Eating difficulties in relation to gender, length of stay, and discharge to institutional care, among patients in stroke rehabilitation.

PURPOSE: To describe and compare eating difficulties from admission to discharge, with regard to length of stay (LOS) and discharge to institutional care, as well as in relation to gender. METHOD: Patients, aged 65 or above, admitted for stroke rehabilitation, having at least one eating difficulty were observed (n =108) as regards to eating on admission and at discharge. Analysis followed earlier findings in which eating difficulties had been found to have three components, i.e. ingestion, deglutition and energy. RESULTS: Of the components, ingestion difficulties were the most common, followed by low energy. The most common single difficulties were low food consumption, difficulties in manipulating food on the plate and transporting it to the mouth. Ingestion difficulties especially decreased during the rehabilitation period. Women were older and ate less on admission and at discharge than men, improved less than men, and also a higher proportion had a low food intake at the time of discharge if having longer LOS and/or being discharged to institutional care. Patients with longer LOS and those discharged to institutional care had more eating difficulties on admission and were more dependent in activities of daily living (ADL) than those with shorter LOS and those who returned home. LOS was mainly explained by ingestion difficulties on admission and low age. Discharge to institutional care was explained by living alone before admission, ingestion difficulties at discharge, male gender and high age. CONCLUSIONS: Ingestion difficulties on admission indicate a longer in-hospital stay and decrease to a greater extent than other types of eating difficulties. If these difficulties persist at the time of discharge the patients are more likely to need institutional care. It is important to assess and take systematic measures for each of the three variants of eating difficulties, i.e. ingestion, deglutition, and energy, to improve eating abilities. Women in particular need attention with regard to low food intake.

Eating difficulties, complications and nursing interventions during a period of three months after a stroke.

AIM: The aim of this study was to describe eating difficulties and especially swallowing in patients with dysphagia, types of nursing intervention, and the development of complications over 3 months. The aim was also to explore common characteristics of eating difficulties that influenced the ability to finish meals. METHODS: Twenty-four consecutive patients admitted because of stroke and dysphagia were included. Nursing interventions, based on assessments, were individually designed. RESULTS: Three subgroups could be identified: those (n=9) who were unable to complete a meal, despite assisted feeding, because of reduced alertness/energy and impaired swallowing function; those (n=5) who could complete a meal, despite suffering from reduced alertness/energy; and those (n=10) who could complete meals with minor difficulties. Patients in the first two groups developed complications such as respiratory infections and/or malnutrition. There was a tendency towards that complications in the third group were less frequent and the hospital stay was significantly shorter than in the other groups. CONCLUSION: The level of alertness/energy in patients with dysphagia after stroke was important for the ability to eat and swallow and the development of complications over time, and thus of great importance for the interventions applied.

High-resolution constant-height imaging with apertured silicon cantilever probes.

We present high-resolution aperture probes based on non-contact silicon atomic force microscopy (AFM) cantilevers for simultaneous AFM and near-infrared scanning near-field optical microscopy (SNOM). For use in near-field optical microscopy, conventional AFM cantilevers are modified by covering their tip side with an opaque aluminium layer. To fabricate an aperture, this metal layer is opened at the end of the polyhedral probe using focused ion beams (FIB). Here we show that apertures of less than 50 nm can be obtained using this technique, which actually yield a resolution of about 50 nm, corresponding to lambda/20 at the wavelength used. To exclude artefacts induced by distance control, we work in constant-height mode. Our attention is particularly focused on the distance dependence of resolution and to the influence of slight cantilever bending on the optical images when scanning at such low scan heights, where first small attractive forces exerted on the cantilever become detectable.

Acute leukaemia or highly malignant lymphoma patients' quality of life over two years: a pilot study.

