Assessment of rehabilitation following acute ischaemic stroke in China: a registry-based retrospective observational study.

OBJECTIVES: This study aimed to describe the frequency, determinants and outcomes for assessment of patients who had an acute ischaemic stroke (AIS) for rehabilitation during hospitalisation in China. DESIGN: A registry-based retrospective observational study. STUDY DESIGN AND SETTINGS: Data regarding assessment or rehabilitation were extracted from the Chinese Stroke Center Alliance database from 1 August 2015 to 31 July 2019. Univariate and multivariate analyses were conducted to identify patient and hospital characteristics associated with rehabilitation assessment during acute hospitalisation as well as discharge outcomes. STUDY COHORT: We included 837 897 patients who had a stroke in this study with patient characteristics, admission location, medical history, hospital characteristics and hospital designation. PRIMARY AND SECONDARY OUTCOME MEASURES: Rehabilitation assessment and discharge outcomes. RESULTS: Among 837 897 patients who had a stroke admitted to 1473 hospitals, 615 991 (73.5%) underwent rehabilitation assessment. There were significant variations in the rates of rehabilitation assessment across hospitals (IQR 61.3% vs 92.9%). According to multivariate analysis, guideline recommended care delivery was associated with a higher rehabilitation assessment rate, whereas high/low body mass index, ambulation (OR 0.88; 95% CI 0.87 to 0.90), history of stroke (OR 0.94; 95% CI 0.93 to 0.95), coronary heart disease (OR 0.84; 95% CI 0.82 to 0.85) and atrial fibrillation (OR 0.91; 95% CI 0.89 to 0.94) were associated with a lower rate. Additionally, rehabilitation assessment during hospitalisation was significantly associated with lower in-hospital mortality (OR 0.38; 95% CI 0.35 to 0.41) and a higher probability of discharge to a rehabilitation centre (OR 2.66; 95% CI 2.5 to 2.82). CONCLUSIONS: Nearly one-quarter of patients who had an AIS do not undergo documented rehabilitation assessment and compliance across hospitals varies. Thus, it is necessary to improve adherence to rehabilitation assessment to improve the quality of medical care for patients who had an AIS.

Predictors of dysphagia screening and pneumonia among patients with intracerebral haemorrhage in China: a cross-sectional hospital-based retrospective study.

OBJECTIVES: This study aimed to investigate factors associated with undergoing dysphagia screening (DS) and developing pneumonia, as well as the relationship between DS and pneumonia in patients with intracerebral haemorrhage (ICH). DESIGN: Our study was a cross-sectional hospital-based retrospective study. STUDY DESIGN AND SETTINGS: We derived data from the China Stroke Centre Alliance, a nationwide clinical registry of ICH from 1476 participating hospitals in mainland China. To identify predictors for pneumonia, multivariable logistic regression models were used to identify patient characteristics that were independently associated with DS and pneumonia. PARTICIPANTS: We included 31 546 patients in this study with patient characteristics, admission location, medical history, hospital characteristics and hospital grade from August 2015 to July 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were DS and pneumonia during acute hospitalisation. RESULTS: In total, 25 749 (81.6%) and 7257 (23.0%) patients with ICH underwent DS and developed pneumonia. Compared with patients without pneumonia, those who developed pneumonia were older and had severe strokes (Glasgow Coma Scale 9-13: 52.7% vs 26.9%). Multivariable analyses revealed that a higher pneumonia risk was associated with dysphagia (OR, 4.34; 95% CI, 4.02 to 4.68), heart failure (OR, 1.85; 95% CI, 1.24 to 2.77) and smoking (OR, 1.12; 95% CI, 1.12 to 0.20). DS was associated with lower odds of pneumonia (OR, 0.65; 95% CI, 0.44 to 0.95). CONCLUSION: Our findings further confirm that dysphagia is an independent risk factor for pneumonia; one-fifth of patients with ICH did not undergo DS. However, comprehensive dysphagia evaluation and effective management are crucial. Nursing processes ensure the collection of complete and accurate information during evaluation of patients. There is a need to increase the rate of DS in patients with ICH, especially those with severe stroke or older. Further, randomised controlled trials are warranted to determine the effectiveness of DS on clinical outcomes.

Knowledge, Attitude, Skill, and Practice of Emergency Nurses Regarding the Early Management of Patients With Acute Ischemic Stroke in Beijing.

