Weight gain following stroke : its everybody's business

Introduction: Approximately 900,000 people in England live with the effects of stroke (NICE 2010). Health behaviour modification can be crucial in stroke rehabilitation. Local stakeholders identified a problem of increased numbers of patients experiencing long term weight gain following a stroke. Method: Mixed method study incorporating i) survey of South Yorkshire Health Cohort participants (n=87); ii) interviews with staff (n=18) and stroke patients (n=10). Data analysed using framework analysis. Results: Weight gain post stroke is not monitored routinely and prevalence is therefore unknown. Findings from this study indicate that post-stroke weight gain is a problem for some people. Contributing factors identified include social isolation, depression and loss of control in cognition and communication affecting ability to manage diet and weight. Ambiguity was seen to arise because weight gain following stroke can be both a sign of progress and of a problem. Results indicate fragmented communication between health care professionals across care pathways limits opportunities to address weight gain. Additional limiting factors include limited availability of specialist support and funding cuts to community based services. Conclusion: Health care professionals need to be mindful of the risk of long term weight gain following stroke. Whether in acute, intermediate, rehabilitation or primary care settings, systems should be in place to identify opportunities for advice and support regarding diet and physical activity by, for example, embracing initiatives such as Making Every Contact Count (MECC). A large cohort study would provide population based data on prevalence and causes of weight gain following a stroke

Weight gain following stroke in younger age (below 70 years) in men and women: challenges and opportunities for prevention and action

This report presents findings from a study to explore the incidence of weight gain in working age adults aged men and women in South Yorkshire. The project was developed following a research prioritisation event focused on obesity. The event was conducted with staff from a range of stakeholder organisations including health, social care, and voluntary sector. Methods: Survey of respondents of the South Yorkshire Cohort, under 70 years old and had had a stroke. In-depth interviews (n=12)with patients responding to the survey living in Sheffield and participants from a local volunteer run stroke support group and professionals (n=18). Framework analysis techniques were adopted. Findings: Long term weight gain is an issue for some patients following their stroke. Interviews with patients highlighted a range of lifestyle related challenges that people face following a stroke. Reduction in activity levels was reported as a key influence on weight gain. The health care system and stroke pathway currently provides short-term support to patients to aid recovery and rehabilitation. Longer-term support is harder to access. Existing and new support networks provided by health services, family and friends are essential in recovery and prevention of weight gain. Interviews with staff revealed gaps in their knowledge of their colleagues' roles across the stroke care pathway. Communication between health care professionals across the care pathway was also limited. The presence of patients who gain weight following a stroke was not evident across the entire stroke pathway for example staff in the acute setting were less likely to notice weight gain. Not all staff gave health promotion advice to patients, however all staff thought health promotion advice should be offered to patients, at a time appropriate to the individual and in a manner that will engage the patient in behaviour change. Staff highlighted the need to engage family members in a patient’s rehabilitation to prevent long term weight gain.</p

Long term weight gain following stroke : exploring incidence and explanations

Stroke is the leading cause of long term disability and third leading cause of death (Curioni et al, 2009). Survival rates are increasing. Approximately 900,000 people in England live with the effects of a stroke (NICE 2010). Health behaviour modification can be crucial in stroke rehabilitation and in avoiding long term impairment. Consultation with stakeholders identified increased numbers of patients experiencing long term weight gain following a stroke. This study aims to explore i) the existence of weight gain following a stroke ii) factors contributing to weight gain and iii) implications for the stroke rehabilitation pathway. A mixed method study incorporating i) a survey of South Yorkshire Health Cohort participants (n=87); ii) interviews with staff (n=18) and stroke patients (n=10). Data were analysed using framework analysis methods. Across the care pathway inconsistencies exist in the recognition that weight gain is an issue for patients post stroke. The findings draw on components of the Theory of Integrated Care (Kodner & Spreeuwenberg, 2002). Applying the theory to the findings provides a means to explain how patients may become lost across the different aspects of the stroke care pathway. Fragmented communication between health care professionals across the pathway limits opportunities to address the risks and realities of weight gain. Ambiguity arises for patients because weight gain following a stroke can be both a sign of progress and of a problem. Individualising care and integration of weight management advice across the whole pathway (acute, community and primary care settings) may prevent weight gain in stroke survivors.</p

Weight gain after a stroke : the issue and control

Background - Over 900,000 people in England live with the effects of a stroke (NICE 2010). Modification of health behaviour can be crucial in stroke rehabilitation and in preventing avoidable long term impairment. Consultation with stakeholders identified a growing number of patients who are gaining weight as a longer term consequence following a stroke. Aims - This study aims to i) explore the issues of weight gain for stroke survivors (aged less than 70); ii) identify what factors contribute to weight gain and iii) inform and develop patient pathways and services. This paper presents emerging findings. Methods - A mixed method design using: surveys of South Yorkshire Cohort participants (n=87); interviews with staff (n=16); and framework analysis methods. Data collected June 2013-October 2013 Results - The long-term effects of strokes influencing weight gain are complex impacting on eating and activity behaviours and social isolation. Families, social networks and lifestyles before and after a stroke influence weight. Interviews indicated that timing of health promotion advice needs to take a patient centred approach and that people were challenged in controlling lifestyle and diet change following their stroke. Discussion - The pathway of community based support is predominantly restricted to twelve weeks which impacts the quality and acceptability of advice given to patients and carers. The loss of control of lifestyle and diet in the medium to long-term was an overarching theme. This paper reflects on the findings and how nurses in acute and community settings can assess and facilitate patients in preventing and reducing weight gain in patients following stroke. Conclusion - Care and information provided to stroke patients is restricted by pathways, availability of specialist support and current funding cuts to community based services. Long term follow up support would provide additional opportunities to influence the diets of patients and carers to reduce weight gain and risk factors for future chronic conditions.</p

