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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 33-39, feb. 2020. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-3434

RESUMO

Objetivo. Identificar los factores asociados con una respuesta inicial inmediata a los síntomas en los pacientes que han padecido un ictus isquémico. Método. Estudio observacional transversal en el que se incluyeron a todos los pacientes con ictus isquémico ingresados de forma consecutiva en el Hospital Universitario de Burgos (España) durante 1 año. Se recogieron parámetros sociodemográficos, clínicos, conductuales, cognitivos y contextuales, y se estudió su posible relación con el tiempo de reacción del paciente (TR) mediante análisis univariante y multivariante. Resultados. Se incluyeron 425 pacientes (mediana del TR de 140 minutos). El TR supuso un 72,6% del tiempo prehospitalario total (TPH), con una respuesta inmediata si el paciente se encontraba acompañado (OR 9,57; IC95% 3,89-23,52), si los síntomas se iniciaban durante el día (OR 8,77; 3,40-22,63), si el paciente sabía cómo actuar ante un posible ictus (OR 3,84; 2,77-7,09), si el primer contacto médico era con el servicio de emergencias médicas (SEM) (OR 3,03; 1,62-5,68), si el paciente percibía la situación como grave o muy grave (OR 2,38; 1,17-4,83) o si el ictus ocurría en el ámbito urbano (OR 2,17; 1,16-4,06). Conclusión. El intervalo de tiempo entre el inicio de los síntomas y la respuesta inicial del paciente se relaciona con factores conductuales, cognitivos y contextuales, los cuales deberían ser considerados en la planificación de futuras campañas educacionales


Objective. To identify factors related to a rapid response to the onset of symptoms and a call for help for patients with ischemic stroke. Methods. Observational cross-sectional study of all patients with ischemic stroke admitted consecutively to Hospital Universitario de Burgos in Spain during 1 year. We collected sociodemographic, clinical, behavioral, cognitive, and contextual data for all patients and applied uni- and multivariate analysis to explore possible associations with the patient's response time. Results. A total of 425 patients were included. The mean patient response time was 140.00 minutes. Patient delay accounted for 72.6% of the total prehospital response time. Factors associated with a rapid call for help were the presence of an accompanying person (OR, 9.57; 95% CI, 3.89–23.52), daytime onset of symptoms (OR, 8.77; 3.40-22.63), patient knowledge of how to act in case of stroke symptoms (OR, 3.84; 2.77-7.09), first medical contact through the public health system's emergency medical service (OR, 3.03; 1.62-5.68), patient perception of symptoms as severe or very severe (OR, 2.38; 1.17-4.83), and stroke onset in an urban area (OR, 2.17; 1.16-4.06). Conclusions. The patient's response time between onset of symptoms is related to behavioral, cognitive and contextual factors that should be taken into account when planning future patient education campaigns

2.
Emergencias ; 32(1): 33-39, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909910

RESUMO

OBJECTIVES: To identify factors related to a rapid response to the onset of symptoms and a call for help for patients with ischemic stroke. MATERIAL AND METHODS: Observational cross-sectional study of all patients with ischemic stroke admitted consecutively to Hospital Universitario de Burgos in Spain during 1 year. We collected sociodemographic, clinical, behavioral, cognitive, and contextual data for all patients and applied uni- and multivariate analysis to explore possible associations with the patient's response time. RESULTS: A total of 425 patients were included. The mean patient response time was 140.00 minutes. Patient delay accounted for 72.6% of the total prehospital response time. Factors associated with a rapid call for help were the presence of an accompanying person (OR, 9.57; 95% CI, 3.89-23.52), daytime onset of symptoms (OR, 8.77; 3.40- 22.63), patient knowledge of how to act in case of stroke symptoms (OR, 3.84; 2.77-7.09), first medical contact through the public health system's emergency medical service (OR, 3.03; 1.62-5.68), patient perception of symptoms as severe or very severe (OR, 2.38; 1.17-4.83), and stroke onset in an urban area (OR, 2.17; 1.16-4.06). CONCLUSION: The patient's response time between onset of symptoms is related to behavioral, cognitive and contextual factors that should be taken into account when planning future patient education campaigns.