INTRODUCTION: Emergency nurses play an important role in the early management of acute ischemic stroke. The purpose of this study was to evaluate the knowledge, attitudes, skills, and practice of emergency nurses in Beijing regarding the early management of acute ischemic stroke. METHODS: This cross-sectional study enrolled emergency nurses in 26 hospitals in Beijing between August and November 2022. Correlations among knowledge, attitude, and skill/practice were evaluated by Pearson correlation analysis. RESULTS: This study included 564 nurses (82.98% were female). The average knowledge, attitude, and skill/practice scores were 15.48 ± 2.39 (possible range, 0-22), 39.84 ± 4.89 (possible range, 9-45), and 40.59 ± 5.21 (possible range, 13-52). The knowledge was significantly positively correlated with attitude and skill/practice (all P< .001). There was also a positive correlation between attitude and skill/practice (P< .001). DISCUSSION: These findings may facilitate the implementation of education/training programs to improve the early management of acute ischemic stroke by nurses in emergency departments.

Assessment of rehabilitation following intracerebral hemorrhage in China: findings from the Chinese stroke center alliance.

OBJECTIVES: Evidence shows that rehabilitation is the most effective strategy to reduce the disability rate of patients with stroke. However, there is limited understanding about the factors associated with rehabilitation assessment among patients with intracerebral hemorrhage (ICH) in China. We aimed to investigate the factors associated with rehabilitation assessment in patients with ICH and the relationship between rehabilitation assessment and hospitalization outcomes. METHODS: Data from 85,664 patients with ICH admitted to 1,312 hospitals between 1 August 2015 and 31 July 2019 were analyzed. A multivariable logistic regression model accounting for in-hospital clustering was used to identify patient and hospital factors associated with rehabilitation assessment during acute hospitalization. RESULTS: A total of 62,228 (72.6%) patients with ICH underwent rehabilitation assessments. In multivariable analyses, factors associated with an increased likelihood of undergoing a rehabilitation assessment (P < .05) included a higher Glasgow Coma Scale score on admission, a history of hypertension, a history of peripheral vascular disease, dysphagia screening, carotid vessel imaging, and a longer length of hospital stay. Conversely, patients admitted to the intensive care unit and tertiary-grade hospitals were less likely to undergo rehabilitation assessments during hospitalization for ICH. DISCUSSION: This study showed that the rate of rehabilitation assessment was 74.2%, which is low. Rehabilitation assessment was associated with longer hospital stays and lower mortality. Therefore, patients with acute cerebral haemorrhage should undergo comprehensive and professional rehabilitation assessment.

Validation of the Hospital Anxiety and Depression Scale and the Perceived Stress Scale and psychological features in patients with periodontitis.

BACKGROUND: To investigate the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) and 10-item Perceived Stress Scale (PSS-10) in patients with periodontitis and to evaluate the psychological features of patients with periodontitis. METHODS: Overall, 460 individuals with periodontitis were enrolled. The HADS and the PSS-10 were administered to all patients. Methodology testing included the exploratory factor analysis, the confirmatory factor analysis (CFA), test-retest reliability, as well as internal consistency. RESULTS: Regarding the CFA results of the HADS, as well as the PSS-10, a bifactor model fitted the data best. The Cronbach alpha value, as well as the intra-class correlation coefficients value of the two measures were all >0.70. The anxiety, depression, distress manifestations, and moderate-to-high perceived stress prevalence were 35.2%, 18.2%, 24.6%, and 43.9%, respectively. Severity of periodontitis, age, smoking, and disease comorbidities were identified as independent prognosticators of the presence of psychological manifestations in periodontitis. CONCLUSION: The HADS and the PSS-10 can be used as general measures for psychological assessment in patients with periodontitis.

Novel Application of 32P Brachytherapy: Treatment of Angiolymphoid Hyperplasia with Eosinophilia in the Right Auricle with 8-Year Follow-Up.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a distinctive benign vascular disease that can be challenging to treat due to inconsistent results for various treatment modalities such as surgical excision, corticosteroids, radiotherapy, laser therapy, and other therapies, so novel approaches are needed to improve treatment outcomes. MATERIALS AND METHODS: ALHE on the right auricle of a 54-year-old Chinese woman underwent brachytherapy using 32P simple drug membranes for five times. The 32P brachytherapy involving simple drug membranes of brachytherapy began by diluting a 32P solution with 0.9% NaCl solution to produce a radioactivity of 69.2-74.7 MBq/mL(1.87-2.02 mCi/mL). The drug membranes were removed between 48 and 72h after application. There were intervals ranging from 65 to 72d between the membrane application periods, and the last treatment was in June 2010. RESULTS: After the 32P brachytherapy, follow-up results over the course of 8 years were promising. The regional symptoms disappeared, the right preauricular swelling decreased, the subcutaneous nodules decreased in size, the exudate disappeared, and the skin appearance improved. CONCLUSIONS: This case indicated that 32P brachytherapy may represent a novel ALHE treatment method that produces a favorable long-term outcome.

