Journal of Nursing Theory and Practice

[Analysis of the impact of dysphagia among stroke patients in acute care]

GRÁNÁSI Bettina1, PAPP László2

JUNE 30, 2021

Journal of Nursing Theory and Practice - 2021;34(3)

Journal Article

[Stroke is the third most common cause of death in Europe. In Hungary, 40-50 thousand people enter the stroke centers in every year, of which about 15 thousand die. Among the residual symptoms, impairment of swallowing function is significant, which can lead to a life-threatening condition. In our prospective, controlled study, we aimed to investigate the descriptive indicators of swallowing disorders in stroke patients undergoing acute care. The study was done at the Stroke Unit of the Department of Neurology, University of Szeged, between July and November 2020. During this period, 122 patients were included in the study group. The degree of consciousness (p <0.001, Cramer’s V 0.479) and the presence of facial paresis (p <0.001, Cramer’s V 0.73) basically determine the risk of developing swallowing disorders. The incidence of aspiration pneumonia was not higher in the sample than in the control group (p = 0.138). Based on our results, the assessment of the risk of swallowing disorders is an essential element in the care of stroke patients.]

AFFILIATIONS

  1. Szegedi Tudományegyetem, Neurológiai Klinika
  2. Szegedi Tudományegyetem, Sürgősségi Betegellátó Osztály

COMMENTS

0 comments

Further articles in this publication

Journal of Nursing Theory and Practice

[The importance of teamwork in healthcare during the COVID-19 pandemic]

NÉMETH Anikó

[The present study aimed to investigate the correlations of healthcare teamwork with burnout, workplace uncertainty, and stress factors at the workplace and at home during the COVID-19 pandemic. This cross-sectional study has been conducted through a self-constructed online questionnaire in the beginning of 2021. The answers of 1965 people have been analysed with SPSS 23.0. Descriptive statistics, chi-square and Kruskal-Wallis were applied (p<0.05). This cross-sectional study has been conducted through a self-constructed online questionnaire in the beginning of 2021. The answers of 1965 people have been analysed with SPSS 23.0. Descriptive statistics, chi-square and Kruskal-Wallis were applied (p<0.05). The present study proved that teamwork has high importance even during the COVID-19 pandemic as a protective factor on many areas.]

Journal of Nursing Theory and Practice

[Changing in the daily nursing duties – epidemiological interventions and protocols in residential care facilities related to elderly care]

HADOBÁSNÉ Kiss Hedvig, BALOGH Zoltán

[In this publication we will represent the SWOT-analysis and abilities of the social residential institutes in terms of safety measures and strategies, against the current pandemic situation caused by the Covid-19 outbreak. Our analysis involves the retirement homes and other caretaking facilities in Szabolcs-Szatmár-Bereg County. The data was acquired through anonym only surveys. We will introduce new challenges and task in the daily life of the retirement homes, furthermore we will provide advice and references to these institutes to help them create their own epidemiological protocols and to measure their own preparedness from a professional viewpoint. The aim of study: The goal of our examination was to assess the entire Szabolcs-Szatmár-Bereg County, which by we can gain insight into the situation of the retirement homes during the current pandemic period in the whole county. In Szabolcs-Szatmár-Bereg County there are 97 active retirement homes and caretaking facilities, the leaders of the facilities were asked to fill out an anonymous online survey. Based on the received data, we formed our opinion and draw conclusions. Based on the aspects of the SWOT-analysis used in the research and after the analysis of the results, we can state that the epidemiological experience, knowledge and expertise of the people working in health care show an insufficient picture. Many institutions have faced unresolved labour challenges and challenges, the difficulty of converting living quarters for isolation, and the general unpreparedness to deal with a viral situation of this caliber. The ban on visits to prevent the spread of the virus has also made it more difficult to care for those in need of special care, and in several cases, the attitude of relatives hindered the work of the institutions. Fortunately, in addition to the difficulties that arise, some positive changes should be also highlighted, such as the conscientious approach to the task of forging a team of employees. As a consequence, we can conclude that in the analysis we obtained and evaluated the serious difficulties in relation to the problems of the institutions, there are some options as solution to these. Possible solutions include further training, institution-specific guidelines, development and application of protocols in epidemic situations, support for crisis management and crisis communication within institutions. In the heightened situation, the acquisition of appropriate communication techniques to reassure relatives and patients are essential tools for the solution. Central guidance, monitoring and support are also needed to make all of these options a reality.]

Journal of Nursing Theory and Practice

[Changes in Quality of Life in Patients with Parkinson’s Disease following Deep Brain Stimulation (DBS) Surgery]

POLGÁRNÉ Lőrinczi Andrea, PAPP László

[The primary objective of our study was to assess the effect of deep brain stimulation (DBS) on subjectively lived quality of life in patients with Parkinson’s disease (PD). Our focus was on postoperative changes in patients’ activities, social relationships, as well as changes observed in drug therapy as a result of stimulation. In our qualitative, phenomenological study, we conducted interviews with PD patients 4–10 months after DBS surgery. The 30-60 minute interviews were conducted between July 1 and December 31, 2020. Patients reported positive changes in daily activities, work ability, sleep quality, mood and medication. No change in cognitive status was identified. After DBS surgery, patients’ quality of life changes in a clear positive direction. To achieve the optimal effect of the intervention, given the complexity of the disease, the basic motive for care should be a holistic approach.]

Journal of Nursing Theory and Practice

[Nursing Bag Technique, Practice in home health care]

HIRDI Henriett Éva, DALLOSNÉ Király Erika, KÁLMÁNNÉ Simon Mária

[The nursing bag has been used by District Nurses and Home Care Visiting Nurses for decades to transport patient care equipment and supplies to patients’ homes. The nursing bag is transported from the patient’s home to another family’s living space and may serve as a vehicle for transmitting pathogen microorganisms. This article will focus on the core and supplementary contents in the nursing bag and on principles of practice called “bag technique” to prevent the transmission of pathogenic microorganisms.]

