540 research outputs found
Volume 27, Number 3, September 2007 OLAC Newsletter
Digitized September 2007 issue of the OLAC Newsletter
Volume 27, Number 1, March 2007 OLAC Newsletter
Digitized March 2007 issue of the OLAC Newsletter
Volume 28, Number 2, June 2008 OLAC Newsletter
Digitized June 2008 issue of the OLAC Newsletter
Volume 29, Number 1, March 2009 OLAC Newsletter
Digitized March 2009 issue of the OLAC Newsletter
Volume 29, Number 4, December 2009 OLAC Newsletter
Digitized December 2009 issue of the OLAC Newsletter
Services for reducing duration of hospital care for acute stroke patients
<p>Background:
Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with rehabilitation at home (early supported discharge (ESD)).</p>
<p>Objectives:
To establish the effects and costs of ESD services compared with conventional services.</p>
<p>Search methods:
We searched the trials registers of the Cochrane Stroke Group (January 2012) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group, MEDLINE (2008 to 7 February 2012), EMBASE (2008 to 7 February 2012) and CINAHL (1982 to 7 February 2012). In an effort to identify further published, unpublished and ongoing trials we searched 17 trial registers (February 2012), performed citation tracking of included studies, checked reference lists of relevant articles and contacted trialists.</p>
<p>Selection criteria:
Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any service intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care.</p>
<p>Data collection and analysis:
The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow up. Two review authors scrutinised trials and categorised them on their eligibility.We then sought standardised individual patient data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not.</p>
<p>Main results:
Outcome data are currently available for 14 trials (1957 patients). Patients tended to be a selected elderly group withmoderate disability. The ESD group showed significant reductions (P = 0.0001) in the length of hospital stay equivalent to approximately seven days. Overall, the odds ratios (OR) (95% confidence interval (CI)) for death, death or institutionalisation, death or dependency at the end
of scheduled follow-up were OR 0.91 (95% CI 0.67 to 1.25, P = 0.58), OR 0.78 (95% CI 0.61 to 1.00, P = 0.05) and OR 0.80 (95% CI 0.67 to 0.97, P = 0.02) respectively. The greatest benefits were seen in the trials evaluating a co-ordinated ESD team and in stroke patients with mild to moderate disability. Improvements were also seen in patients’ extended activities of daily living scores
(standardised mean difference 0.12, 95% CI 0.00 to 0.25, P = 0.05) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02) but no statistically significant differences were seen in carers’ subjective health status, mood or satisfaction with services. The apparent benefits were no longer statistically significant at five-year follow-up.</p>
<p>Authors’ conclusions:
Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. We observed no adverse impact on the mood or subjective health status of patients or carers.</p>
Charge carrier solvation and large polaron formation on a polymer chain revealed in model ab initio computations
When an excess charge carrier is added to a semiconducting polymer chain, it
is well known that the carrier may self-trap into a polaronic state accompanied
by a bond length adjustment pattern. A different mechanism of self-localization
is the solvation of charge carriers expected to take place when the polymer
chain is immersed in polar media such as common solvents. We use
state-of-the-art ab initio computations in conjunction with the Polarizable
Continuum Model to unequivocally demonstrate solvation-induced self-consistent
charge localization into large-radius one-dimensional (1D) polarons on long
carbon chains with the polyynic structure. Within the framework
used, the solvation results in a much more pronounced charge localization. We
believe this mechanism of polaron formation to be of relevance for various 1D
semiconductors in polar environments
Scoliosis: a journal dedicated to multidisciplinary research on prevention, control, and treatment of scoliosis and other spinal deformities
Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?
INTRODUCTION:
The aim of this study was to evaluate if women meeting criteria for gestational diabetes mellitus (GDM) by the One Step test as per International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by other less strict criteria have adverse pregnancy outcomes compared with GDM-negative controls. The primary outcome was the incidence of macrosomia, defined as birthweight > 4000 g.
MATERIAL AND METHODS:
Electronic databases were searched from their inception until May 2017. All studies identifying pregnant women negative at the Two Step test, but positive at the One Step test for IADPSG criteria were included. We excluded studies that randomized women to the One Step vs. the Two Step tests; studies that compared different criteria within the same screening method; randomized studies comparing treatments for GDM; and studies comparing incidence of GDM in women doing the One Step test vs. the Two Step test.
RESULTS:
Eight retrospective cohort studies, including 29 983 women, were included. Five study groups and four control groups were identified. The heterogeneity between the studies was high. Gestational hypertension, preeclampsia and large for gestational age, as well as in some analyses cesarean delivery, macrosomia and preterm birth, were significantly more frequent, and small for gestational age in some analyses significantly less frequent, in women GDM-positive by the One Step, but not the Two Step.
CONCLUSION:
Women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria have an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia and large for gestational age, compared with GDM-negative controls. Based on these findings, and evidence from other studies that treatment decreases these adverse outcomes, we suggest screening for GDM using the One Step IADPSG criteria
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