Rightward bias in right hemisphere infarct patients with or without thrombolytic treatment and in healthy controls.

Right hemisphere (RH) infarct patients have a tendency to begin visual scanning from the right side of a given stimulus. Our aim was to find out whether RH patients with (T+) or without (T-) thrombolytic treatment and healthy controls differ in their starting points in three cancellation tasks. Our sample comprised of 77 patients and 62 controls. Thirty-four patients received thrombolysis. Rightward orientation bias was more evident in the T- group than in the T+ group. The T+ group showed a robust tendency to start all cancellation tasks more often on the right side than the controls. Regardless of whether they had visual neglect, patients in the T+ group showed still defective rightward orienting, possibly indicating residual attentional problems. The analyses of starting points in visual cancellation tasks provide additional information on residual symptoms of attention difficulties after stroke.

Predictors of discharge to home after thrombolytic treatment in right hemisphere infarct patients.

BACKGROUND: The aim of the study was to assess the association between thrombolysis and length of hospital stay after right hemisphere (RH) infarct, and to identify which cognitive functions were predictive of discharge. METHODS: The study group consisted of 75 acute RH patients. Thirty-three patients had thrombolysis. Neuropsychological examinations were performed within 11 days of stroke onset. The cognitive predictors were visual neglect, visual memory, visual search and reasoning and visuoconstructive abilities. The outcome variable was time from stroke to discharge to home. RESULTS: Thrombolysis emerged as a statistically significant predictor of discharge time in patients with moderate/severe stroke (NIHSS ≥5). In the total series of patients and in patients with mild stroke (NIHSS <5), thrombolysis was not significantly associated with discharge time. Milder visuoconstructive defects shortened the hospital stay of the whole patient group and of patients with moderate/severe stroke. In all patient groups, independence in activities of daily living (ADL) was a significant single predictor of a shorter hospital stay. The best combination of predictors for discharge was independence in ADL in the total series of patients and in patients with mild stroke, and thrombolysis and independence in ADL in patients with moderate/severe stroke. CONCLUSIONS: Thrombolytic treatment was a significant predictor of earlier discharge to home in patients with moderate/severe RH infarct, while cognitive functions had less predictive power.

The sinking of the Estonia: the effects of critical incident stress debriefing (CISD) on rescuers.

On the morning of September 28, 1994 the ferry Estonia sank off the coast of Finland. The loss of life reached 852 persons, while 137 persons were rescued. This study investigated the effectiveness of Critical Incident Stress Debriefing (CISD) as a crisis intervention process. Results of this controlled investigation revealed that the CISD intervention proved effective in reducing symptoms of distress and psychological trauma as psychometrically assessed.