Prevalence of Worsening Problems Using Post-Stroke Checklist and Associations with Quality of Life in Patients with Stroke.

BACKGROUND AND AIM: A post-stroke checklist was developed to improve the standard of long-term post-stroke care and health-related quality of life. We aimed to investigate the prevalence of worsening problems using a post-stroke checklist at 3, 6, and 12 months post-stroke and their associations with health-related quality of life in patients with stroke. METHODS: In stroke patients admitted between June 2014 and December 2015, post-stroke checklist and EuroQol-5D three level were assessed at post-stroke 3 (n=181), 6 (n=175), and 12 months (n=89). The prevalence of worsening problems and its association with EQ-5D index at post-stroke 3 and 6 months were analyzed. RESULTS: The most frequently and continuously identified worsening problems were mood disturbances (reported by 8.8%, 16.0% and 13.5% of patients at 3, 6, and 12 months post-stroke, respectively). Worsening mobility was significantly associated with worse EQ-5D index at post-stroke 3 months (ß= -0.583; 95% confidence interval [CI], -1.045 to -0.120; P=0.014). The worsening of mobility and communication was significantly associated with worse EQ-5D index at post-stroke 6 months (mobility: ß= -0.170; 95% confidence interval [CI], -0.305 to -0.034; P=0.014, communication: ß=-0.164; 95% confidence interval [CI], -0.309 to -0.020; P=0.026). CONCLUSIONS: A post-stroke checklist may be useful for detection of various subjective worsening problems during serial clinical follow-up after stroke. Appropriate rehabilitation and management strategy to solve the identified problems could improve the quality of life in stroke survivors.

Radiation Dose During Videofluoroscopic Swallowing Studies and Associated Factors in Pediatric Patients.

Although children are more radio-sensitive than adults, few studies have evaluated radiation dosage during videofluoroscopic swallowing study (VFSS) in children. The aim of the study was to investigate the radiation dosage using dose-area product (DAP) for VFSS in pediatric cases and to identify factors affecting the radiation dose. Patients aged 0-17 years who had undergone VFSS were included. The following data were collected retrospectively: DAP; fluoroscopic time; number of tried diets; and clinical characteristics including sex, age, etiology of dysphagia, and recommended feeding type. In the videofluoroscopic field, use of collimation and appearance of metal object, such as a lead apron or a wheel chair, was checked. A total of 290 VFSSs were included. The mean DAP was 5.78 ± 4.34 Gy cm2 with a mean screening time of 2.69 ± 1.30 min. The factors associated with the DAP included screening time, appearance of metal objects in the field, and use of collimation. In 98 cases with no metal object in the field and with collimation, the mean DAP was decreased to 2.96 ± 2.53 Gy cm2. This study evaluated the radiation dosage during VFSS in children according to age groups and the influencing factors such as screening time, appearance of metal objects in the field, and use of collimation in VFSS. To reduce radiation risk, it is important to identify and control modifiable factors.

Intraoperative Monitoring of Hypoglossal Nerve Using Hypoglossal Motor Evoked Potential in Infratentorial Tumor Surgery: A Report of Two Cases.

The hypoglossal nerve (CN XII) may be placed at risk during posterior fossa surgeries. The use of intraoperative monitoring (IOM), including the utilization of spontaneous and triggered electromyography (EMG), from tongue muscles innervated by CN XII has been used to reduce these risks. However, there were few reports regarding the intraoperative transcranial motor evoked potential (MEP) of hypoglossal nerve from the tongue muscles. For this reason, we report here two cases of intraoperative hypoglossal MEP monitoring in brain surgery as an indicator of hypoglossal deficits. Although the amplitude of the MEP was reduced in both patients, only in the case 1 whose MEP was disappeared demonstrated the neurological deficits of the hypoglossal nerve. Therefore, the disappearance of the hypoglossal MEP recorded from the tongue, could be considered a predictor of the postoperative hypoglossal nerve deficits.

Barriers to Outpatient Hospital-Based Cardiac Rehabilitation in Korean Patients With Acute Coronary Syndrome.

OBJECTIVE: To investigate factors associated with enrollment and participation in cardiac rehabilitation (CR) in Korea. METHODS: Patients admitted to four university hospitals with acute coronary syndrome between June 2014 and May 2016 were enrolled. The Cardiac Rehabilitation Barriers Scale (CRBS) made of 21-item questionnaire and divided in four subdomains was administered during admission. CRBS items used a 5-point Likert scale and ≥2.5 was considered as a barrier. Differences between CR non-attender and CR attender, or CR non-enroller and CR enroller in subscale and each items of CRBS were examined using the chi-square test. RESULTS: The CR participation rate in four hospitals was 31% (170 of the 552). Logistical factors (odds ratio [OR]=7.61; 95% confidence interval [CI], 4.62-12.55) and comorbidities/functional status (OR=6.60; 95% CI, 3.95-11.01) were identified as a barrier to CR enrollment in the subdomain analysis. Among patients who were enrolled (agreed to participate in CR during admission), only work/time conflict was a significant barrier to CR participation (OR=2.17; 95% CI, 1.29-3.66). CONCLUSION: Diverse barriers to CR participation were identified in patients with acute coronary syndrome. Providing the tailored model for CR according to the individual patient's barrier could improve the CR utilization. Further multicenter study with large sample size including other CR indication is required.