Predicting discharge destination with admission outcome scores in stroke patients.

BACKGROUND: The goal of this study was to predict the discharge location for stroke patients. OBJECTIVE: To design a tool to assess a community discharge that will assist in development of individualized care plans and discharge planning. METHODS: Patients (N = 407) hospitalized for an acute stroke in an inpatient rehabilitation facility were used for this retrospective study. Admission data from the Functional Independence Measure (FIM) and Simplified Stroke Rehabilitation Assessment of Movement (S-STREAM) were used to determine predictive factors for a community discharge. RESULTS: Logistic regressions and chi-square analyses were used to determine admission factors that predict a community discharge and the cut off score for each predictive variable. The S-STREAM, Motor FIM, Total FIM, FIM Bladder, FIM bed transfer, FIM toilet transfer, FIM bathing, and FIM memory were predictive of a community discharge. A predictive tool with a sensitivity and specificity of 76% and 64% was developed using the combined relative risk scores of the S-Stream, FIM Bladder, FIM Bed Transfer and FIM Memory. CONCLUSIONS: By using outcome data at the time of admission, a discharge destination can be predicted for stroke patients with significant sensitivity and specificity.

Biochemical and ultrastructural studies on estrogen-induced pituitary tumors in F344 rats.

The hormone function, the metabolism of nucleic acids, and the ultrastructure of estrogen-induced pituitary tumors and of normal glands were examined in male F344 rats. The tumors had a high capacity for prolactin (PRL) synthesis, and the plasma levels of PRL were elevated 65-fold to 100-fold in the tumor-bearing animals. Uridine uptake and phosphorylation to nucleotides, as well as uridine incorporation into total RNA, were similar in tumors and normal glands, whereas [3H]thymidine incorporation into DNA was double in the former group as compared to the latter. After a [3H]uridine pulse, labeled RNA turnover was different in tumors and normal glands. Electron microscopy of the tumors revealed hypertrophy, degranulation, and hyperplasia of cells producing PRL with proliferation of their ergastoplasm in whorls. Other pituitary cell types were reduced in number. It is suggested that the whorl configuration caused the high rate of protein and PRL synthesis as well as the changes in RNA metabolism displayed by the tumors.

Protein and RNA synthesis in pituitary tumors from F344 rats given implants of estrogen.

The synthesis of total proteins, growth hormone, and prolactin and the incorporation of radioactive precursors into RNA was studied in Pituitaries from normal F344 rats and rats given implants of 15 mg diethylstilbestrol (DES). Prolonged DES treatment (greater than 50 days) induced pituitary tumors in male and female rats. The tumor tissue had a high rate of cell protein synthesis and an unusual capacity to synthesize a single-protein hormone (prolactin). After 17 days of DES treatment, the increase in prolactin synthesis in the hyperplastic pituitaries was not as marked as that in the tumors. At the time of tumor induction and high prolactin synthesis, incorporation of uridine or cytidine into RNA was not stimulated, and orotic acid incorporation in tumors from male rats was decreased. During early estrogen treatment (5 and 17 days), significantly less uridine was incorporated into RNA. These data suggested that the increment in protein and hormone synthesis promoted by DES may be related to a decrease in RNA turnover.