3.
J Clin Med ; 8(10)2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31627368

RESUMO

BACKGROUND: Despite recent advances in acute stroke care, only 1-8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). OBJECTIVE: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. METHODS: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. RESULTS: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47-23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09-19.34) and the weekend (OR 2.64; 95% CI 1.19-5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97-25.55), using a prenotification system (OR 6.46; 95% CI 1.71-8.39), patient's perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60-10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38-7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32-5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16-4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03-3.82). CONCLUSIONS: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.

4.
Emergencias ; 31(2): 86-90, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30963735

RESUMO

OBJECTIVES: To identify factors associated with activation of emergency medical services (EMS) in stroke. MATERIAL AND METHODS: Cross-sectional study of all patients admitted with stroke to Hospital Universitario de Burgos in Spain between September 1, 2015, and August 31, 2016. We recorded sociodemographic, clinical, behavioral, cognitive, and context information and explored possible associations with calls for EMS units. RESULTS: Three hundred eleven patients were included. EMS units were activated in 171 cases (55%) associated with an assessment that the patient was unable to manage the health situation from the onset of symptoms (adjusted odds ratio [OR], 6.95; 95% CI, 3.64-13.26), a witness's call for help (rather than the patient's) (OR, 5.68; 95% CI, 2.99-10.83), serious neurological deficit defined by a score over 16 on the National Institute of Health Stroke Scale (OR, 4.51; 95% CI, 1.10-18.46), a patient's awareness of serious symptoms leading to a call for help (OR, 4.03; 95% CI, 1.42-11.42), and a patient's history of high blood pressure (OR, 2.38; 95% CI, 1.25-4.54). CONCLUSION: Calls for EMS attendance from either a patient or a witness are associated with objective signs of severe stroke and subjective perception of severity.

5.
Emergencias (Sant Vicenç dels Horts) ; 31(2): 86-90, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182524

RESUMO

Objetivo: Identificar los factores asociados con la activación del servicio de emergencias médicas (SEM) en pacientes que han padecido un ictus. Método: Estudio transversal en el que se incluyeron a todos los pacientes con ictus ingresados en el Hospital Universitario de Burgos (España) entre el 01/09/2015 y el 31/08/2016. Se recogieron datos sociodemográficos, clínicos, conductuales, cognitivos y contextuales, y se estudió su posible relación con el uso del SEM. Resultados: Se incluyeron 311 pacientes. El uso del SEM (n = 171; 55%) se asoció con el pensamiento del paciente de no ser capaz de manejar la situación en el momento de inicio de los síntomas con OR (ajustada) 6,95 (IC 95%: 3,64-13,26), con ser los testigos y no el paciente quienes solicitaran ayuda con OR 5,68 (IC 95%: 2,99-10,83), con presentar un déficit neurológico grave (NIHSS > 16) con OR 4,51 (IC 95%: 1,10-18,46), cuando el paciente solicitó ayuda atendiendo a la gravedad de los síntomas con OR 4,03 (IC 95%: 1,42-11,42) o cuando tenía antecedentes personales de hipertensión arterial OR 2,38 (IC 95%: 1,25-4,54). Conclusión: La solicitud de asistencia al SEM por parte del paciente o testigos se relaciona con factores objetivos de gravedad del ictus y con la percepción subjetiva de gravedad


Objective: To identify factors associated with activation of emergency medical services (EMS) in stroke. Methods: Cross-sectional study of all patients admitted with stroke to Hospital Universitario de Burgos in Spain between September 1, 2015, and August 31, 2016. We recorded sociodemographic, clinical, behavioral, cognitive, and context information and explored possible associations with calls for EMS units. Results: Three hundred eleven patients were included. EMS units were activated in 171 cases (55%) associated with an assessment that the patient was unable to manage the health situation from the onset of symptoms (adjusted odds ratio [OR], 6.95; 95% CI, 3.64-13.26), a witness's call for help (rather than the patient's) (OR, 5.68; 95% CI, 2.99-10.83), serious neurological deficit defined by a score over 16 on the National Institute of Health Stroke Scale (OR, 4.51; 95% CI, 1.10-18.46), a patient's awareness of serious symptoms leading to a call for help (OR, 4.03; 95% CI, 1.42-11.42), and a patient's history of high blood pressure (OR, 2.38; 95% CI, 1.25-4.54). Conclusion: Calls for EMS attendance from either a patient or a witness are associated with objective signs of severe stroke and subjective perception of severity


