envisaged. In addition, more attention should be paid to maintaining the patients' activities. The wellbeing of these stroke patients could be increased further if greater attention is paid to these aspects of life. This seems to be applicable to general practice.</p

Metodología y criterios de restauración de restos óseos pleistocenos. El tratamiento de los fósiles humanos de TD6 (Gran Dolina, Sierra de Atapuerca).

Aquesta tesi doctoral pretén proporcionar criteris per a realitzar intervencions de conservació-restauració (o preparació) en restes òssies plistocenes, sobre les quals es realitzen estudis des d'una doble perspectiva: l'arqueològica i la paleontològica. Dins d'aquests dos camps, hi ha diversos estudis que poden veure's beneficiats en major o menor mesura en funció del tipus i el nivell de restauració que s'apliqui als fòssils (grau de neteja, de reconstrucció, etc). El treball es basa en la restauració de fòssils d’Homo antecessor procedents del nivell TD6 de Gran Dolina (Sierra de Atapuerca, Burgos). Aquests fòssils presenten problemes comuns a molts altres jaciments, especialment de mitjà càrstic: el sediment amb freqüència és compacte i està fortament adherit a la superfície òssia. En conseqüència, part del treball consisteix a esmenar fractures d'excavació i a “acabar d'excavar” els fòssils al laboratori. La Conservació i Restauració té els seus propis principis i mètodes. Les intervencions es basen en el coneixement tant dels fòssils com de les tècniques i productes de restauració. A més, sempre es dissenyen a partir del diagnòstic de les alteracions i dels objectius fixats abans de la intervenció. En aquesta tesi, es proposa que els requeriments dels diferents estudis realitzats sobre fòssils han de servir com a pautes per a fixar els objectius i els graus d'intervenció. Queda molt treball de recerca per desenvolupar, ja que encara cal incrementar el encara insuficient corpus sobre restauració de restes òssies, sobre les tècniques i els criteris específics d'actuació. En aquesta tesi s'inclouen algunes publicacions les quals tenen per objectiu començar a cobrir aquest buit.Esta tesis doctoral pretende proporcionar criterios para realizar intervenciones de conservación-restauración (o preparación) en restos óseos pleistocenos, sobre los cuales se realizan estudios desde una doble perspectiva, la arqueológica y la paleontológica. Dentro de estos dos campos, hay diversos estudios que pueden verse beneficiados en mayor o menor medida en función del tipo y del nivel de restauración que se aplique a los fósiles (grado de limpieza, de reconstrucción, etc). El trabajo se basa en la restauración de fósiles de Homo antecessor procedentes del nivel TD6 de Gran Dolina (Sierra de Atapuerca, Burgos). Estos fósiles presentan problemas comunes a otros muchos yacimientos, especialmente de medio kárstico: el sedimento con frecuencia es compacto y está fuertemente adherido a la superficie ósea. En consecuencia, parte del trabajo consiste en subsanar fracturas de excavación y en “terminar de excavar” los fósiles en el laboratorio. La Conservación y Restauración tiene sus propios principios y métodos. Las intervenciones se basan en el conocimiento tanto de los fósiles como de las técnicas y productos de restauración. Además, siempre se diseñan a partir del diagnóstico de las alteraciones y de unos los objetivos fijados antes de la intervención. En esta tesis se propone que los requerimientos de los distintos estudios realizados sobre fósiles, pueden servir como como pautas para fijar los objetivos y los grados de intervención. Queda mucho trabajo de investigación por desarrollar, ya que aún hay que incrementar el aún insuficiente el corpus sobre restauración de restos óseos, sobre las técnicas y los criterios específicos de actuación. En esta tesis se incluyen algunas publicaciones cuyo objetivo es empezar a cubrir este hueco. This doctoral thesis aims to provide criteria for conservation-restoration interventions (or preparation) of Pleistocene bones, which may be studied from either archaeological or paleontological perspective. Within these two fields, there are several studies that can benefit to a greater or lesser extent depending on the type and level of treatment of the fossil (degree of cleaning, reconstruction, etc.). The work is based on the preparation of Homo antecessor fossils from TD6 unit of Gran Dolina (Atapuerca, Burgos). These fossils have common problems to many other sites, particularly other karstic sites: the sediment is frequently compact and strongly adhered to the bone surface. Consequently, part of the preparation work involves adheriing fragments and `finishing digging´ in the laboratory. Conservation is a discipline that has its own principles and methods. Treatments are based on knowledge of either the fossils and the products and techniques for conservation. Treatments are always designed after the diagnosis of alterations and considering the objectives before the intervention. This thesis proposes that the requirements of the different studies of fossils can serve as guidelines for setting objectives and degrees of intervention. There is much research to develop in order to increase the still insufficient corpus on conservation or preparation of bones, both on the techniques and also on specific criteria. This thesis it includes some publications aimed to start to cover this gap

Tissue plasminogen activator for acute ischemic stroke in patients with unruptured cerebral aneurysms

Intracranial hemorrhage (ICH) is the most feared complication of thrombolytic therapy for acute ischemic stroke. There are limited data on the risks of thrombolysis in patients with asymptomatic intracranial aneurysm. We report 2 adults with signs of hemispheric ischemia who were successfully treated with intravenous tissue plasminogen activator (t-PA), despite the presence of asymptomatic intracranial aneurysm. The presence of an asymptomatic intracranial aneurysm may not necessarily preclude a good outcome from acute ischemic stroke treated with rt-PA. Selected patients harboring incidental, unruptured intracranial aneurysm may benefit from thrombolytics