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1.
Cochrane Database Syst Rev ; 12: CD003864, 2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-33314046

RESUMO

BACKGROUND: For people with physical, sensory and cognitive limitations due to stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group. OBJECTIVES: To compare the effectiveness of OHC interventions with usual care or other treatment options for ensuring oral health in people after a stroke. SEARCH METHODS: We searched the Cochrane Stroke Group and Cochrane Oral Health Group trials registers, CENTRAL, MEDLINE, Embase, and six other databases in February 2019. We scanned reference lists from relevant papers and contacted authors and researchers in the field. We handsearched the reference lists of relevant articles and contacted other researchers. There were no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated one or more interventions designed to improve the cleanliness and health of the mouth, tongue and teeth in people with a stroke who received assisted OHC led by healthcare staff. We included trials with a mixed population provided we could extract the stroke-specific data. The primary outcomes were dental plaque or denture plaque. Secondary outcomes included presence of oral disease, presence of related infection and oral opportunistic pathogens related to OHC and pneumonia, stroke survivor and providers' knowledge and attitudes to OHC, and patient satisfaction and quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently screened abstracts and full-text articles according to prespecified selection criteria, extracted data and assessed the methodological quality using the Cochrane 'Risk of bias' tool. We sought clarification from investigators when required. Where suitable statistical data were available, we combined the selected outcome data in pooled meta-analyses. We used GRADE to assess the quality of evidence for each outcome. MAIN RESULTS: Fifteen RCTs (22 randomised comparisons) involving 3631 participants with data for 1546 people with stroke met the selection criteria. OHC interventions compared with usual care Seven trials (2865 participants, with data for 903 participants with stroke, 1028 healthcare providers, 94 informal carers) investigated OHC interventions compared with usual care. Multi-component OHC interventions showed no evidence of a difference in the mean score (DMS) of dental plaque one month after the intervention was delivered (DMS -0.66, 95% CI -1.40 to 0.09; 2 trials, 83 participants; I2 = 83%; P = 0.08; very low-quality evidence). Stroke survivors had less plaque on their dentures when staff had access to the multi-component OHC intervention (DMS -1.31, 95% CI -1.96 to -0.66; 1 trial, 38 participants; P < 0.0001; low-quality evidence). There was no evidence of a difference in gingivitis (DMS -0.60, 95% CI -1.66 to 0.45; 2 trials, 83 participants; I2 = 93%; P = 0.26: very low-quality evidence) or denture-induced stomatitis (DMS -0.33, 95% CI -0.92 to 0.26; 1 trial, 38 participants; P = 0.69; low-quality evidence) among participants receiving the multi-component OHC protocol compared with usual care one month after the intervention. There was no difference in the incidence of pneumonia in participants receiving a multi-component OHC intervention (99 participants; 5 incidents of pneumonia) compared with those receiving usual care (105 participants; 1 incident of pneumonia) (OR 4.17, CI 95% 0.82 to 21.11; 1 trial, 204 participants; P = 0.08; low-quality evidence). OHC training for stroke survivors and healthcare providers significantly improved their OHC knowledge at one month after training (SMD 0.70, 95% CI 0.06 to 1.35; 3 trials, 728 participants; I2 = 94%; P = 0.03; very low-quality evidence). Pooled data one month after training also showed evidence of a difference between stroke survivor and providers' oral health attitudes (SMD 0.28, 95% CI 0.01 to 0.54; 3 trials, 728 participants; I2 = 65%; P = 0.06; very low-quality evidence). OHC interventions compared with placebo Three trials (394 participants, with data for 271 participants with stroke) compared an OHC intervention with placebo. There were no data for primary outcomes. There was no evidence of a difference in the incidence of pneumonia in participants receiving an OHC intervention compared with placebo (OR 0.39, CI 95% 0.14 to 1.09; 2 trials, 242 participants; I2 = 42%; P = 0.07; low-quality evidence). However, decontamination gel reduced the incidence of pneumonia among the intervention group compared with placebo gel group (OR 0.20, 95% CI 0.05 to 0.84; 1 trial, 203 participants; P = 0.028). There was no difference in the incidence of pneumonia in participants treated with povidone-iodine compared with a placebo (OR 0.81, 95% CI 0.18 to 3.51; 1 trial, 39 participants; P = 0.77). One OHC intervention compared with another OHC intervention Twelve trials (372 participants with stroke) compared one OHC intervention with another OHC intervention. There was no difference in dental plaque scores between those participants that received an enhanced multi-component OHC intervention compared with conventional OHC interventions at three months (MD -0.04, 95% CI -0.33 to 0.25; 1 trial, 61 participants; P = 0.78; low-quality evidence). There were no data for denture plaque. AUTHORS' CONCLUSIONS: We found low- to very low-quality evidence suggesting that OHC interventions can improve the cleanliness of patient's dentures and stroke survivor and providers' knowledge and attitudes. There is limited low-quality evidence that selective decontamination gel may be more beneficial than placebo at reducing the incidence of pneumonia. Improvements in the cleanliness of a patient's own teeth was limited. We judged the quality of the evidence included within meta-analyses to be low or very low quality, and this limits our confidence in the results. We still lack high-quality evidence of the optimal approach to providing OHC to people after stroke.


