PCN119 Cost-Effectiveness Simulation of Colonography Versus Colonoscopy in Germany: Is Laxative-Free Colonography Cost-Effective?

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Lacunar infarcts, depression and anxiety symptoms one year after stroke

Background: Mood disorders are frequent after stroke and are associated with poorer quality of life. Previous studies have reported conflicting results as to stroke subtype in the incidence of poststroke mood disorders. We explored the relationship between subcortical ischemic stroke subtype (lacunar) and presence of such symptoms at 1 year after stroke. Methods: Anonymized data were accessed from the Virtual International Stroke Trials Archive. Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment classification. Depression and anxiety symptoms were assessed using Hospital Anxiety and Depression Scale. We investigated independent predictors of depression and anxiety symptoms using a logistic regression model. Results: Data were available for 2160 patients. Almost one fifth of the patients developed both anxiety and depression at 1-year follow-up. After adjusting for confounders, the lacunar subtype was least associated with both anxiety (odds ratio [OR] = .61; 95% confidence interval [CI] = .46-.80) and depression symptoms (OR = .71; CI = .55-.93) versus other stroke subtypes. Conclusions: Lacunar strokes have a weaker association with presence of anxiety and depression symptoms compared with other subtypes

Ethnic differences in stroke recurrence

Objective To determine whether stroke recurrence and the effect of recurrence on mortality differ by ethnicity. Methods Using methods from the Brain Attack Surveillance in Corpus Christi project, we prospectively identified first-ever ischemic strokes from emergency department logs and hospital admissions (January 2000 to December 2004). Recurrent strokes and deaths were identified for the same period. Cumulative probability of stroke recurrence was estimated. Cox proportional hazards models were used to examine ethnic differences in recurrence and to examine the relation among ethnicity, recurrence, and mortality. Results During the time interval, 1,345 first-ever ischemic strokes were validated. Median age of patients was 72 years; 53% were Mexican American (MA). There were 126 recurrent strokes. Cumulative risk for recurrence at 30 days and 1 year was 2.6 and 7.5%, respectively. MAs had higher risk for stroke recurrence (risk ratio, 1.57; 95% confidence interval, 1.05–2.34) compared with non-Hispanic white patients, adjusted for demographics, stroke risk factors, and stroke severity. Stroke recurrence was related to mortality to a similar extent across ethnic groups (non-Hispanic white patients: risk ratio, 3.32; 95% confidence interval, 2.07–5.32; MAs: risk ratio, 2.35; 95% confidence interval, 1.42–3.88). Interpretation MAs had higher stroke recurrence risk compared with non-Hispanic white patients. Stroke recurrence had an important impact on mortality. Efforts to reduce stroke recurrence in MAs are needed. Ann Neurol 2006Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55835/1/20943_ftp.pd

Predicting ischaemic stroke subtype from presenting systolic blood pressure: the BASIC Project

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73464/1/j.1365-2796.2008.02022.x.pd

Cortical activation changes underlying stimulation-induced behavioural gains in chronic stroke

Transcranial direct current stimulation, a form of non-invasive brain stimulation, is showing increasing promise as an adjunct therapy in rehabilitation following stroke. However, although significant behavioural improvements have been reported in proof-of-principle studies, the underlying mechanisms are poorly understood. The rationale for transcranial direct current stimulation as therapy for stroke is that therapeutic stimulation paradigms increase activity in ipsilesional motor cortical areas, but this has not previously been directly tested for conventional electrode placements. This study was performed to test directly whether increases in ipsilesional cortical activation with transcranial direct current stimulation are associated with behavioural improvements in chronic stroke patients. Patients at least 6 months post-first stroke participated in a behavioural experiment (n = 13) or a functional magnetic resonance imaging experiment (n = 11), each investigating the effects of three stimulation conditions in separate sessions: anodal stimulation to the ipsilesional hemisphere; cathodal stimulation to the contralesional hemisphere; and sham stimulation. Anodal (facilitatory) stimulation to the ipsilesional hemisphere led to significant improvements (5–10%) in response times with the affected hand in both experiments. This improvement was associated with an increase in movement-related cortical activity in the stimulated primary motor cortex and functionally interconnected regions. Cathodal (inhibitory) stimulation to the contralesional hemisphere led to a functional improvement only when compared with sham stimulation. We show for the first time that the significant behavioural improvements produced by anodal stimulation to the ipsilesional hemisphere are associated with a functionally relevant increase in activity within the ipsilesional primary motor cortex in patients with a wide range of disabilities following stroke

Stroke survivors’ and carers’ experiences of a systematic voiding programme to treat urinary incontinence after stroke

Aims and objectives To explore the views and experiences of stroke survivors and carers about a systematic voiding programme for post-stroke incontinence. Background Urinary incontinence after stroke is common and associated with poorer functional outcome. Structured assessment and management are potentially effective interventions but it is important that there is a good understanding of stroke survivors’ and carers’ views of their acceptability and implementation. Design Qualitative study within a feasibility trial. Methods 16 participants (12 stroke survivors, 4 carers) were interviewed using a structured schedule shortly before discharge from one of six inpatient stroke units across six hospitals. Interviews were audiorecorded, transcribed verbatim, and thematic analysis was conducted. Findings Participants included seven male and five female stroke survivors (mean age 76 years), and four female carers (two wives, two daughters). Themes relating to the preliminary (assessment) phase of the programme were: physical impact, psychological impact, beliefs about incontinence, and the assessment process itself. Main themes relating to the implementation of the programme included: Timed voiding decisions, adapting the programme or the timed voiding schedule, and urinary incontinence management techniques. Participants felt that the programme helped them to re-establish a regular pattern of micturition and to regain autonomy. Conclusions The effectiveness of a systematic voiding programme may partly lie in its educational component, challenging patients’ and carers’ assumptions that post-stroke incontinence is inevitable. Individual adaptation of the programme, and the ability to incorporate it alongside other aspects of care, are likely to be key factors influencing implementation. Relevance to clinical practice Urinary incontinence is common after stroke. In order to maximise benefits from a systematic voiding programme, nurses should support stroke survivors to overturn erroneous beliefs, to participate in tailoring of the programme, and in self-management where appropriate

Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients

<p>Abstract</p> <p>Background</p> <p>Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine.</p> <p>Methods</p> <p>The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks.</p> <p>Results</p> <p>The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability.</p> <p>Conclusions</p> <p>The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.</p