Patients’ expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study

BACKGROUND: An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients’ expectations of coming home very early after stroke with support and rehabilitations at home. METHOD: This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0–5 days before discharge and the material was analyzed with qualitative content analysis. RESULTS: Four main categories containing 11 subcategories were found. The VESD team was expected to provide “Support towards independency”, by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to “A new and unknown situation”, causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, “Returning to one’s own setting” described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. “A new everyday life” waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. CONCLUSIONS: The participants described mixed expectations such as insecurity and fear, and on the other hand, longing to come home. Moreover, they had a high degree of confidence in the expected support of the VESD team. The health professionals at the hospital may build on this trust to reduce the patients’ insecurity for coming home. In addition, it may be beneficial to explore the patients’ expectations thoroughly in front of discharge, as certain feelings and thoughts could complicate or support the home coming process. Thus, a greater attention on such expectations may facilitate the patient’s transition from hospital to home after stroke

Stroke in women — from evidence to inequalities

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke — including diabetes mellitus and atrial fibrillation — are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials — despite governmental actions highlighting the need to include both men and women in clinical trials — resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women

De MRI-compatible pacemaker

Tijdens een afstudeeronderzoek is onderzoek gedaan naar MRI-compatible pacemakers via literatuuronderzoek en interviews. Uit het onderzoek blijft dat er een tweetal aspecten zijn waar men rekening mee dient te houden bij een MRI-compatible pacemaker. Het eerste aspect heeft betrekking op de scanparameters. De belangrijkste hiervan zijn de SAR en de Gradiënt Slew Rate. De fabrikanten hebben voor elk type pacemakersysteem en leads een maximale SAR en Gradiënt Slew Rate opgesteld. Het tweede aspect heeft betrekking op de bewaking van de patiënt tijdens het MRI-onderzoek. Voorafgaand aan het onderzoek moet de pacemaker in de ‘MRI-stand’ worden gezet. Daarnaast dient de patiënt tijdens het MRI-onderzoek ten alle tijden bewaakt te worden door middel van een MRI-compatible ECG en saturatiemete

ARC² ₄ — A double-arch positioner for bistatic RCS measurements with four degrees of freedom

Bistatic RCS measurements are complex and time-demanding due to the different measurement dimensions. In cases, where target characterization requires a large amount of bistatic angle pairs, automated measurement facilities are demanded, that cover large spatial dimensions. This paper presents a positioning system for overcoming some of the typical limitations and makes the procedure of measuring bistatic RCS measurements more automated and cost-effective