Assuntos
Cuidadores , Educação em Saúde Bucal , Higiene Bucal/métodos , Acidente Vascular Cerebral/enfermagem , Atitude Frente a Saúde , Placa Dentária/diagnóstico , Gengivite/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Casas de Saúde , Pneumonia/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estomatite sob Prótese/epidemiologia
2.
J Neurosci Nurs ; 52(6): 300-301, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32740317

RESUMO

INTRODUCTION: During the COVID-19 pandemic, hospitals still have to meet external regulations while delivering compassionate patient care. This reflections article provides a solution for certified stroke programs to continue to meet stroke certification requirements. One area of focus, in this article, is stroke education. Because of "shelter-in-place orders," there were no visitors permitted at the bedside, yet we know that high-quality poststroke education is important to improve outcomes. The purpose of this reflections article is to share what has worked at my institution. INNOVATIONS: We found that calling family members to engage them in stroke education was a great option. They seemed engaged, took notes, and asked questions. Nurses document details from these phone encounters in the patient's medical record. Many people placed the call on speaker so other family members could listen to the education session. While family members were at home, telehealth nursing has its own set of challenges. Although telehealth is not a perfect solution, it was one we found most reasonable and found it to work well through this unprecedented time. SUMMARY: These strategies are being shared to promote dissemination of innovative nursing interventions that will help to continue providing loved ones with the information and education they deserve to receive even during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Família/psicologia , Cuidados de Enfermagem , Pandemias , Educação de Pacientes como Assunto , Pneumonia Viral , Acidente Vascular Cerebral/enfermagem , Betacoronavirus , Humanos , Telemedicina
3.
J Stroke Cerebrovasc Dis ; 29(9): 105013, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807428

