Single-mode Er-doped fiber random laser with distributed Bragg grating feedback.

We report the implementation of a one-dimensional random laser based on an Er/Ge co-doped single-mode fiber with randomly spaced Bragg gratings. The random grating array forms a complex cavity with high quality factor resonances in the range of gain wavelengths centered around 1535.5 nm. The reflection spectra of the grating array and the emission spectra of the laser are investigated for different numbers of gratings. The experimental results are compared qualitatively with numerical simulations of the light propagation in one-dimensional Bragg grating arrays based on a transfer matrix method. The system is pumped at 980 nm and the experimentally observed output radiation presents a typical laser threshold behavior as a function of the pump power. We find that the laser output contains several competing spectral modes.

[Subacute care of stroke-affected patients. Satisfaction and results]. / Atención subaguda al paciente con ictus. Satisfacción y resultados.

OBJECTIVE: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. MATERIAL AND METHOD: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. RESULTS: The patient profile is a 71 year-old male, with low/intermediate social risk, high co-morbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. CONCLUSIONS: Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving.

Rehabilitation efficiency and destination on discharge after stroke.

BACKGROUND: Predicting functional recovery of patients is key for setting the objectives of the rehabilitation programme and making decisions on their destination on discharge. Many variables have an impact on disability and quality of life after stroke, including patient age, comorbidity, severity of neurological deficit, state of mind and social risk. Accordingly, it is also essential from a care perspective to optimise the functional recovery and efficiency of rehabilitation programmes, exploring their relationship with these variables. AIM: To analyze the efficiency of post-stroke rehabilitation, identifying factors that most strongly influence functional recovery and destination on discharge. DESIGN: Multicentre prospective cohort study SETTING/POPULATION: All patients admitted to the Rehabilitation Units of the two hospitals after stroke over eight months METHODS: Collected data on sociodemographic characteristics, social risk (Gijón Scale), comorbidity (Charlson Index), neurological severity (National Institute of Health Stroke Scale), daily living functioning scale (Barthel Index), length of hospital stay and destination on discharge. RESULTS: We included 241 patients, with a mean stay of 35±22 days, 81.5% returning home on discharge. On admission 45.2% were totally dependent, and this figure fell to 12.8% on discharge, the mean Barthel Index score increasing by 32.5 points. Neurological severity, hemiparetic severity, impairment of deep sensation and trunk control on admission were the mayor variables influence on rehabilitation efficiency (P<0.001). Destination on discharge was most closely associated with civil status, social risk and Barthel Index score (P<0.001). The likelihood of transferring to residential care is 3- and 2.71-fold higher among patients with total dependence and high comorbidity scores, respectively. CONCLUSION: Many variables influence on outcomes of stroke inpatient rehabilitation. CLINICAL REHABILITATION IMPACT: Comprehensive assessments are required to predict patient recovery, efficiency and plan for discharge.

Atención subaguda al paciente con ictus. Satisfacción y resultados / Subacute care of stroke-affected patients. Satisfaction and results

Objetivo: Conocer la satisfacción de los pacientes con ictus y sus cuidadores durante su hospitalización en rehabilitación y analizar la efectividad del tratamiento, el riesgo social y el destino del paciente al alta. Material y método: Estudio multicéntrico de cohorte longitudinal prospectivo. Se valoró el riesgo social (escala Gijón), la comorbilidad (índice de Charlson), la discapacidad (índice de Barthel), la efectividad del tratamiento rehabilitador, la satisfacción con la atención (cuestionario de Pound) y el destino al alta en 241 pacientes. De 119 cuidadores evaluados a los 6 meses postictus se recogieron la edad, el parentesco, las horas diarias dedicadas al cuidado y la satisfacción con la información/formación y con la accesibilidad del equipo rehabilitador. Resultados: El perfil del paciente era el de un varón de 71 años, con riesgo social bajo/intermedio, comorbilidad alta y dependencia total/severa. Un 27,1% vivían solos. El 96,6% referían estar satisfechos/muy satisfechos con el tratamiento, siendo menor la satisfación con la recuperación (80,3%). La efectividad fue de 32,5 ± 20,4. El 81,7% de los pacientes regresaron a su domicilio. La media de edad de los cuidadores fue de 58,8 ± 12,3 años y el 73,9% eran mujeres. La dedicación a los cuidados era superior a 6 h diarias en el 62%. El 89,9% de los cuidadores estaban satisfechos/muy satisfechos con la información recibida. Conclusiones: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de los casos. La satisfacción con el tratamiento rehabilitador y la información es elevada. Un campo especialmente mejorable es la formación del cuidador (AU)

Objective: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. Material and method: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. Results: The patient profile is a 71 year-old male, with low/intermediate social risk, high comorbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. Conclusions: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de casos. Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving

Calidad de vida a los 6 meses tras un ictus / Quality of life 6 months after a stroke

Objetivo. Describir la calidad de vida (CV) de los pacientes a los 6 meses de evolución del ictus y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos. Estudio multicéntrico de cohortes longitudinal (n = 157). Los pacientes incluidos ingresaron en la fase subaguda tras un ictus en 2 Servicios de Rehabilitación. Se recogieron los siguientes datos a los 6 meses postictus: género, edad, riesgo social, comorbilidad, disfagia, afasia, estado cognitivo, depresión y grado de discapacidad evaluado mediante el índice de Barthel modificado. Se evaluó la influencia de estas variables en la CV, para lo que se empleó la escala específica de calidad de vida para el ictus ECVI-38. Resultados. La media de edad fue de 70,93 ± 11,85 años; fue significativamente superior en las mujeres. El paciente tipo presentó una elevada comorbilidad, un bajo riesgo social y dependencia moderada. La puntuación media total de la escala ECVI-38 fue de 35,30 ± 16,17 y los dominios más afectados los referentes a las actividades comunes y básicas de la vida diaria. Las variables que más se relacionan con la CV fueron el género, la afasia, la disfagia, la depresión, el déficit cognitivo y el estado funcional. El dolor de elevada intensidad estuvo presente en un 21% de los pacientes. Conclusión. Son muy diversas las variables que influyen en la CV del paciente con ictus que se deben considerar, para su potencial abordaje, en la planificación de las intervenciones rehabilitadoras (AU)

Objective. To describe quality of life (QoL) in patients at 6 months poststroke and its relationship with sociodemographic, clinical and functional characteristics. Material and method. This multicenter longitudinal cohort study (n = 157) included patients from 2 hospital rehabilitation services who were admitted for stroke in the subacute phase. The following data were gathered at 6 months poststroke: gender, age, social risk, comorbidity, dysphagia, aphasia, cognitive status, depression, and disability measured by the modified Barthel Index. The influence of these variables on QoL was evaluated using the stroke-specific quality of life scale, ECVI-38. Results. The mean age was 70.93 ± 11.85 years and was significantly higher in women. Most of the patients had high comorbidity, low social risk and moderate dependence. The mean total score on the ECVI-38 scale was 35.30 ± 16.17 and the most affected domains were those concerning common and basic activities of daily living. The variables associated with QoL were gender, aphasia, dysphagia, depression, cognitive impairment, and functional status. High-intensity pain was present in 21% of patients. Conclusion. Numerous variables influence QoL in patients with stroke and should be considered in the planning of rehabilitation interventions (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)