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Serviço Hospitalar de Emergência , Estudos Transversais , Cuidados Críticos , Ambulâncias , Transferência de Pacientes , Epidemiologia Descritiva
6.
Rev. neurol. (Ed. impr.) ; 65(5): 209-215, 1 sept., 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-166956

RESUMO

Objetivo. El ictus es la condición médica más importante que origina discapacidad permanente en el adulto. El objetivo es valorar la eficacia de ortesis dinámicas en la rehabilitación del miembro superior en pacientes que han presentado un ictus. Pacientes y métodos. Estudio longitudinal de casos y controles. Se incluyó una muestra de pacientes procedentes de centros de rehabilitación que presentaban hemiparesia secundaria a ictus isquémico o hemorrágico. De forma aleatoria, los pacientes fueron distribuidos en un grupo de estudio, cuyos miembros recibieron una ortesis dinámica en el miembro superior durante seis meses, y un grupo control. Se realizaron valoraciones pre y postratamiento con la ortesis con la Fugl-Meyer Assessment Scale y con la Wolf Motor Function para medir los dominios de las funciones y actividades corporales. Se compararon las diferencias entre pre y postest usando ANCOVA y t de Student. Resultados. Se incluyó a 40 pacientes (65% hombres) que presentaban una hemiparesia crónica secundaria a ictus isquémico (n = 28) o hemorrágico (n = 12), con una edad media de 58,43 ± 8,67 años. Tras el seguimiento de seis meses, se observó una mejoría en ambos grupos en la función motora según ambas escalas. El uso de la ortesis dinámica se asoció a una tendencia hacia la mejoría en la fuerza de la extremidad superior. Conclusiones. La rehabilitación tras el ictus mejora la fuerza y las actividades corporales en el miembro superior. El uso de una ortesis dinámica puede adicionalmente mejorar la fuerza en este miembro, pero se necesitan más estudios para confirmar nuestros resultados (AU)


Aims. Stroke is the most important medical condition leading to permanent disability in adults. The aim of this study is to evaluate the efficacy of dynamic orthoses in the rehabilitation of the upper limbs in patients who have had a stroke. Patients and methods. We conducted a longitudinal case-control study. The sample used in the study consisted of patients from rehabilitation centres who presented hemiparesis secondary to an ischaemic or haemorrhagic stroke. The patients were randomly distributed into a study group, whose members received a dynamic orthosis on an upper limb for a sixmonth period, and a control group. Appraisals were performed pre- and post-treatment with the orthosis with Fugl-Meyer Assessment Scale and with Wolf Motor Function to measure their command over body functions and activities. Differences between pre- and post-test were compared using ANCOVA and Student’s t. Results. The sample included 40 patients (65% males) who presented chronic hemiparesis secondary to ischaemic (n = 28) or haemorrhagic stroke (n = 12), with a mean age of 58.43 ± 8.67 years. After the six-month follow-up, improved motor function was observed in both groups, according to both scales. The use of a dynamic orthosis was associated with a tendency towards improved strength in the upper limb. Conclusions. Rehabilitation following a stroke improves strength and body activities in the upper limb. the use of a dynamic orthosis can further improve the strength in this limb, but additional research is needed to confirm our results (AU)


Assuntos
Humanos , Acidente Vascular Cerebral/complicações , Aparelhos Ortopédicos , Extremidade Superior/lesões , Pessoas com Deficiência/reabilitação , Acidente Vascular Cerebral/reabilitação , Dano Encefálico Crônico/reabilitação , Estudos Longitudinais
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