RESUMO

BACKGROUND: Higher rates of delirium have been reported among patients with acute stroke. However, poorly modifiable risk factors have been documented to date while sign and symptoms capable of early detecting its onset and outcomes in this specific population have been largely neglected. The aim of this study was to emerge nurses' clinical knowledge and experiences regarding post-stroke delirium (a) risk factors, (b) signs and symptoms of delirium onset, and (c) outcomes. METHOD: A qualitative study based upon focus groups have been performed on 2019 and here reported according to the COnsolidated criteria for REporting Qualitative research. A purposeful sample of 28 nurses was invited to participate in focus groups at two Italian hospitals, and 20 participated. A semi-structured question guide was developed; all focus groups were audio recorded and then transcribed verbatim. Two researchers independently analysed, coded and categorised the findings according to the main research question. A member checking with ten nurses was also performed to ensure rigour. RESULTS: Four risk factors emerged (a) at the individual level; (b) associated with previous (e.g., dementia) and the current clinical condition (stroke), (c) associated with the nursing care delivered, and (d) associated with the hospital environment. In their daily practice, nurses suspect the onset of delirium when some motor, verbal or multidimensional signs and symptoms occur. The delirium episodes affect outcomes at the individual, family, and at the system levels. CONCLUSIONS: In a field of research in need of study, we have involved expert nurses who shared their tacit knowledge to gain insights regarding risk factors, early signs and symptoms of delirium and its outcomes to address future directions of this research field.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Delírio/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/psicologia , Acidente Vascular Cerebral/enfermagem , Adulto , Delírio/diagnóstico , Delírio/etiologia , Delírio/psicologia , Feminino , Humanos , Entrevistas como Assunto , Itália , Masculino , Pessoa de Meia-Idade , Prognóstico , Pesquisa Qualitativa , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia
4.
Enferm. clín. (Ed. impr.) ; 30(3): 160-167, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196681

RESUMO

INTRODUCCIÓN: El ictus es causa importante de morbimortalidad en adultos y supone un elevado coste sociosanitario por las secuelas que provoca. Para minimizarlas es importante aplicar guías de buenas prácticas que aseguren cuidados basados en la evidencia y reduzcan la variabilidad clínica. El objetivo del estudio es evaluar los resultados de implantación de una Guía de buenas prácticas para la atención de pacientes con ictus hospitalizados. MÉTODO: Estudio cuasi-experimental pre/post-intervención. Mayores de 18 años ingresados en el Complejo Hospitalario Universitario de Albacete (CHUA) y Complejo Hospitalario de Navarra (CHN) con diagnóstico de ictus. Variables de proceso: valoración neurológica (Escala canadiense y la National Institute of Health Stroke Scale), valoración de la disfagia (Test del agua y el método de exploración clínica volumen-viscosidad), riesgo de caídas (Escala Downton), detección de dolor (Escala numérica), riesgo de lesiones por presión (Escala Braden) y educación sanitaria. Variables de resultado: neumonía por aspiración, caídas, independencia para las actividades de la vida diaria (índice de Barthel y Rankin modificada), lesiones por presión e intensidad del dolor. RESULTADOS: Se evaluaron 1.270 pacientes en el CHUA y 627 en el CHN, mayoritariamente hombres mayores de 69 años y con alta incidencia de ictus isquémicos. En el CHUA se registraron 16 lesiones por presión, 17 caídas y 20 casos de neumonías por aspiración. En CHN se identificaron 15 casos de lesiones por presión. El aumento de casos podría atribuirse al incremento de pacientes evaluados y a una mayor concienciación para registrar estos eventos. CONCLUSIONES: La aplicación de las recomendaciones de la GBP ha mejorado de manera estadísticamente significativa a lo largo del tiempo, existiendo posibilidades de mejora tanto en la calidad de los cuidados prestados como en los resultados en salud de los pacientes


INTRODUCTION: Stroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients. METHOD: Quasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. Outcome variables: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity. RESULTS: 1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events. CONCLUSIONS: Application of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Implementação de Plano de Saúde/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Acidente Vascular Cerebral/epidemiologia , Cuidados de Enfermagem/normas , Fidelidade a Diretrizes/normas , Acidente Vascular Cerebral/enfermagem , Avaliação em Enfermagem , Avaliação de Processos em Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Hospitalização
5.
Comput Inform Nurs ; 38(7): 358-366, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32427611

RESUMO

Cerebrovascular accident is a serious public health problem and requires the attention of professionals who can detect, diagnose, and provide care in a timely fashion. A quantitative quasi-experimental study was conducted using a mobile app called mSmartAVC for clinical evaluation of nursing care at the bedside. The study aimed at measuring the knowledge of nurses and nursing students in the detection and care of cerebrovascular accident. In this study, a total of 115 nurses from health services in the South of Brazil and 35 nursing students of a community university participated. The stages focused on development, modeling of clinical cases, problem-based learning, pretest (before) app use, and posttest (after) use of the app. The results of the pretest and posttest corrections showed a substantial statistical difference (P < .001), indicating a significant knowledge gain after the use of the app, particularly in terms of the detection scales and interpretation of the imaging tests. The mSmartAVC app used at the bedside supported decision-making for detection and nursing care. It was possible to confirm that the use of mobile apps plays an essential role as a learning tool for nurses and nursing students.