All articles in the issue

Related contents

Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

Capability of stroke scales to detect large vessel occlusion in acute ischemic stroke – a pilot study

TÁRKÁNYI Gábor, KARÁDI Nozomi Zsófia, CSÉCSEI Péter, BOSNYÁK Edit, FEHÉR Gergely, MOLNÁR Tihamér, SZAPÁRY László

Rapid changes of stroke management in recent years facilitate the need for accurate and easy-to-use screening methods for early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our aim was to evaluate the ability of various stroke scales to discriminate an LVO in AIS. We have performed a cross-sectional, observational study based on a registry of consecutive patients with first ever AIS admitted up to 4.5 hours after symptom onset to a comprehensive stroke centre. The diagnostic capability of 14 stroke scales were investigated using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) values of NIHSS, modified NIHSS, shortened NIHSS-EMS, sNIHSS-8, sNIHSS-5 and Rapid Arterial Occlusion Evaluation (RACE) scales were among the highest (>0.800 respectively). A total of 6 scales had cut-off values providing at least 80% specificity and 50% sensitivity, and 5 scales had cut-off values with at least 70% specificity and 75% sensitivity. Certain stroke scales may be suitable for discriminating an LVO in AIS. The NIHSS and modified NIHSS are primarily suitable for use in hospital settings. However, sNIHSS-EMS, sNIHSS-8, sNIHSS-5, RACE and 3-Item Stroke Scale (3I-SS) are easier to perform and interpret, hence their use may be more advantageous in the prehospital setting. Prospective (prehospital) validation of these scales could be the scope of future studies.

Clinical Neuroscience

How does the use of antiplatelet and anticoagulants affect the success of mechanical thrombectomy in acute ischemic stroke cases?

ÇABALAR Murat , ŞENGEZE Nihat , EREN Alper , İNANÇ Yusuf , GİRAY Semih

In this study, we wanted to investigate the effect of antiplatelet and anticoagulant use on the success of mechanical thrombectomy in acute ischemic stroke cases. 174 patients who were brought to the Stroke Center of Gaziantep University Şahinbey Research and Practice Hospital between January 2018 and February 2019 due to acute ischemic stroke and who underwent mechanical thrombectomy were retrospectively analyzed. The demographic characteristics, antiplatelet/anticoagulant use before the stroke and mTICI (modified-Throm­bolysis-In-Cerebral-Infarction) scores used for reperfusion in mechanical thrombectomy were evaluated. The findings were analyzed statistically (p<0.05). The mean age was 63.3 ± 13.5 in 174 patients who underwent mechanical thrombectomy. 23/174 (13.2%) patients were using anticoagulant therapy (warfarin-OAC or new generation oral anticoagulant-NOAC) and 28/174 (16.1%) were using antiplatelet therapy. A history of atrial fibrillation (AF) was significantly higher in patients receiving anticoagulant therapy before acute ischemic stroke (p=0.001). Patients with a history of hyper tension (HT), diabetes mellitus (DM) and coronary artery disease (CAD) before acute ischemic stroke were receiving antiplatelet therapy in higher rates (respectively; p=0.003, p=0.037, p=0.005). Successful recanalization (mTICI ≥ 2b) was higher in patients with a history of anticoagulant use and who underwent mechanical thrombectomy (p=0.025). Our study showed that the use of anti­platelet or anticoagulants before mechanical thrombec­tomy may have an indirect positive effect on the success of the procedure.

Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Clinical Neuroscience

Evaluation of ischemic stroke patients with systemic cancer

UFUK Emre, TASKIN Gunes, IREM Pinar, FURUZAN Kokturk, ESENGUL Liman, ORHAN Yağiz

Purpose - In cancer patients, an ischemic stroke can be seen as both a direct effect of cancer and a complication of treatment. This condition can negatively affect the follow-up and treatment of these patients. For this research, we aimed to evaluate the clinical features, stroke types and etiological features of ischemic stroke patients with histories of cancer or found to have cancer during the aetiological investigation. Materials and methods - We retrospectively evaluated 100 patients (57 males, 43 females) who were hospitalized with acute stroke and determined to have the presence of cancer or a cancer history during the aetiological investigation between 2011 and 2016. All the demographic features, stroke types and localizations, National Institutes of Health Stroke Scale (NIHSS) scores, Rankin Scale scores, durations of cancer and cancer treatments were recorded. Results - The mean age of the patients was 67.07 ± 10.9 years old, the median NIHSS score was 5, and the median Rankin Scale score was 4. While 79% of patients had ischemic stroke risk factors, 21% did not. Atherosclerotic stroke was the most common stroke type (49%, n=49) and cryptogenic strokes were detected in 21% (n=21). In addition, 63% of the patients had chronic cancer (later than 6 months), 31% of the patients had recent cancer histories (less than 6 months), and 29% of the patients had metastases. Among all the malignancies, lung cancer (n=23), gastrointestinal cancer (n=20) and gynaecological-breast cancer (n=16) were the three most common. Moreover, 37% of the patients underwent chemotherapy, 29% underwent radiotherapy, and 88% of the patients had Carotid/Vertebral Doppler USG abnormalities. Conclusion - Similar to what is stated in the literature, an atherosclerotic stroke was the most common type of stroke in the cancer patients. Stroke risk factors were not detected in 21% of the patients, and in the majority of the patients, atherosclerotic changes in the carotid artery were observed in the Doppler examinations. In the aetiology and prognosis of ischemic stroke, it is important to keep in mind the existence of cancer in addition to the classical stroke risk factors.