Impact of Implementing Evidence-Based Acute Stroke Interventions on Survival: The South London Stroke Register.

Impact of implementing evidence-based acute stroke interventions on survival: the South london stroke register.

PLoS One. 2013; 8(4): e61581
Addo J, Crichton S, Bhalla A, Rudd AG, Wolfe CD, McKevitt C

Studies examining the impact of organised acute stroke care interventions on survival in subgroups of stroke patients remain limited.This study examined the effects of a range of evidence-based interventions of acute stroke care on one year survival post-stroke and determined the size of the effect across different socio-demographic and clinical subgroups of patients.Data on 4026 patients with a first-ever stroke recruited to the population-based South London Stroke Register between 1995 and 2010 were used. In uni-variable analyses, one year cumulative survival rates in socio-demographic groups and by care received was determined. Survival functions were compared using Log-rank tests. Multivariable Cox models were used to test for interactions between components of care and age group, sex, ethnic group, social class, stroke subtype and level of consciousness.1949 (56.4%) patients were admitted to a stroke unit. Patients managed on a stroke unit, those with deficits receiving specific rehabilitation therapies and those with ischaemic stroke subtype receiving aspirin in the acute phase had better one year survival compared to those who did not receive these interventions. The greatest reduction in the hazards of death among patients treated on a stroke unit were in the youngest patients aged <65 years, (HR 0.39; 95% CI: 0.25-0.62), and those with reduced levels of consciousness, GCS <9, (HR: 0.44; CI: 0.33-0.58).There was evidence of better one year survival in patients receiving specific acute interventions after stroke with a significantly greater effect in stroke subgroups, suggesting the possibility of re-organising stroke services to ensure that the most appropriate care is made accessible to patients likely to derive the most benefits from such interventions. HubMed – rehab

Acute Care Alternate-Level-of-Care Days Due to Delayed Discharge for Traumatic and Non-Traumatic Brain Injuries.

Healthc Policy. 2012 May; 7(4): 41-55
Amy C, Zagorski B, Chan V, Parsons D, Vander Laan R, Colantonio A

Alternate-level-of-care (ALC) days represent hospital beds that are taken up by patients who would more appropriately be cared for in other settings. ALC days have been found to be costly and may result in worse functional outcomes, reduced motor skills and longer lengths of stay in rehabilitation. This study examines the factors that are associated with acute care ALC days among patients with acquired brain injury (ABI). We used the Discharge Abstract Database to identify patients with ABI using International Classification of Disease-10 codes. From fiscal years 2007/08 to 2009/10, 17.5% of patients with traumatic and 14% of patients with non-traumatic brain injury had at least one ALC day. Significant predictors include having a psychiatric co-morbidity, increasing age and length of stay in acute care. These findings can inform planning for care of people with ABI in a publicly funded healthcare system. HubMed – rehab

Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals.

J Man Manip Ther. 2012 May; 20(2): 90-5
Kearns G, Wang S

This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomechanical assessment of the elbow and carpals revealed a loss of lateral glide of the humerus on the ulna and a loss of palmar glide of the triquetral on the hamate. After the patient received two thrust manipulations of the elbow and one thrust manipulation of the carpals over the course of four sessions, her pain and paresthesia were resolved. This case demonstrates that the use of thrust manipulation to the elbow and carpals may be an effective approach in the management of insidious onset CuTS. This patient was successfully treated with thrust manipulation when joint dysfunction of the elbow and wrist were appropriately identified. This case report may shed light on the examination and management of insidious onset CuTS. HubMed – rehab

Treatment of an early failing implant by guided bone regeneration using resorbable collagen membrane and bioactive glass.

J Indian Soc Periodontol. 2013 Jan; 17(1): 131-6
Talreja PS, Gayathri GV, Mehta DS

Implant failure can be divided into early (prior to prosthetic treatment) or late (after prosthetic rehabilitation). Early failure is generally due to interference in the healing process after implant placement. Implants undergoing early failure will show progressive bone loss on radiographs during the healing period (4 to 6 weeks). In the present case report, early progressive bone loss was seen at 6 weeks, after placement of a non-submerged single piece mini implant. Clinical examination revealed peri-implant bleeding on probing and pocket and grade-1 mobility. Treatment protocol included mechanical debridement (plastic curettes), chemical detoxification with supersaturated solution of citric acid, antibiotics and guided bone regeneration therapy using the collagen membrane as guided bone regeneration barrier in combination with bioactive glass as bone grafting material. The 6 month postoperative examination showed complete resolution of the osseous defect, thus suggesting that this technique may hold promise in the treatment of implants undergoing early failure. HubMed – rehab