ABSTRACT
BACKGROUND: Stroke patients are at increased risk of falls and fractures. The aim of this study was to determine the rate, predictors and consequences of falls within 2 years after stroke in a prospective population-based study in North Dublin, Ireland. DESIGN: Prospective population-based cohort study. SUBJECTS: 567 adults aged >18 years from the North Dublin Population Stroke Study. METHODS: Participants were enrolled from an Irish urban population of 294,592 individuals, according to recommended criteria. Patients were followed for 2 years. Outcome measures included death, modified Rankin Scale (mRS), fall and fracture rate. RESULTS: At 2 years, 23.5% (124/522) had fallen at least once since their stroke, 14.2% (74/522) had 2 or more falls and 5.4% (28/522) had a fracture. Of 332 survivors at 2 years, 107 (32.2%) had fallen, of whom 60.7% (65/107) had 2 or more falls and 23.4% (25/107) had fractured. In a multivariable model controlling for age and gender, independent risk factors for falling within the first 2 years of stroke included use of alpha-blocker medications for treatment of hypertension (P = 0.02). When mobility measured at Day 90 was included in the model, patients who were mobility impaired (mRS 2-3) were at the highest risk of falling within 2 years of stroke [odds ratio (OR) 2.30, P = 0.003] and those functionally dependent (mRS 4-5) displayed intermediate risk (OR 2.02, P = 0.03) when compared with independently mobile patients. CONCLUSION: Greater attention to falls risk, fall prevention strategies and bone health in the stroke population are required.
Subject(s)
Accidental Falls/statistics & numerical data , Fractures, Bone/epidemiology , Stroke/epidemiology , Accidental Falls/mortality , Adrenergic alpha-Antagonists/therapeutic use , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Chi-Square Distribution , Comorbidity , Disability Evaluation , Female , Fractures, Bone/diagnosis , Fractures, Bone/mortality , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Ireland/epidemiology , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Mobility Limitation , Multivariate Analysis , Odds Ratio , Prevalence , Prognosis , Prospective Studies , Risk Factors , Stroke/diagnosis , Stroke/mortality , Time Factors , Urban HealthABSTRACT
BACKGROUND: A weekend emergency medical admission has been associated with a higher mortality. We have examined all weekend admissions to St James' Hospital, Dublin between 2002 and 2009. METHODS: We divided admissions by weekday or weekend (Saturday or Sunday) presentation. We utilised a multivariate logistic model, to determine whether a weekend admission was independently predictive of 30 day outcome. RESULTS: There were 49337 episodes recorded in 25883 patients; 30-day inhospital mortality at the weekend (9.9% vs. 9.0%) had an unadjusted Odds Ratio of 1.11 (95% CI 0.99, 1.23: p=0.057). In the full risk unlike the univariate) model, a weekend admission was not independently predictive (OR 1.05; 95% CI: 0.88, 1.24). The case-mix for a weekend admission differed; with more neurological diagnoses (22.8% vs 20.4% : p = 0.001) and less gastrointestinal disease (18.3% vs 21.1% : p = 0.001). A biochemistry only illness severity score predicted a higher mortality for weekend admissions. CONCLUSION: Patients admitted at the weekend had an approximate 11% increased 30-day in-hospital mortality, compared with a weekday admission. However, admission at the weekend was not independently predictive in a risk model that included Illness Severity (age and biochemical markers) and co-morbidity. Sicker patients, with a worse outcome, are admitted over the weekend; these considerations should inform the allocation of healthcare resources.
Subject(s)
Emergencies/epidemiology , Emergency Service, Hospital/statistics & numerical data , Hospital Mortality/trends , Patient Admission , Risk Adjustment/methods , Severity of Illness Index , Adult , Aged , Female , Follow-Up Studies , Humans , Ireland/epidemiology , Length of Stay/trends , Male , Middle Aged , Odds Ratio , Retrospective Studies , Time FactorsABSTRACT
OBJECTIVE: In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy. METHODS: In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days. RESULTS: Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p =0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p =0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p =0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6-837.5, p =0.03), and 7 days (HR 9.1, 1.1-79.2, p =0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p =0.06). CONCLUSIONS: Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.
Subject(s)
Endarterectomy, Carotid/methods , Stroke/surgery , Aged , Aged, 80 and over , Carotid Stenosis/complications , Carotid Stenosis/surgery , Cohort Studies , Female , Functional Laterality , Humans , Ireland/epidemiology , Magnetic Resonance Angiography/methods , Male , Middle Aged , Recurrence , Regression Analysis , Risk Factors , Stroke/complications , Time Factors , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: The use of the bedside to teach the art of clinical medicine is controversial. Rising student numbers can limit patient availability. Studies examining inpatient attitudes to bedside teaching are few. AIMS: We examined inpatients' attitudes to bedside teaching of undergraduate medical students. METHODS: The study was carried out in a 439-bed teaching hospital. A questionnaire, numerically scored (0-10), was prospectively administered to 102 consecutive patients involved in bedside teaching of undergraduate medical students. RESULTS: The results were available from 92 patients. Patients enjoyed the teaching process (mean score 9.13 +/- 1.16) and benefited from a better understanding of their illness (7.11 +/- 2.57). Patients appreciated their role in educating future doctors (mean score 9.52 +/- 1.11) but demonstrated less confidence in their personal contribution to the teaching process (7.81 +/- 1.89). CONCLUSIONS: Inpatients are very willing participants in bedside teaching of undergraduate medical students.
Subject(s)
Education, Medical, Undergraduate/methods , Patient Satisfaction/statistics & numerical data , Point-of-Care Systems , Practice Patterns, Physicians' , Teaching , Clinical Competence , Educational Measurement , Educational Status , Faculty, Medical , Female , Health Knowledge, Attitudes, Practice , Hospitals, Teaching , Humans , Inpatients , Ireland , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Students, Medical , Surveys and QuestionnairesABSTRACT
A patient developed toxic epidermal necrolysis (TEN), which was triggered by sun exposure while the patient was on long-term hydroxychloroquine. Phototoxic and photoallergic reactions are known to occur with hydroxychloroquine, but, to our knowledge, this is the first reported case of photo-induced TEN associated with the drug.
