National Survey of Stroke Survivors: Documenting the Experiences and Levels of Self-Reported Long-Term Need in Stroke Survivors in the First 5 years.Systematic Review:Factors Associated with Community Re-integration in the First 12 months Post Stroke: A Qualitative Synthesis.

Introduction In Ireland it is estimated that there are 30,000 persons living with residual effects of stroke.1 The Irish National Audit of Stroke Care, carried out in 2007, identified substantial deficits in a number of areas including discharge planning, rehabilitation, on-going secondary prevention, and communication with patients and families.2 The present study builds on the findings of the audit. It explores in detail the current needs of people post stroke in Ireland who are living in the community. It also provides a profile of many possible problems that stroke can cause. In addition it provides a comprehensive review of the literature. Aim This report contains two distinct pieces of research: Firstly, a systematic review and qualitative synthesis (metasynthesis) of the literature was conducted. The aim of the systematic review was to identify perceived barriers and facilitators to community re-integration in the first 12 months after stroke, from the perspective of persons with stroke Secondly, a national survey of stroke survivors who experienced their stroke up to 5 years previously was carried out. The aim of the survey was to document the experiences and levels of self-reported long-term need among community-dwelling stroke survivors in Ireland Methods of the National Survey Stroke survivors were recruited to take part in the survey primarily though the Irish Heart Foundation National Stroke Support Group Network and non-statutory organisations that provide support after acquired brain injury. The survey was also advertised online to a broader stroke population. A questionnaire was developed to assess respondents’ own perceptions of their recovery, community re-integration and on-going needs from existing validated questionnaires with the permission of the original authors.3 Data collection took place between June and October 2013. Main findings: Systematic Review Eighteen articles, using qualitative methodology, were included in the final review. Four primary themes that were perceived to act as barriers or facilitators to community re-integration for individuals in the first year after stroke were identified from the included studies: Primary effects of stroke Personal factors Social factors Relationships with professionals National Survey A total of 196 stroke survivors, aged between 24 and 89 years, responded to the surve Mobility difficulties were reported by eighty-three per cent of respondents. Emotional problems, fatigue, concentration and arm dysfunction were reported almost as commonly Of the 150 individuals with emotional difficulties only eleven per cent received psychological services Sixty per cent of respondents felt that their household finances were affected by their stroke. Thirty-six per cent of respondents reported paying privately for rehabilitation. Thirty-four per cent of respondents had to pay privately to adapt their home Over half of respondents needed help with personal care and two thirds needed help with household tasks since their stroke. Family provided most of this help Forty-two per cent of respondents who were in a relationship at the time of the survey felt that it has been significantly affected by their stroke Less than a quarter of respondents under the age of 66 have worked in a full or part-time capacity since their stroke, while sixty per cent of drivers have returned to driving Conclusions Stroke had a personal, social and economical impact on the lives of many respondents. Successful return to work levels after stroke, as reported, were particularly low. Emotional distress and fatigue were common and were barriers to many activities. Satisfaction with the level of help available for these problems was poor

Increased peri-ductal collagen micro-organization may contribute to raised mammographic density

BACKGROUND: High mammographic density is a therapeutically modifiable risk factor for breast cancer. Although mammographic density is correlated with the relative abundance of collagen-rich fibroglandular tissue, the causative mechanisms, associated structural remodelling and mechanical consequences remain poorly defined. In this study we have developed a new collaborative bedside-to-bench workflow to determine the relationship between mammographic density, collagen abundance and alignment, tissue stiffness and the expression of extracellular matrix organising proteins. METHODS: Mammographic density was assessed in 22 post-menopausal women (aged 54–66 y). A radiologist and a pathologist identified and excised regions of elevated non-cancerous X-ray density prior to laboratory characterization. Collagen abundance was determined by both Masson’s trichrome and Picrosirius red staining (which enhances collagen birefringence when viewed under polarised light). The structural specificity of these collagen visualisation methods was determined by comparing the relative birefringence and ultrastructure (visualised by atomic force microscopy) of unaligned collagen I fibrils in reconstituted gels with the highly aligned collagen fibrils in rat tail tendon. Localised collagen fibril organisation and stiffness was also evaluated in tissue sections by atomic force microscopy/spectroscopy and the abundance of key extracellular proteins was assessed using mass spectrometry. RESULTS: Mammographic density was positively correlated with the abundance of aligned periductal fibrils rather than with the abundance of amorphous collagen. Compared with matched tissue resected from the breasts of low mammographic density patients, the highly birefringent tissue in mammographically dense breasts was both significantly stiffer and characterised by large (>80 μm long) fibrillar collagen bundles. Subsequent proteomic analyses not only confirmed the absence of collagen fibrosis in high mammographic density tissue, but additionally identified the up-regulation of periostin and collagen XVI (regulators of collagen fibril structure and architecture) as potential mediators of localised mechanical stiffness. CONCLUSIONS: These preliminary data suggest that remodelling, and hence stiffening, of the existing stromal collagen microarchitecture promotes high mammographic density within the breast. In turn, this aberrant mechanical environment may trigger neoplasia-associated mechanotransduction pathways within the epithelial cell population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13058-015-0664-2) contains supplementary material, which is available to authorized users

Blow the Wind

David Mooney (arranger) writes This arrangement for choir, harp and treble solo combines two well-know folk tunes relating to the subject of the wind. It has been written specially for this project. The North Wind Doth Blow and Blow the Wind Southerly provide the principal thematic material. The two beautiful melodies are woven into the setting while the harp provides a descriptive underlay and word-painting . The performers are Dr. Cliona Doris (concert harp), Max O\u27Neill (treble solo), The DIT Junior Choirs (dir. by Dr. Lorraine O\u27Connell), Niamh McCormack (soprano), Aoife Moore (soprano) and Sheena Styles (alto)

A comparison of service organisation and guideline compliance between two adjacent European health services

Introduction Outcomes in stroke patients are improved by a co-ordinated organisation of stroke services and provision of evidence-based care. We studied the organisation of care and application of guidelines in two neighbouring health care systems with similar characteristics. Methods Organisational elements of the 2015 National Stroke Audit (NSA) from the Republic of Ireland (ROI) were compared with the Sentinel Stroke National Audit Programme (SSNAP) in Northern Ireland (NI) and the United Kingdom (UK). Compliance was compared with UK and European guidelines. Results Twenty-one of 28 ROI hospitals (78%) reported having a stroke unit (SU) compared with all 10 in NI. Average SU size was smaller in ROI (6 beds vs. 15 beds) and bed availability per head of population was lower (1:30,633 vs. 1:12,037 p &lt; 0.0001 Chi Sq). Fifty-four percent of ROI patients were admitted to SU care compared with 96% of UK patients ( p &lt; 0.0001). Twenty-four–hour physiological monitoring was available in 54% of ROI SUs compared to 91% of UK units ( p &lt; 0.0001). There was no significant difference between ROI and NI in access to senior specialist physicians or nurses or in SU nurse staffing (3.9/10 beds weekday mornings) but there was a higher proportion of trained nurses in ROI units (2.9/10 beds vs. 2.3/10 beds ( p = 0.02 Chi Sq). Conclusion Whilst the majority of hospitals in both jurisdictions met key criteria for organised stroke care the small size and underdevelopment of the ROI units meant a substantial proportion of patients were unable to access this specialised care. </jats:sec