Assuntos
Educação Continuada em Enfermagem/métodos , Aprendizagem , Aplicativos Móveis/normas , Acidente Vascular Cerebral/enfermagem , Adulto , Brasil , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Educação Continuada em Enfermagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Aplicativos Móveis/estatística & dados numéricos , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos
6.
J Clin Nurs ; 29(15-16): 3089-3096, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32445410

RESUMO

AIMS AND OBJECTIVES: To develop, in an inpatient rehabilitation setting, a programme theory that promotes continence in people who have suffered a stroke. BACKGROUND: Urinary incontinence in stroke survivors impacts the quality of life, rehabilitation outcomes and ultimately incurred costs of the patient. Different approaches are available for developing and testing complex interventions. DESIGN: Building a research-based programme theory. METHODS: To elaborate the intervention, a guidance for developing a complex intervention for nursing was chosen and the sources that should be considered were defined. Subsequently, a research-based programme theory was generated that was represented via a theoretical approach logic model. This study was guided by the checklist for reporting theory of change in public health interventions. RESULTS: The intervention consists of six parts with three outcome chains on interconnected levels, which are oriented towards patients and nurses. The important aspects of the programme theory are communication, individually tailored measures and the definition of interdisciplinary objectives. CONCLUSION: Developing a programme theory and representing it via a logic model help clarify the initial intervention and ensure that implementation strategies are well thought out. RELEVANCE TO CLINICAL PRACTICE: By employing detailed reflection and using previous research, it is expected that the intervention can be implemented successfully and its effectiveness can be investigated in more depth.


Assuntos
Desenvolvimento de Programas/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Incontinência Urinária/enfermagem , Humanos , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem , Incontinência Urinária/etiologia
7.
Nurs Stand ; 35(4): 68-75, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32227723

RESUMO

The recognition of stroke as a medical emergency, provision of specialist services and advances in treatments have contributed to a decrease in stroke-related mortality, but the incidence and burden of stroke continue to rise. A stroke is a life-threatening and life-limiting event, but prompt identification and early treatment can reduce mortality and disability, and enhance the recovery and rehabilitation potential of survivors. Nurses working in acute stroke services have a wide-ranging role that includes assessment, identification and monitoring, as well as rehabilitation, psychological support and end of life care. This article provides an overview of the diagnosis and management of strokes and transient ischaemic attacks, and describes the role of nurses in acute stroke care.


Assuntos
Papel do Profissional de Enfermagem , Acidente Vascular Cerebral , Cuidados Críticos , Humanos , Acidente Vascular Cerebral/enfermagem , Reabilitação do Acidente Vascular Cerebral , Sobreviventes
8.
Crit Care Nurs Clin North Am ; 32(1): 1-19, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32014156

RESUMO

Acute stroke assessment is classically supported by clinical localization whereby presenting disabilities are associated with key arterial territories in the brain. Clinical localization skills are rarely taught to nonneurologists; yet, these skills are essential to the provision of evidence-based nursing care of stroke, enabling rapid patient identification, diagnosis, and ultimately, the delivery of acute treatment. This article explores the process of clinical localization in relation to the physiology affected by stroke vascular insufficiency. Elements of the neurologic examination are described as they relate to discreet areas in the brain and the National Institutes of Health Stroke Scale.


