Regional Differences in Post-discharge Stroke Care in India: A Qualitative Study

Background: Stroke is the fourth leading cause of death and fifth leading cause of disability in India. Stroke rehabilitation can reduce mortality and improve outcomes, but India has limited resources to provide comprehensive stroke care after hospitalisation. Consequently, stroke survivors and family carers experience a range of challenges with long-term care and support. Secondary prevention and stroke rehabilitation services are important in post-discharge stroke care; however, there is insufficient information on post-discharge stroke services in India. Aim: This study aims to explore the clinical staff perspectives of post-discharge stroke services across different regions of India. Methods: Semi-structured interviews were undertaken with a purposive sample of health professionals from multidisciplinary stroke teams at the All India Institute of Medical Sciences, New Delhi (North), Baptist Christian Hospital (North-East), Sree Chitra Tirunal Institute for Medical Sciences and Technology (South) between July and August 2021. The interviews were conducted, translated, and transcribed by the research team. Data were analysed thematically using NVivo software. Results: Twenty-six health professionals participated: 9 Nurses, 7 Doctors, 5 Physiotherapists, 2 Speech and Language Therapists, and 1 Social Worker, Dietician, and Palliative Care team member. Four themes were identified: Integrated Inpatient Discharge Care Planning; Patient and Caregiver Engagement; Post-Discharge Care and Support; Resources and Workforce. Conclusion: Patient and caregiver engagement is an integral part of post-discharge processes; however, regional variation exists in the discharge planning, staff, resources, and services available for post-discharge support. Moreover, patient and caregiver challenges vary across geographical locations, educational backgrounds, financial status, family, and support networks

CLINICAL STAFF PERSPECTIVE OF POST-DISCHARGE STROKE CARE IN NORTH INDIA

Background Stroke rehabilitation can reduce mortality and improve outcomes1,2, but India has limited resources to provide comprehensive stroke care post-discharge. This study explores the key components and challenges of post discharge stroke services with clinical staff. Methods Semi-structured interviews were undertaken with a purposive sample of health professionals from the All India Institute of Medical Sciences, New Delhi. The interviews were conducted, translated and transcribed by a Research Associate. Data were analysed thematically using NVivo software. Results Ten healthcare professionals participated: 6 Nurses, 2 Neurologists, 1 Physiotherapist, 1 Consultant (Research). Four key themes were identified (see table). Conclusion The multidisciplinary team empowers patients and caregivers by providing tailored and targeted education, training and support. The existing post-discharge management system could be formally documented at AIIMS to facilitate a more consistent and comprehensive approach

CLINICAL STAFF PERSPECTIVE OF POST-DISCHARGE STROKE CARE IN SOUTH INDIA

Background Stroke rehabilitation can reduce mortality and improve outcomes1,2, but India has limited resources to provide comprehensive stroke care post-discharge. The aim of this study was to explore the key components and challenges of post-discharge stroke services with clinical staff. Methods Semi-structured interviews were undertaken with a purposive sample of health professionals from Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Kerala. The interviews were conducted, translated and transcribed by a Research Associate and data analysed thematically using NVivo software. Results A total of 10 healthcare professionals participated: 2 neurologists, 3 nurses, 2 physiotherapists, 2 speech therapists and 1 medico-social worker. Four themes were identifie

Motion sickness onboard ships : subjective vertical theory and its application to full-scale trials

This article presents a new approach for the prediction of motion sickness on ships, with a focus on high-speed craft. The methodology presented is based on a variant of the sensory conflict hypothesis and the human vestibular system. The proposed model was developed using control theory and is capable of taking account of all six degrees of freedom vessel motion for the prediction of motion sickness. Furthermore, full-scale trials were carried out onboard three different high-speed craft to measure the ship motions and consequently to analyse their effects on passengers in terms of motion sickness. Through the accumulated results, the developed model was validated and was compared with existing methods/criteria for the prediction of the incidence of motion sickness

Volcanic suppression of Nile summer flooding triggers revolt and constrains interstate conflict in ancient Egypt.

Volcanic eruptions provide tests of human and natural system sensitivity to abrupt shocks because their repeated occurrence allows the identification of systematic relationships in the presence of random variability. Here we show a suppression of Nile summer flooding via the radiative and dynamical impacts of explosive volcanism on the African monsoon, using climate model output, ice-core-based volcanic forcing data, Nilometer measurements, and ancient Egyptian writings. We then examine the response of Ptolemaic Egypt (305-30 BCE), one of the best-documented ancient superpowers, to volcanically induced Nile suppression. Eruptions are associated with revolt onset against elite rule, and the cessation of Ptolemaic state warfare with their great rival, the Seleukid Empire. Eruptions are also followed by socioeconomic stress with increased hereditary land sales, and the issuance of priestly decrees to reinforce elite authority. Ptolemaic vulnerability to volcanic eruptions offers a caution for all monsoon-dependent agricultural regions, presently including 70% of world population.The degree to which human societies have responded to past climatic changes remains unclear. Here, using a novel combination of approaches, the authors show how volcanically-induced suppression of Nile summer flooding led to societal unrest in Ptolemaic Egypt (305-30 BCE)