One year post stroke:A research on quality of life of elderly ischaemic stroke patients and follow-up care.

Steeds meer ouderen leven met de gevolgen van een beroerte (hierna: CVA). Dit proefschrift beschrijft hoe de kwaliteit van leven van deze patiënten is en of Nederlandse huisartsen de juiste preventie en nazorg leveren. Als eerste is bepaald of de overleving van CVA-patiënten is toegenomen nadat de richtlijn ’Landelijke Transmurale Afspraak TIA/CVA’ is ingevoerd en of de nazorg hierna veranderde. Er is geen toename van de 1-jaars overleving gevonden. Wel bleek er meer aandacht voor nazorg te zijn. Hiernaast is bepaald welke nazorg oudere CVA-patiënten precies krijgen. Het blijkt dat huisartsen de richtlijnen redelijk goed naleven, maar dat er nog meer aandacht besteed kan worden aan onder andere secundaire preventie. Het is belangrijk om te weten wat de kwaliteit van leven is van CVA-patiënten en hoe we deze kunnen verbeteren. Uit dit proefschrift blijkt dat de kwaliteit van leven van zelfstandig wonende oudere CVA-patiënten vergelijkbaar is met die van de Nederlandse ouderenpopulatie. Hierbij is trombolyse (behandeling waarbij een stolsel in een bloedvat wordt opgelost) van grote waarde om een betere kwaliteit van leven te bereiken. De kwaliteit van leven wordt nadelig beïnvloed door een lagere ADL zelfstandigheid, afname van activiteiten/hobby’s en door depressies en angststoornissen. Omdat depressies en angststoornissen veel voorkomen is het belangrijk hier aandacht voor te hebben. Om het welzijn verder te verbeteren, is een nazorgprogramma ontwikkeld met extra aandacht voor het mentaal functioneren en het behoud van diverse hobby’s en activiteiten. Ondanks deze intensievere nazorg zijn er geen grote verschillen gevonden in het welzijn van patiënten met en zonder deze nazorg

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

Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

One year post stroke

Steeds meer ouderen leven met de gevolgen van een beroerte (hierna: CVA). Dit proefschrift beschrijft hoe de kwaliteit van leven van deze patiënten is en of Nederlandse huisartsen de juiste preventie en nazorg leveren. Als eerste is bepaald of de overleving van CVA-patiënten is toegenomen nadat de richtlijn ’Landelijke Transmurale Afspraak TIA/CVA’ is ingevoerd en of de nazorg hierna veranderde. Er is geen toename van de 1-jaars overleving gevonden. Wel bleek er meer aandacht voor nazorg te zijn. Hiernaast is bepaald welke nazorg oudere CVA-patiënten precies krijgen. Het blijkt dat huisartsen de richtlijnen redelijk goed naleven, maar dat er nog meer aandacht besteed kan worden aan onder andere secundaire preventie. Het is belangrijk om te weten wat de kwaliteit van leven is van CVA-patiënten en hoe we deze kunnen verbeteren. Uit dit proefschrift blijkt dat de kwaliteit van leven van zelfstandig wonende oudere CVA-patiënten vergelijkbaar is met die van de Nederlandse ouderenpopulatie. Hierbij is trombolyse (behandeling waarbij een stolsel in een bloedvat wordt opgelost) van grote waarde om een betere kwaliteit van leven te bereiken. De kwaliteit van leven wordt nadelig beïnvloed door een lagere ADL zelfstandigheid, afname van activiteiten/hobby’s en door depressies en angststoornissen. Omdat depressies en angststoornissen veel voorkomen is het belangrijk hier aandacht voor te hebben. Om het welzijn verder te verbeteren, is een nazorgprogramma ontwikkeld met extra aandacht voor het mentaal functioneren en het behoud van diverse hobby’s en activiteiten. Ondanks deze intensievere nazorg zijn er geen grote verschillen gevonden in het welzijn van patiënten met en zonder deze nazorg. A growing number of elderly people are living with the consequences of a stroke (CVA). This thesis describes the quality of life for this group of elderly people and whether Dutch general practitioners are providing the correct prevention and aftercare. First of all it was determined whether the survival of stroke patients has increased since the introduction of the guideline ’Dutch Transmural Protocol TIA/CVA’ and whether the aftercare provided changed after this. No increase in the one-year survival was found. However, it was discovered that more attention was paid to the aftercare. Next it was determined exactly what type of aftercare elderly stroke patients receive. Dutch general practitioners were found to comply reasonably well with the guidelines but more attention could be paid to issues such as secondary prevention. It is important to know what the quality of life of stroke patients is and how we can improve this. This thesis reveals that the quality of life for elderly stroke patients who live independently is comparable with that of the elderly population in the Netherlands. In this regard, thrombolysis (treatment in which a clot in a blood vessel is dissolved) is particularly valuable in achieving a better quality of life. Quality of life is detrimentally influenced by a lower ADL independence, decrease in activities/hobbies and by depressions and anxiety disorders. As depression and anxiety disorders are highly prevalent, due consideration should be given to these. To further improve the well-being, an aftercare programme has been developed with extra attention for the mental functioning and for the keeping up of various hobbies and activities. Despite this more intensive form of aftercare, no large differences were found in the well-being of patients with and without this aftercare.