Assuntos
Encéfalo/patologia , Dominância Cerebral/fisiologia , Exame Neurológico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Artérias Cerebrais/patologia , Hemianopsia , Hemiplegia , Humanos , Enfermagem em Neurociência , Índice de Gravidade de Doença , Acidente Vascular Cerebral/enfermagem , Estados Unidos
9.
Crit Care Nurs Clin North Am ; 32(1): 21-36, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32014159

RESUMO

Acute ischemic stroke is a major cause of death and disability in the United States. Historically, acute stroke patients were treated with intravenous (IV) thrombolysis. Patients with large vessel occlusions (LVOs) should be offered mechanical thrombectomy, with or without IV thrombolysis, in an extended window up to 24 hours of last known well. Both treatment options are the standard of care for a patient with an LVO. It is critical that the intensive care unit nurse understand new treatment indications for LVO strokes, and the priorities of nursing care with medical and endovascular intervention.


Assuntos
Isquemia Encefálica/complicações , Transtornos Cerebrovasculares/cirurgia , Trombólise Mecânica , Acidente Vascular Cerebral/terapia , Encéfalo/anatomia & histologia , Circulação Cerebrovascular/fisiologia , Enfermagem de Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/enfermagem
10.
Crit Care Nurs Clin North Am ; 32(1): 67-84, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32014162

RESUMO

Nearly 20% of all patients with ischemic stroke will require care in an intensive care unit (ICU), particularly those who have received intravenous alteplase or endovascular therapy. Prioritizing nursing intervention and intensive care monitoring can improve patient outcomes and reduce disability. A collaborative interdisciplinary team approach best facilitates the ICU care of an acute stroke patient.


Assuntos
Enfermagem de Cuidados Críticos , Fibrinolíticos/uso terapêutico , Monitorização Fisiológica , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Humanos , Unidades de Terapia Intensiva , Acidente Vascular Cerebral/enfermagem , Terapia Trombolítica
12.
Crit Care Nurse ; 40(1): 56-65, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32006035

RESUMO

TOPIC: Protecting patient safety and preventing modifiable complications after acute ischemic stroke. CLINICAL RELEVANCE: Stroke is a leading cause of death and disability in adults. Stroke survivors often experience a variety of deficits related to mobility, nutrition, immunity, mood, and cognition. These post-stroke complications and residual effects can adversely affect safety, placing the patient at risk for further injury. In order to develop a plan of care that protects patient safety, critical care and progressive care nurses must understand the unique needs of this patient population. PURPOSE: To describe selected ischemic stroke-related physiological changes, how these changes contribute to safety risks, and methods of enhancing patient safety. CONTENT COVERED: Stroke physiology and stroke-specific interventions that can enable nurses to reduce the risk of falls, dysphagia, malnutrition, dehydration, altered glucose metabolism, device-related infections, aspiration pneumonia, delirium, and depression.


Assuntos
Enfermagem de Cuidados Críticos/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
13.
Am J Nurs ; 120(3): 48-54, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32079799

RESUMO

The National Institutes of Health Stroke Scale (NIHSS) is considered the standard for assessing neurologic status after an acute stroke. Currently, there is no guideline for when this assessment should be completed, nor is there consensus on how frequently or for how long.We initiated a quality improvement project that sought first to determine when and how often nurses at a variety of institutions in our multisite health care system completed the NIHSS assessment and then to identify the minimum frequency at which nurses should complete the assessment. After reviewing the literature and current practices and observing internal and external benchmarks, we set a new standard for all institutions in the system to follow.The new assessment frequency was based on patient condition and level of care, although that frequency would change if a patient showed new or worsening neurologic changes. The new standard was successfully implemented at all the primary and comprehensive certified stroke centers in our network. Ongoing monitoring confirmed that the frequency of NIHSS assessment met the needs of our patients and ensured staff adherence to the new practice.


