Out of sight, out of mind: long-term outcomes for people discharged home, to inpatient rehabilitation and to residential aged care after stroke

OnlinePubl.Purpose: The aim of this study was to describe differences in long-term outcomes for patients discharged to inpatient rehabilitation facilities (IRFs) following stroke compared to patients discharged directly home or to residential aged care facilities (RACFs). Materials and Methods: Cohort study. Data from the Australian Stroke Clinical Registry were linked to hospital admissions records and the national death index. Main outcomes: death and hospital readmissions up to 12 months post-admission, Health-related Quality of Life (HRQoL) 90-180 days post-admission. Results: Of 8,555 included patients (median age 75, 55% male, 83% ischemic stroke), 4,405 (51.5%) were discharged home, 3,442 (40.2%) to IRFs, and 708 (8.3%) to RACFs. No between-group differences were observed in hazard of death between patients discharged to IRFs versus home. Fewer patients discharged to IRFs were readmitted to hospital within 90, 180 or 365-days compared to patients discharged home (adjusted subhazard ratio [aSHR]:90-days 0.54, 95%CI 0.49, 0.61; aSHR:180-days 0.74, 95%CI 0.67, 0.82; aSHR:365-days 0.85, 95%CI 0.78, 0.93). Fewer patients discharged to IRFs reported problems with mobility compared to those discharged home (adjusted OR 0.54, 95%CI 0.47, 0.63), or to RACFs (aOR 0.35, 95%CI 0.25, 0.48). Overall HRQoL between 90-180 days was worse for people discharged to IRFs versus those discharged home and better than those discharged to RACFs. Conclusions: Several long-term outcomes differed significantly for patients discharged to different settings after stroke. Patients discharged to IRFs reported some better outcomes than people discharge directly home despite having markers of more severe stroke. Implications for rehabilitation: People with mild strokes are usually discharged directly home, people with moderate severity strokes to inpatient rehabilitation, and people with very severe strokes are usually discharged to residential aged care facilities. People discharged to inpatient rehabilitation reported fewer problems with mobility and had a reduced risk of hospital readmission in the first year post-stroke compared to people discharged directly home after stroke. The median self-reported health-related quality of life for people discharged to residential aged care equated to 'worst health state imaginable'.Elizabeth A. Lynch, Angela S. Labberton, Joosup Kim, Monique F. Kilkenny, Nadine E. Andrew, Natasha A. Lannin, Rohan Grimley, Steven G. Faux and Dominique A. Cadilhac; on behalf of the Stroke123 Investigators and AuSCR Consortiu

VICTORIA: A mechanistic model of radionuclide behavior in the reactor coolant system under severe accident conditions

This document provides a description of a model of the radionuclide behavior in the reactor coolant system (RCS) of a light water reactor during a severe accident. This document serves as the user's manual for the computer code called VICTORIA, based upon the model. The VICTORIA code predicts fission product release from the fuel, chemical reactions between fission products and structural materials, vapor and aerosol behavior, and fission product decay heating. This document provides a detailed description of each part of the implementation of the model into VICTORIA, the numerical algorithms used, and the correlations and thermochemical data necessary for determining a solution. A description of the code structure, input and output, and a sample problem are provided. The VICTORIA code was developed upon a CRAY-XMP at Sandia National Laboratories in the USA and a CRAY-2 and various SUN workstations at the Winfrith Technology Centre in England. 60 refs

Supplementary Material for: Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry

<b><i>Background:</i></b> Given the potential differences in etiology and impact, the treatment and outcome of younger patients (aged 18–64 years) require examination separately to older adults (aged ≥65 years) who experience acute stroke. <b><i>Methods:</i></b><i></i> Data from the Australian Stroke Clinical Registry (2010–2015) including demographic and clinical characteristics, provision of evidence-based therapies and health-related quality of life (HRQoL) post-stroke was used. Descriptive statistics and multilevel regression models were used for group comparisons. <b><i>Results:</i></b> Compared to older patients (age ≥65 years) among 26,220 registrants, 6,526 (25%) younger patients (age 18–64 years) were more often male (63 vs. 51%; <i>p</i> < 0.001), born in Australia (70 vs. 63%; <i>p</i> < 0.001), more often discharged home from acute care (56 vs. 38%; <i>p</i> < 0.001), and less likely to receive antihypertensive medication (61 vs. 73%; <i>p</i> < 0.001). Younger patients had a 74% greater odds of having lower HRQoL compared to an equivalent aged-matched general population (adjusted OR 1.74, 95% CI 1.56–1.93, <i>p</i> < 0.001). <b><i>Conclusions:</i></b><i></i> Younger stroke patients exhibited distinct differences from their older counterparts with respect to demographic and clinical characteristics, prescription of antihypertensive medications and residual health status