Stroke patients admitted within normal working hours are more likely to achieve process standards and to have better outcomes

Acknowledgements The authors are grateful to David Murphy of the SSCA for providing data and to Lynsey Waugh of ISD Scotland for linking the SSCA data with General Register Office data. The authors also acknowledge the help of all who enter data into SSCA. Funding This study was funded by Chest, Heart and Stroke Scotland (Grant no R14/A156). The SSCA is funded by NHS Scotland via ISD.Peer reviewedPublisher PD

Agreement between routine electronic hospital discharge and Scottish Stroke Care Audit (SSCA) data in identifying stroke in the Scottish population

Background In Scotland all non-obstetric, non-psychiatric acute inpatient and day case stays are recorded by an administrative hospital discharge database, the Scottish Morbidity Record (SMR01). The Scottish Stroke Care Audit (SSCA) collects data from all hospitals managing acute stroke in Scotland to support and improve quality of stroke care. The aim was to assess whether there were discrepancies between these data sources for admissions from 2010 to 2011. Methods Records were matched when admission dates from the two data sources were within two days of each other and if an International Classification of Diseases (ICD) code of I61, I63, I64, or G45 was in the primary or secondary diagnosis field on SMR01. We also carried out a linkage analysis followed by a case-note review within one hospital in Scotland. Results There were a total of 22 416 entries on SSCA and 22 200 entries on SMR01. The concordance between SSCA and SMR01 was 16 823. SSCA contained 5593 strokes that were not present in SMR01, whereas SMR01 contained 185 strokes that were not present in SSCA. In the case-note review the concordance was 531, with SSCA containing 157 strokes that were not present in SMR01 and SMR01 containing 32 strokes that were not present in SSCA. Conclusions When identifying strokes, hospital administrative discharge databases should be used with caution. Our results demonstrate that SSCA most accurately represents the number of strokes occurring in Scotland. This resource is useful for determining the provision of adequate patient care, stroke services and resources, and as a tool for research

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging in patients with transient ischaemic attack and minor stroke : a systematic review, meta-analysis and economic evaluation

Erratum issued September 2015 Erratum DOI: 10.3310/hta18270-c201509Peer reviewedPublisher PD

Implementing a Simple Care Bundle Is Associated With Improved Outcomes in a National Cohort of Patients With Ischemic Stroke

Acknowledgements We acknowledge the support of all audit coordinators and clinicians who contribute to the Scottish Stroke Care Audit. Information Services Division, National Health Service Scotland (in particular Lindsey Waugh) supported data linkage with General Register OfficePeer reviewedPostprintPostprin

The Living with Dysarthria group : implementation and feasibility of a group intervention for people with dysarthria following stroke and family members

The broad life implications of acquired dysarthria are recognised, but have received little attention in stroke management. Reports of group therapy, which may be a suitable approach to intervention, are not available for stroke related dysarthria. To examine the operational feasibility of and response to a new 8 session weekly group intervention programme, Living with Dysarthria, designed for people with chronic dysarthria following stroke and their main communication partners. The target participation was for programme completion by two groups of eight people with dysarthria (PWD) and available family members (FMs) or carers. An active recruitment strategy was undertaken from the speech and language therapy case records for the previous six years in two hospitals with combined annual stroke admissions of over 500. Twelve PWD and seven FMs were recruited (group 1: 7 PWD and 4 FMs; group 2: 5 PWD and 3FMs). Speech intelligibility, communication effectiveness, general wellbeing, quality of communication life and knowledge of stroke and dysarthria were assessed pre and post programme. Each PWD and FM also set an individual goal and rated their achievement of this on a 0-10 scale. Recruitment to the programme was lower than anticipated and below target. The 12 PWD were recruited from 62 initial contacts, which was the total number who according to available information met criteria. The programme was viable: it ran to plan, with only minor content alterations, in community accommodation, and with good participant engagement. Group median score changes were in a positive direction for all measures and effect sizes ranged from 0.17 (quality of communication life) to 0.46 (intelligibility). Significant post programme changes were present for intelligibility and knowledge of stroke and dysarthria (p = 0.05). Participants’ ratings of goal achievements ranged from 6 (some change) to 10 (a lot of change). The recruitment experience revealed a take-up rate of around 20% from people with dysarthria following stroke, informing future planning. The participant engagement and performance results from the piloting of the programme indicate that the Living with Dysarthria programme is viable and has potential for effecting positive change. Further testing is justified

The 'Choice and Autonomy Framework' : implications for occupational therapy practice

Introduction This paper presents findings from a PhD study exploring autonomy of adults with physical disability. The plethora of descriptions of autonomy in psychological, occupational therapy and rehabilitation literature (e.g. Ryan and Deci 2000, Rogers 1982, Cardol et al 2002) detracts from the centrality of autonomy and results in difficulty incorporating it into occupational therapy practice. This paper presents a framework providing an integrated, clinically useful approach to autonomy. Methods Sixteen people were recruited, based on age, gender, impairment and living circumstances (community/residential settings). All have significant physical disability, use a wheelchair and require personal assistance for some/all self-care activities. Qualitative methods were used for data collection, including life-history narrative, diary information and extensive interview. An integrated method of analysis was used, including content analysis and bracketing. Results The ‘Choice and Autonomy Framework’ consists of five strands, including: • the meaning of autonomy • whether or not autonomy is a goal or value • the experience of autonomy • personality factors that impact autonomy • environmental features that enhance or negate autonomy. This paper will describe each strand, as derived from the research. The results suggest that, contrary to common wisdom (Hmel and Pincus 2002), autonomy is not necessarily a universal goal for people with physical disability; an understanding of the person’s own perspective will enhance person-centred practice and enable therapists to further recognise individuality of clients. It will argue that the concept of autonomy needs to be further understood and incorporated into occupational therapy practice