Assuntos
Exame Neurológico/enfermagem , Padrões de Prática em Enfermagem/normas , Acidente Vascular Cerebral/enfermagem , Benchmarking/métodos , Humanos , National Institutes of Health (U.S.) , Melhoria de Qualidade , Inquéritos e Questionários , Estados Unidos
14.
J Clin Nurs ; 29(9-10): 1527-1538, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31970825

RESUMO

INTRODUCTION: Nurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost-effectiveness of these tests. METHODS: Following PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta-analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS-2. RESULTS: Twenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use. There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta-analysis, demonstrating high sensitivity; 96% (95% CI 0.90-0.99), but low specificity, 65% (95% CI 0.47-0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor. CONCLUSIONS: There is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost-effectiveness in acute stroke. RELEVANCE TO CLINICAL PRACTICE: Nurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke dysphagia. It is important to use a validated assessment tool that demonstrates good accuracy, clinical utility and cost-effectiveness.


Assuntos
Transtornos de Deglutição/diagnóstico , Programas de Rastreamento/métodos , Análise Custo-Benefício , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/enfermagem , Feminino , Humanos , Programas de Rastreamento/normas , Valor Preditivo dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem
16.
Stroke ; 51(1): 54-60, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31818230

RESUMO

Background and Purpose- Persistent depression after ischemic stroke is common in stroke survivors and may be even higher in family caregivers, but few studies have examined depressive symptom levels and their predictors in patient and caregiver groups simultaneously. Methods- Stroke survivors and their family caregivers (205 dyads) were enrolled from the national REGARDS study (Reasons for Geographic and Racial Differences in Stroke) into the CARES study (Caring for Adults Recovering from the Effects of Stroke) ≈9 months after a first-time ischemic stroke. Demographically matched stroke-free dyads (N=205) were also enrolled. Participants were interviewed by telephone, and depressive symptoms were assessed with the 20-item Center for Epidemiological Studies-Depression scale. Results- Significant elevations in depressive symptoms (Ps<0.03) were observed for stroke survivors (M=8.38) and for their family caregivers (M=6.42) relative to their matched controls (Ms=5.18 and 4.62, respectively). Stroke survivors reported more symptoms of depression than their caregivers (P=0.008). No race or sex differences were found, but differential prediction of depressive symptom levels was found across patients and caregivers. Younger age and having an older caregiver were associated with more depressive symptoms in stroke survivors while being a spouse caregiver and reporting fewer positive aspects of caregiving were associated with more depressive symptoms in caregivers. The percentage of caregivers at risk for clinically significant depression was lower in this population-based sample (12%) than in previous studies of caregivers from convenience or clinical samples. Conclusions- High depressive symptom levels are common 9 months after first-time ischemic strokes for stroke survivors and family caregivers, but rates of depressive symptoms at risk for clinical depression were lower for caregivers than previously reported. Predictors of depression differ for patients and caregivers, and standards of care should incorporate family caregiving factors.


Assuntos
Cuidadores/psicologia , Depressão/enfermagem , Acidente Vascular Cerebral/enfermagem , Sobreviventes/psicologia , Adaptação Psicológica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Rev. eletrônica enferm ; 22: 1-8, 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1121712

RESUMO

Objetivo: Investigar a relação entre a resiliência, a capacidade funcional e o apoio social de pessoas com sequelas de acidente vascular encefálico. Método: Estudo transversal, realizado com 108 indivíduos com sequelas de acidente vascular encefálico, cadastrados em Unidades de Saúde da Família, do município de João Pessoa, Paraíba, Brasil. Os instrumentos utilizados foram: Escala de Resiliência, Índice de Barthel e Escala de Apoio Social. Para análise, utilizou-se estatística descritiva e inferencial. Resultados: Houve maior frequência do sexo feminino (57,4%), 60 anos ou mais (59,2%), com companheiro (47,2%) e cuidador (76,6%). Os participantes apresentaram mais frequentemente o nível de resiliência moderada (64,8%), dependência funcional (93,6%) para realização das atividades diárias e médio apoio social (48,2%). Foi verificado que quanto maior a capacidade funcional e o apoio social, maior a resiliência. Conclusão: A capacidade funcional e o apoio social são preditores da resiliência de pessoas com sequelas de acidente vascular encefálico.