Mechanisms Underlying HIV Associated Non-infectious Lung Disease

Pulmonary disease remains a primary source of morbidity and mortality in persons living with HIV (PLWH), although the advent of potent combination antiretroviral therapy has resulted in a shift from predominantly infectious to noninfectious pulmonary complications. PLWH are at high risk for COPD, pulmonary hypertension, and lung cancer even in the era of combination antiretroviral therapy. The underlying mechanisms of this are incompletely understood, but recent research in both human and animal models suggests that oxidative stress, expression of matrix metalloproteinases, and genetic instability may result in lung damage, which predisposes PLWH to these conditions. Some of the factors that drive these processes include tobacco and other substance use, direct HIV infection and expression of specific HIV proteins, inflammation, and shifts in the microbiome toward pathogenic and opportunistic organisms. Further studies are needed to understand the relative importance of these factors to the development of lung disease in PLWH

Ice-Dammed Lake Drainage Evolution at Russell Glacier, West Greenland

KEY POINTS/HIGHLIGHTSTwo rapid ice-dammed lake drainage events gauged and ice dam geometry measured.A melt enlargement model is developed to examine the evolution of drainage mechanism(s).Lake temperature dominated conduit melt enlargement and we hypothesize a flotation trigger.Glaciological and hydraulic factors that control the timing and mechanisms of glacier lake outburst floods (GLOFs) remain poorly understood. This study used measurements of lake level at 15 min intervals and known lake bathymetry to calculate lake outflow during two GLOF events from the northern margin of Russell Glacier, west Greenland. We used measured ice surface elevation, interpolated subglacial topography and likely conduit geometry to inform a melt enlargement model of the outburst evolution. The model was tuned to best-fit the hydrograph rising limb and timing of peak discharge in both events; it achieved Mean Absolute Errors of &lt;5%. About one third of the way through the rising limb, conduit melt enlargement became the dominant drainage mechanism. Lake water temperature, which strongly governed the enlargement rate, preconditioned the high peak discharge and short duration of these floods. We hypothesize that both GLOFs were triggered by ice dam flotation, and localized hydraulic jacking sustained most of their early-stage outflow, explaining the particularly rapid water egress in comparison to that recorded at other ice-marginal lakes. As ice overburden pressure relative to lake water hydraulic head diminished, flow became confined to a subglacial conduit. This study has emphasized the inter-play between ice dam thickness and lake level, drainage timing, lake water temperature and consequently rising stage lake outflow and flood evolution

Dual bronchodilators in Bronchiectasis study (DIBS): protocol for a pragmatic, multicentre, placebo-controlled, three-arm, double-blinded, randomised controlled trial studying bronchodilators in preventing exacerbations of bronchiectasis

INTRODUCTION: Bronchiectasis is a long-term lung condition, with dilated bronchi, chronic inflammation, chronic infection and acute exacerbations. Recurrent exacerbations are associated with poorer clinical outcomes such as increased severity of lung disease, further exacerbations, hospitalisations, reduced quality of life and increased risk of death. Despite an increasing prevalence of bronchiectasis, there is a critical lack of high-quality studies into the disease and no treatments specifically approved for its treatment. This trial aims to establish whether inhaled dual bronchodilators (long acting beta agonist (LABA) and long acting muscarinic antagonist (LAMA)) taken as either a stand-alone therapy or in combination with inhaled corticosteroid (ICS) reduce the number of exacerbations of bronchiectasis requiring treatment with antibiotics during a 12 month treatment period. METHODS: This is a multicentre, pragmatic, double-blind, randomised controlled trial, incorporating an internal pilot and embedded economic evaluation. 600 adult patients (≥18 years) with CT confirmed bronchiectasis will be recruited and randomised to either inhaled dual therapy (LABA+LAMA), triple therapy (LABA+LAMA+ICS) or matched placebo, in a 2:2:1 ratio (respectively). The primary outcome is the number of protocol defined exacerbations requiring treatment with antibiotics during the 12 month treatment period. ETHICS AND DISSEMINATION: Favourable ethical opinion was received from the North East-Newcastle and North Tyneside 2 Research Ethics Committee (reference: 21/NE/0020). Results will be disseminated in peer-reviewed publications, at national and international conferences, in the NIHR Health Technology Assessments journal and to participants and the public (using lay language). TRIAL REGISTRATION NUMBER: ISRCTN15988757