Spouses' need for information and satisfaction with the patient's care and rehabilitation after stroke. Importance of depression and prescheduled follow-up.

OBJECTIVES: We aimed to study the information needs of the spouses of stroke survivors, and whether the functional ability, depressive mood, or demographic factors of the survivors or spouses associate with the information needs or satisfaction with care. We also investigated whether prescheduled follow-up improves information provision. METHODS: Ninety-six spouses of consecutive stroke survivors completed a questionnaire on their information needs and satisfaction with care 21 months post-stroke. The results of samples before (n = 59) and after (n = 37) the implementation of the prescheduled follow-up were compared. RESULTS: Before the follow-up, 75% of the spouses had received information on stroke and the well-being of the survivor, with 31% having received information on the survivors' and 18% on the spouses' own mood. The information provision improved after the follow-up: 86%, 44%, and 50%, respectively. The need for more information and satisfaction with care were associated with the spouse's depression, but not with functional impairment. CONCLUSIONS: Even if information on stroke is satisfactorily provided, the mood and well-being of spouses is often neglected. Information provision and support can be improved with systematic prescheduled follow-up. PRACTICE IMPLICATIONS: Our results suggest the routine assessment of the depressive symptoms and needs of spouses of stroke survivors.

Behaviour of Extractives in Norway Spruce (Picea abies) Bark during Pile Storage.

The current practices regarding the procurement chain of forest industry sidestreams, such as conifer bark, do not always lead to optimal conditions for preserving individual chemical compounds. This study investigates the standard way of storing bark in large piles in an open area. We mainly focus on the degradation of the most essential hydrophilic and hydrophobic extractives and carbohydrates. First, two large 450 m3 piles of bark from Norway spruce (Picea abies) were formed, one of which was covered with snow. The degradation of the bark extractives was monitored for 24 weeks. Samples were taken from the middle, side and top of the pile. Each sample was extracted at 120 °C with both n-hexane and water, and the extracts produced were then analysed chromatographically using gas chromatography with flame ionisation or mass selective detection and high-performance liquid chromatography. The carbohydrates were next analysed using acidic hydrolysis and acidic methanolysis, followed by chromatographic separation of the monosaccharides formed and their derivatives. The results showed that the most intensive degradation occurred during the first 4 weeks of storage. The levels of hydrophilic extractives were also found to decrease drastically (69% in normal pile and 73% in snow-covered pile) during storage, whereas the decrease in hydrophobic extractives was relatively stable (15% in normal pile and 8% in snow-covered pile). The top of the piles exhibited the most significant decrease in the total level of extractives (73% in normal and snow-covered pile), whereas the bark in the middle of the pile retained the highest amount of extractives (decreased by 51% in normal pile and 47% in snow-covered pile) after 24-week storage.

Implementation of Prescheduled Follow-Ups With Education Improve Poststroke Depression Screening Compliance in Routine Clinical Practice.

OBJECTIVES: To investigate the extent to which the mood of stroke patients is assessed and what kind of assessment methods are used in routine clinical practice, and whether prescheduled follow-ups can improve the detection of depression, particularly when this practice is blended with better education for health care professionals in assessing and detecting depression. DESIGN: Before-after trial with an 18-month follow-up and a review of medical records. SETTING: Acute care hospital, community. PARTICIPANTS: Consecutive acute stroke patients (N=398) were screened. Patients lived in a health care district with a population of 132,000. The screening took place in the first half of 2010 and then again, after the implementation of the follow-up system, in the first half of 2012. After exclusion of patients too severely ill to be interviewed, there were n=105 patients in the 2010 sample and n=112 patients in the 2012 sample. INTERVENTION: Implementation of a follow-up path for all stroke patients. MAIN OUTCOME MEASURES: The percentage and quality of mood assessments in the medical records; and the stroke patients' depressive symptoms and their satisfaction with their care. RESULTS: In the 2010 sample, 47% of the patients (n=48) had documentation of mood in their medical records. After the implementation of prescheduled follow-ups, 77% of the patients (n=86) had documented moods. The increase was highly significant (P<.001). During the early outpatient phase, the use of interviews increased from 14% (n=15) to 45% (n=50) of the patients (P<.001). The increase in the satisfaction with care did not reach statistical significance. Depressive symptoms recorded at any time were associated with depressive symptoms at 18 months (P<.001). CONCLUSIONS: Prescheduled follow-ups for all stroke patients, including routine depression screening, can remarkably improve the compliance with depression screening and the detection of depression.