Objective: To investigate the relationship between resilience, functional capacity and social support of people with stroke sequelae. Method: Cross-sectional study, conducted with 108 individuals with sequelae of stroke, registered in Family Health Units, of the municipality of João Pessoa, Paraíba, Brazil. The instruments used were: Resilience Scale, Barthel Index and the Social Support Scale. For analysis, descriptive and inferential statistics were used. Results: There was a higher frequency of females (57.4%), 60 years old or more (59.2%), with partner (47.2%) and caregiver (76.6%). The participants presented more frequently the level of moderate resilience (64.8%), functional dependence (93.6%) for performing daily activities and medium social support (48.2%). It was verified that the greater the functional capacity and social support, the greater the resilience. Conclusion: Functional capacity and social support are predictors of resilience of people with sequelae of stroke.


Assuntos
Humanos , Apoio Social , Acidente Vascular Cerebral/enfermagem , Resiliência Psicológica , Acidente Vascular Cerebral/psicologia , Cuidados de Enfermagem
18.
Rev. Esc. Enferm. USP ; 54: e03560, 2020. tab
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1125590

RESUMO

Abstract Objective: To associate sociodemographic variables and risk factors for stroke to the degree of dependence for performing the activities of daily living of women of childbearing age after suffering a stroke. Method: A prospective and analytical longitudinal study conducted in three public hospitals in Fortaleza, CE, Brazil. The Modified Barthel Index was used at the time of attending the unit and 3 months after the stroke to assess the degree of disability in the performance of activities of daily living. The chi-squared and likelihood ratio tests were chosen to analyze the association between variables. Results: There were 109 women of childbearing age who participated in the study. There was an association between higher degrees of dependence in women from the interior/rural areas, with lower income and black people (p = 0.032, p = 0.043, p = 0.03, respectively). Regarding personal risk factors, there was a greater dependency in women with heart disease (p = 0.040), sedentary (p = 0.030) and alcoholics (p = 0.017). Conclusion: The results show the factors associated with higher degrees of dependence for performing activities of daily living by women of childbearing age after the occurrence of stroke.


Resumen Objetivo: Asociar las variables sociodemográficas y los factores de riesgo para Accidente Cerebrovascular con el grado de dependencia para la realización de las actividades de vida diaria de mujeres en la edad fértil con Accidente Cerebrovascular. Método: Investigación longitudinal prospectiva y analítica, llevada a cabo en tres hospitales públicos de Fortaleza, CE. A fin de evaluar el grado de discapacidad en el desempeño de las actividades de vida diaria, se utilizó el Índice de Barthel Modificado en el momento de la asistencia a la unidad y 3 meses después del Accidente Cerebrovascular. Para el análisis de asociación entre variables, se optó por las pruebas de Chi cuadrado y Razón de Verosimilitud. Resultados: Participaron en el estudio 109 mujeres en edad fértil. Se percibió asociación entre mayores grados de dependencia en las mujeres procedentes del interior, con menores ingresos y de raza negra (p=0,032, p=0,043, p=0,03, respectivamente). En cuanto a los factores de riesgo personales, se observó mayor dependencia en las mujeres con enfermedad cardiaca (p=0,040), sedentarias (p=0,030) y alcohólicas (p=0,017). Conclusión: Los resultados presentan los factores asociados con los mayores grados de dependencia para la realización de las actividades de vida diaria por las mujeres en edad fértil, tras la ocurrencia de Accidente Cerebrovascular.