Resting-state functional magnetic resonance imaging in patients with leukoaraiosis-associated subcortical vascular cognitive impairment: a cross-sectional study.

OBJECTIVES: The aim of the study was to investigate the difference of resting-state default-mode network (DMN) between patients with leukoaraiosis (LA)-associated subcortical vascular cognitive impairment (SVCI) and control subjects, and to provide functional imaging evidence of SVCI. METHODS: All subjects (n = 58) were divided into two groups based on their clinical diagnosis: a LA-associated SVCI group (n = 31, 14 males) and a control group (n = 27, 14 males). Demographic information and resting-state functional MRI (rs-fMRI) data were obtained. These subjects were assessed using the Hamilton Anxiety Depression Scale, Clinical Dementia Rating, Mini Mental State Exam, and Montreal Cognitive Assessment. Experimental data and confounding factors were described with a General Liner Model. Independent components of fMRI data were analyzed with an fMRI toolbox. RESULTS: The active areas involved in DMN of LA-associated SVCI group were similar to those of the control group. However, several active areas of LA-associated SVCI group, especially the left anterior cingulate cortex and the right parahippocampal gyrus, showed significantly lower blood oxygen level-dependent (BOLD) signals compared with the control group (p ≤ 0.05); whereas the left caudate nucleus (p = 0.015), the right frontal lobe (p = 0.004), and the superior temporal gyrus/inferior parietal gyrus (p = 0.001) exhibited significantly higher BOLD signals compared with the control group. DISCUSSION: The present study provides neuroimaging evidence for the recognition of LA-associated SVCI. Moreover, the differences in the functional alterations of the resting-state DMN might be a distinguishing feature between SVCI and amnestic mild cognitive impairment patients.

[Application and dimensional structure of the early childhood oral health impact scale].

OBJECTIVE: To investigate influence of oral diseases on child oral health-related quality of life, and to identify the dimensional structure of the early childhood oral health impact scale (ECOHIS). METHODS: The Chinese language version of ECOHIS was applied to 280 patients aged 2-5 years old from the paediatric dentistry clinic of West China School of Stomatology, Sichuan University. The three-dimensional construct was confirmed by confirmatory factor analysis(CFA). RESULTS: Two hundred and sixty-eight valid questionnaires (95.7%) were reclaimed. For the child impact section of the ECOHIS, "pain in the teeth, mouth or jaws" was the most frequently reported item by the parents. Item of "feeling upset or guilty" was most frequently reported in the family impact section of the ECOHIS. The CFA results indicated that all factor loadings to its items were 0.25-0.81 with one factor loadings less than 0.30. The modified factor model revealed a better fit to the data. CONCLUSION: Oral diseases have negative impact on the children's oral health-related quality of life. ECOHIS is a three-dimensional structure.

Successful treatment of thyroid crisis accompanied by hypoglycemia, lactic acidosis, and multiple organ failure.

We describe a case of thyroid crisis with hypoglycemia, lactic acidosis, multiple organ failure, and disseminated intravascular coagulation--rare but severe complications of thyroid crisis. The patient was a 59-year-old Chinese woman who presented with evidence of heart failure and atrial fibrillation. Analysis of a blood sample yielded astonishing results: her blood glucose was 1.7 mmol/L, and lactate greater than 15 mmol/L with the arterial pH as 6.94. Liver enzymes (alanine aminotransferase, 1846 U/L; aspartate aminotransferase, 6242 U/L) and bilirubin elevated rapidly and dramatically. Prompt treatments such as mechanical ventilation, plasma exchange, and continuous venovenous hemofiltration were preformed, along with antithyroid medication. The patient finally survived after 3 weeks of intensive care. We herein discuss the possible mechanisms of these metabolic disorders in thyroid crisis and possible therapeutic measures that could be used to reduce mortality.