Quality of life of elderly ischaemic stroke patients one year after thrombolytic therapy. A comparison between patients with and without thrombolytic therapy

Background: An observational study to examine whether thrombolytic therapy in stroke patients realizes better quality of life outcomes compared to patients without thrombolytic therapy one year after stroke. We also examined whether daily functioning, mental functioning and activities improved after thrombolytic treatment. Methods: A total of 88 stroke patients were interviewed at home one year post-stroke. Health-related quality of life (HRQOL) was assessed using the RAND-36, disability with the Barthel Index, depression and anxiety with the Hospital Anxiety and Depression Scale, and a questionnaire about patient way of life was completed. People aged under 60, moving to a nursing home or with a haemorrhage were excluded. Results: The thrombolysis group (TG) had more severe stroke (higher NIHSS) scores and were younger than the group without thrombolytic therapy (WTG). The primary outcome was HRQOL, which was high and nearly identical in both groups, however the TG had significantly better HRQOL for the ;mental 'mental and 'vitality' scales. Patients who stopped or reduced their hobbies because of stroke had a significantly worse HRQOL. One year after stroke, more patients in the TG were totally or severely ADL dependent (12% TG and 0% WTG, p = 0.022). The level of dependence decreased in the TG (p = 0.042) and worsened in the WTG (p <0.001) after one year. Being more dependent is related to diminishing daily occupations in both groups. In the TG the level of dependence had less impact on visiting family and friends and going on holiday. The prevalence of anxiety disorder and depression was low compared to other studies and there is no significant difference between the two groups. Conclusion: No major differences in the primary outcome (HRQOL) could be found between the two groups. In addition, no essential difference could be found in mental functioning and participation. We expected that patients undergoing thrombolytic therapy would have worse quality of life because of the greater initial severity of their stroke. Therefore, thrombolytic therapy seems to be of great importance in achieving better quality of life in ischemic stroke patients who respond to this therapy

Quality of life of elderly ischaemic stroke patients one year after thrombolytic therapy. A comparison between patients with and without thrombolytic therapy

Abstract Background An observational study to examine whether thrombolytic therapy in stroke patients realizes better quality of life outcomes compared to patients without thrombolytic therapy one year after stroke. We also examined whether daily functioning, mental functioning and activities improved after thrombolytic treatment. Methods A total of 88 stroke patients were interviewed at home one year post-stroke. Health-related quality of life (HRQOL) was assessed using the RAND-36, disability with the Barthel Index, depression and anxiety with the Hospital Anxiety and Depression Scale, and a questionnaire about patient way of life was completed. People aged under 60, moving to a nursing home or with a haemorrhage were excluded. Results The thrombolysis group (TG) had more severe stroke (higher NIHSS) scores and were younger than the group without thrombolytic therapy (WTG). The primary outcome was HRQOL, which was high and nearly identical in both groups, however the TG had significantly better HRQOL for the ‘mental health’ and ‘vitality’ scales. Patients who stopped or reduced their hobbies because of stroke had a significantly worse HRQOL. One year after stroke, more patients in the TG were totally or severely ADL dependent (12% TG and 0% WTG, p = 0.022). The level of dependence decreased in the TG (p = 0.042) and worsened in the WTG (p  Conclusion No major differences in the primary outcome (HRQOL) could be found between the two groups. In addition, no essential difference could be found in mental functioning and participation. We expected that patients undergoing thrombolytic therapy would have worse quality of life because of the greater initial severity of their stroke. Therefore, thrombolytic therapy seems to be of great importance in achieving better quality of life in ischemic stroke patients who respond to this therapy.</p

Survival of stroke patients after introduction of the 'Dutch Transmural Protocol TIA/CVA'

<p>Background: Earlier research showed that healthcare in stroke could be better organized, aiming for improved survival and less comorbidity. Therefore, in 2004 the Dutch College of General Practitioners (NHG) and the Dutch Association of Neurology (NVN) introduced the 'Dutch Transmural Protocol TIA/CVA' (the LTA) to improve survival, minimize the risk of stroke recurrence, and increase quality of life after stroke. This study examines whether survival improved after implementation of the new protocol, and whether there was an increase in contacts with the general practitioner (GP)/nurse practitioner, registration of comorbidity and prescription of medication.</p><p>Methods: From the primary care database of the Registration Network Groningen (RNG) two cohorts were composed: one cohort compiled before and one after introduction of the LTA. Cohort 1 (n = 131, first stroke 2001-2002) was compared with cohort 2 (n = 132, first stroke 2005-2006) with regard to survival and the secondary outcomes.</p><p>Results: Comparison of the two cohorts showed no significant improvement in survival. In cohort 2, the number of contacts with the GP was significantly lower and with the nurse practitioner significantly higher, compared with cohort 1. All risk factors for stroke were more prevalent in cohort 2, but were only significant for hypercholesterolemia. In both cohorts more medication was prescribed after stroke, whereas ACE inhibitors were prescribed more frequently only in cohort 2.</p><p>Conclusion: No major changes in survival and secondary outcomes were apparent after introduction of the LTA. Although, there was a small improvement in secondary prevention, this study shows that optimal treatment after introduction of the LTA has not yet been achieved.</p>