Resumo Objetivo: Associar as variáveis sociodemográficas e os fatores de risco para Acidente Vascular Cerebral ao grau de dependência para realização das atividades de vida diária de mulheres na idade fértil com Acidente Vascular Cerebral. Método: Pesquisa longitudinal prospectiva e analítica, realizada em três hospitais públicos de Fortaleza, CE. Para avaliar o grau de incapacidade no desempenho das atividades de vida diária, foi utilizado o Índice de Barthel Modificado no momento do comparecimento à unidade e 3 meses após o Acidente Vascular Cerebral. Para a análise de associação entre variáveis, optaram-se pelos testes Qui-quadrado e Razão de Verossimilhança. Resultados: Participaram do estudo 109 mulheres em idade fértil. Percebeu-se associação entre maiores graus de dependência nas mulheres procedentes do interior, com menor renda e de raça negra (p=0,032, p=0,043, p=0,03, respectivamente). Quanto aos fatores de risco pessoais, observou-se maior dependência nas mulheres com doença cardíaca (p=0,040), sedentárias (p=0,030) e alcoolistas (p=0,017). Conclusão: Os resultados apresentam os fatores associados aos maiores graus de dependência para realização das atividades de vida diária pelas mulheres em idade fértil, após a ocorrência de Acidente Vascular Cerebral.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Atividades Cotidianas , Saúde da Mulher , Acidente Vascular Cerebral/enfermagem , Estudos Prospectivos , Fatores de Risco , Estilo de Vida
19.
Rev Rene (Online) ; 21: 42171, 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1053051

RESUMO

Objetivo: identificar os fatores associados à presença de ideação suicida em cuidadores de sobreviventes de acidente vascular encefálico. Métodos: pesquisa transversal, realizada com 151 cuidadores informais primários. Utilizaram-se da Escala de Depressão, Ansiedade e Estresse-21 (Depression Anxiety and Stress Scale) e de questionário para avaliação da presença de pensamentos de ideação suicida, cujos dados foram analisados por estatística descritiva e inferencial. Resultados: a maior parte dos cuidadores apresentou níveis normais de depressão (76,8%), ansiedade (76,2%) e estresse (79,5%), assim como a ausência de pensamentos de ideação suicida (70,9%). A correlação entre as escalas evidenciou que à medida que os níveis de ansiedade, depressão e estresse aumentam, os pensamentos de ideação suicida se elevam de maneira proporcional. Conclusão: observou-se que níveis elevados de depressão, ansiedade e estresse favoreceram o aumento da frequência de pensamentos de ideação suicida entre os cuidadores de sobreviventes de acidente vascular encefálico. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Cuidadores , Acidente Vascular Cerebral/enfermagem , Ideação Suicida , Ansiedade , Estresse Psicológico , Estudos Transversais , Fatores de Risco , Depressão
20.
Rev Bras Enferm ; 72(suppl 2): 251-258, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31826218

RESUMO

OBJECTIVE: To describe relationships between the ECPICID-AVC scale factors and the NANDA-I domains, classes, and Nursing Diagnoses (NDs). METHOD: Cross-mapping study between the NANDA-I taxonomy and ECPICID-AVC scale was constructed based on the eight ECPICID-AVC scale factors and the 13 NANDA-I domains. A descriptive analysis was performed to present the mapped elements. RESULTS: Areas of similarity and intersection were found between the eight ECPICID-AVC factors and nine NANDA-I domains, 19 classes, and 72 NDs. All scale factors were mapped with the Domain 1/Health Promotion, Class 2/Health Management and the ND "Frail elderly syndrome". FINAL CONSIDERATIONS: The ECPICID-AVC scale factors were mapped with nine domains, their classes and diagnoses. This study demonstrates the importance of identifying nursing diagnoses and their relationship with factors that evaluate caregiving capacity. The ECPICID-AVC can help nurses generate nursing diagnoses regarding the caregiver's needs and their capacities related to care to focus such needs.


Assuntos
Cuidadores/psicologia , Diagnóstico de Enfermagem/estatística & dados numéricos , Acidente Vascular Cerebral/enfermagem , Humanos , Terminologia Padronizada em Enfermagem , Acidente Vascular Cerebral/psicologia
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