Poststroke checklist: un cuestionario para detectar las necesidades de rehabilitación después del ictus / The poststroke checklist: a questionnaire to detect rehabilitation needs after stroke

Introducción. El Poststroke checklist (PSC) es un cuestionario breve y fácil de usar que pretende estandarizar el seguimiento de los pacientes con ictus crónico y asegurar el acceso a intervenciones de rehabilitación basadas en la evidencia. El objetivo de este trabajo es describir la metodología seguida para elaborar el cuestionario y su validación preliminar. Material y métodos. Se describe la elaboración del PSC original y de la versión en castellano (retrotraducción y adaptación al lenguaje clínico local). Se realizó una validación preliminar para evaluar su comprensibilidad en 20 pacientes con ictus de más de 6 meses de evolución (tiempo de latencia de respuesta y grado de comprensión de cada ítem). Por último, se evaluó la satisfacción de los pacientes con el PSC en cuanto a la capacidad de identificar los problemas que afectaban su vida después del ictus. Resultados. El tiempo medio de respuesta fue < 2 seg para todas las preguntas del PSC. Respecto a la interpretación del cuestionario, la comprensión fue buena para la mayoría de pacientes. La comprensión fue parcial en la pregunta sobre movilidad en 5 pacientes, actividades de la vida diaria, comunicación, cognición y vida tras el ictus en 4 y sobre espasticidad en 3. Solo un paciente no comprendió la cuestión sobre prevención secundaria. Los 20 pacientes se mostraron satisfechos con el cuestionario. Conclusiones. El PSC es una herramienta de uso rápido y comprensible para los pacientes, y puede ser útil para detectar necesidades de rehabilitación a largo plazo después de un ictus (AU)

Introduction. The Poststroke checklist (PSC) is a short, easy-to-use questionnaire, intended to facilitate a standardized approach to identifying long-term problems in stroke survivors and ensure access to evidence-based rehabilitation interventions. The aim of this study was to describe the methodology used to develop the questionnaire and its preliminary validation. Material and methods. The development of the original PSC and the Spanish version (back-translation and adaptation to the local clinical language) is described. Preliminary validation was performed to assess its comprehensibility in 20 stroke patients over a 6-month period (latency of response and degree of understanding of each item). Finally, patients’ satisfaction with the PSC regarding its ability to identify problems affecting their lives after stroke was evaluated. Results. The average response time was < 2 sec for all questions in the PSC. Concerning the interpretation of the questionnaire, understanding was good for most patients. Understanding was partial in the question on mobility in 5 patients, activities of daily living, communication, cognition and life after stroke in 4, and spasticity in 3. Only one patient did not understand the question on secondary prevention. The 20 patients were satisfied with the questionnaire. Conclusions. The PSC is a brief tool that is easily understood by patients and could be useful for detecting long term needs after stroke and to facilitate appropriate referrals (AU)

Rehabilitación del ictus: modelo asistencial. Recomendaciones de la Sociedad Española de Rehabilitación y Medicina Física, 2009 / Stroke rehabilitation: Care model. Recommendations of the Spanish Society of Physical Medicine and Rehabilitation, 2009

Objetivos: La Sociedad Española de Medicina Física y Rehabilitación elabora un documento de recomendaciones de buena práctica clínica sobre el modelo asistencial en la rehabilitación (RHB) del ictus basadas en la experiencia clínica y el consenso de los autores y las guías de práctica clínica de referencia. Estrategia de búsqueda: La búsqueda se centra en guías de práctica clínica y artículos relevantes sobre el modelo asistencial en la RHB del ictus en las bases de datos MEDLINE, Embase y Cochrane Databases desde enero de 2004 hasta enero de 2009.Selección de estudios: Se seleccionan ensayos clínicos aleatorizados, metaanálisis, revisiones sistemáticas y artículos de revisión sobre el modelo asistencial en la RHB del ictus. Síntesis de resultados: El programa rehabilitador del ictus es un proceso complejo que requiere un abordaje multidisciplinario, siendo elementos claves el inicio precoz, la intensidad adecuada, la evaluación periódica y la participación activa de pacientes y cuidadores. Conclusiones: En todos los niveles de atención sanitaria y sociosanitaria, hospitalaria o comunitaria se debe asegurar la atención de RHB a cargo de un equipo multidisciplinario, coordinada por un médico especialista en RHB con adecuados niveles de organización y experiencia de los profesionales (AU)

Objectives: The Spanish Society of Physical Medicine and Rehabilitation has elaborated a document of good clinical practice recommendations on the care model in stroke rehabilitation based on the clinical experience and consensus of the authors and reference clinical practice guides. Search strategy: The search was focused on clinical practice guides and articles related with the care model in stroke rehabilitation in the MEDLINE, EMBASE and COCHRANE DATABASES from January 2004 to January 2009.Selection of studies Randomized clinical trials, meta-analyses, systematic reviews and review articles on the care model in stroke rehabilitation were selected. Synthesis of results: The stroke rehabilitation program is a complex procedure that requires a multidisciplinary approach. Its key elements are early initiation, adequate intensity, periodic evaluation and active participation of the patients and caregivers. Conclusions: Rehabilitation care under the responsibility of a multidisciplinary team, coordinated by a medical specialist in rehabilitation with adequate levels of organization and experience of the professionals should be assured on all health a and socio-health care, hospital or community levels (AU)

A new perspective in the estimation of postmortem interval (PMI) based on vitreous.

The relation between the potassium concentration in the vitreous humor, [K+], and the postmortem interval has been studied by several authors. Many formulae are available and they are based on a correlation test and linear regression using the PMI as the independent variable and [K+] as the dependent variable. The estimation of the confidence interval is based on this formulation. However, in forensic work, it is necessary to use [K+] as the independent variable to estimate the PMI. Although all authors have obtained the PMI by direct use of these formulae, it is, nevertheless, an inexact approach, which leads to false estimations. What is required is to change the variables, obtaining a new equation in which [K+] is considered as the independent variable and the PMI as the dependent. The regression line obtained from our data is [K+] = 5.35 + 0.22 PMI, by changing the variables we get PMI = 2.58[K+] - 9.30. When only nonhospital deaths are considered, the results are considerably improved. In this case, we get [K+] = 5.60 + 0.17 PMI and, consequently, PMI = 3.92[K+] - 19.04.

Stature estimation from radiographically determined long bone length in a Spanish population sample.

The estimation of stature from of a variety of bones is an important aspect of forensic work. In order to obtain reliable results, it is important to have comparative data obtained from the same population group as the skeletal remains. However, lack of up to date information on the population groups of Southern Europe makes the estimation of stature from bones in this area subject to possible error. In this study, the stature of 104 healthy adults from Spain was measured, and an anteroposterior teleradiograph of the right lower and the right upper limb of every subject in the study was made in order to measure the lengths of the femur, tibia, fibula, humerus, cubitus and ulna. Pearson's regression formulae were obtained for both limbs. In males, we found the femur to be the most accurate predictor of stature (R = 0.851), whereas in females best results were obtained with the tibia (R = 0.876).