Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial

Background Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. Methods The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training—including information provision, joint goal setting, carer training, and task-specific training—that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3–6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). Findings Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78–1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 [14%]patients in the intervention group vs 82 [13%] in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 [13%] intervention patients vs 110 events in 79 [13%] control patients; p=0·80). Interpretation Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care

Effects of perceived cost, service quality, and customer satisfaction on health insurance service continuance

This paper aims to contribute to the universal discourse on financial services continuance behavior by examining the impact of service cost on customers\u27 service-quality perception and service continuance intention. It presents the results of an empirical study that has explored the impacts of service cost, service quality, and customer satisfaction on health insurance customers\u27 behavioral intention toward continuing or discontinuing with their service providers. Very few studies had examined the impact of service cost on service-quality perception. Our study attempts to fill that gap. A sample of 820 customers was surveyed, and 624 usable responses were analyzed with ANOVA, standard multiple regression, and logistic regression. Our findings indicate that, although highly satisfied health insurance customers will most likely retain their current service providers, customer dissatisfaction does not necessarily lead to discontinuance. Our results also provide some operational implications for health insurance managers, with strategies for reducing attrition and improving customer retention

Catalytic current polarographic determination of traces of titanium in water after preconcentration by coflotation

A new method is reported for the-determination of trace levels of Ti(IV) in water by cofiotation and polargraphy. Ti(IV) is preconcentrated and separated by cofiotation using aluminium hydroxide as coprecipitant and sodium oleate as surfactant. Polarographic determination of titanium content in the froth is based on the catalytic wave ofTi(IV) in the presenceof chlorate and oxalate. The effect ofvarious cations and anions on the fiotation and determination of titanium has been investigated. The method has been applied to estimation of titanium in natural fresh water samples

Adsorbing colloid flotation separation and polarographic determination' of mo(vi) in water

method is described for the flotation and determination of Mo(VI) in water at ng/ml levels. Mo(VI) is preconcentrated and separated by adsorbing colloid flotation employing aluminium(III) hydroxide as collector and sodium lauryl sulphate as surfactant at pH 5.3 ± 0.1. The molybdenum content in the froth is estimated by using the catalytic wave of Mo(VI) in the presence of nitrate, by charging current compensated d.c. polarography (CCCDCP) or differential pulse polarography (DPP). The effect of variables such as pH, ionic strength, concentration of collector and surfactant, time of stirring and gas flow-rate on the recovery of Mo by flotation is reported. The effects of various cations and anions on the flotation and determination of Mo are studied. This method is employed for the determination of molybdenum in natural fresh water samples

Enhancement of the Sensitivity of Tungster Determination by Catalytic Current Polarography

A new method based on catalytic current in differential pulse polarogrms in a medium containing chlorate and -hydroxyquinoline (oxine) is described for the determination of tungsten.Experimental conditions such as pH and the composition of supporting electrolyte are optimized to get a linear calibration graph and also to lower the detection limit. The influence of possible interferences on the catalytic current has been investigated. The mechanism of the electrode process Is studied using DPP diagnostic criteria

Preconcentration by cofiotation for the polarographic determination of traces of heavy metals in water

Preconcentration by coflotation is employed to improve the detection limits for the determination of parts per billion levels of heavy metal ions such as copper(II), lead(lI), cadmium(II), zinc(II), nickel(II) and coba1t(II) in natural and sea water by differential pulse polarography (DPP). Trace amounts of these ions in water are coprecipitated on colloidal aluminium hydroxide and the precipitate is floated with the aid of sodium oleate and a stream of nitrogen bubbles. Experimental conditions are optimized to obtain maximum recovery of these ions by cofiotation. The effect of surfactant on the DPP peak currents of these ions in 'the supporting electrolyte used in this work is studied

Differential pulse polarographic determination of trace levels of iron(ill)by using the catalytic current

Trace of iron (III) are determined by differential pulse polarography in a medium of sodium hydroxide and sodium bromate using the catalytic current. Various cations do not interfere. The relative standard deviation is 2%

Differential Pulse Polarographic Determination of Vanadium(V) using Catalytic current in the Presence of Bromate

A method [or the determination of trace levels of vanadium(V) using differential pulse polarography (DPP) is described. The method is based on the catalytic current of vanadium(V) obtained in the presence of sodium bromate. Experimental conditions such as pH and the composition of supporting electrolyte were optimized to get a linear calibration graph. The effect of several cations and anions on the catalytic current was investigated. The relative standard deviation (from 6 replications) at 0.50 Fg/ml vanadium(V) was 2.5%

Enhanced sensitivity for the differential pulse polarographic determination of Mo(VI) based on adsorption catalytic current

the adsorption catalytic current in a medium containing chlorate and 8-hydroxyquinoline (exine) is suggested for the determination of molybdenum(VI). Experimental conditions such as pH and the composition of supporting electrolyte have been optimized to get a linear calibration graph at trace levels of Mo(VI). The sensitivity for molybdenum can be considerably enhanced by this method. The influence of possible interferences on the catalytic current has been investigated. The sensitivity of the method is compared with those obtained for other DPP methods for molybdenum. A detection limit of 1.0 1Q-8 mol/L has been found

Pyridinium poly(hydrogen fluoride). A versatile fluorinating reagent preparation and characterization of nonmetal and metal complex fluoro salts

Abstract is not available