The aim of this study was, first, to investigate the quality of life and sense of coherence for acute leukaemia and malignant lymphoma patients at the start of treatment and over 2 years. A second aim was to compare questionnaire responses with patients' statements in open-ended interviews. A consecutive sample of 16 patients responded to the Quality of Life Questionnaire (QLQ-C30), Lund Gerontological Centre questionnaire and the Sense of Coherence Scale at the start of treatment and after 12 and 24 months. The QLQ-C30 questionnaire was administered also after 4, 8, 16 and 20 months. Tape-recorded open-ended interviews were conducted every 4 months before the patients responded to the questionnaires. Quality of life (QoL) and sense of coherence were scored more highly at the beginning of treatment for patients who did not relapse, than for those who relapsed. This difference remained throughout the study period. There was no correspondence in responses between questionnaire and personal interviews, although the results from the interviews, in some aspects, validated the result from the QLQ-C30. Those patients who relapsed may have had different prerequisites or been in a worse position at the onset of the disease and, reasonably, they needed more compensatory nursing care. More knowledge about the correspondence between a person's perceived QoL when discussed in personal interviews compared with responses given in standardised QoL questionnaires is needed before any assumption about clinical relevance can be made.

Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation.

The aim of this study was to describe the types and extent of eating difficulties, the need for assistance when eating, the nutritional status and pressure ulcers in consecutive patients (n = 162) admitted for stroke rehabilitation over a period of 1 year. Structured observations and assessments of eating, nutritional status (subjective global assessment of nutritional status), pressure ulcers and activities in daily living (Katz ADL-index) were performed by a nurse who also trained the staff to perform these assessments. Difficulties in eating were found in 80%, and 52.5% were unable to eat without assistance. Eating difficulties were: 'eats three-quarters or less of served food' (60%), difficulties in 'manipulating food on the plate' (56%), 'transportation of food to the mouth' (46%), 'sitting position' (29%), 'aberrant eating speed' (slow or forced) (26%), 'manipulating food in the mouth' (leakage, hoarding, chewing difficulties) (24%), 'swallowing difficulties' (18%), 'opening and/or closing the mouth' (16%), and 'alertness' (9%). Thirty-two percent were undernourished (49% of patients needing assisted eating and 13% of those not needing assistance, P < 0.0005). Among patients who were dependent in one or more functions according to the Katz ADL-index, 15% had pressure ulcers. The strongest eating variables for predicting nutritional status were 'alertness', 'swallowing difficulties', 'eats three-quarters or less of served food', and 'aberrant eating speed'. Nutritional status could in turn significantly predict pressure ulcers. Eating difficulties among patients with stroke are complex and the patient's situation before stroke adds to this complexity, especially among those dependent on assisted eating. As difficulties occur both among patients needing and not needing assisted eating, all patients with stroke admitted for rehabilitation need to be systematically assessed for eating difficulties and action needs to be taken to facilitate eating, especially as patients with eating difficulties risk becoming undernourished and in turn developing pressure ulcers.

Nano-slit probes for near-field optical microscopy fabricated by focused ion beams.

The near-field probes described in this paper are based on metallized non-contact atomic force microscope cantilevers made of silicon. For application in high-resolution near-field optical/infrared microscopy, we use aperture probes with the aperture being fabricated by focused ion beams. This technique allows us to create apertures of sub-wavelength dimensions with different geometries. In this paper we present the use of slit-shaped apertures which show a polarization-dependent transmission efficiency and a lateral resolution of < 100 nm at a wavelength of 1064 nm. As a test sample to characterize the near-field probes we investigated gold/palladium structures, deposited on an ultrathin chromium sublayer on a silicon wafer, in constant-height mode.

Nursing assessment of dysphagia among patients with stroke.

The aims of this study were to investigate the frequency of dysphagia among patients with acute stroke and compare non-dysphagic and dysphagic stroke patients regarding demographic aspects, performance in activities of daily living and type of neurological deficiency and to test a bedside screening tool to identify patients with dysphagia. The frequency of dysphagia was found to be 27%, or 40% if those patients who were unconscious, terminally ill or had a previous history of dysphagia were included. Overall stroke severity seemed to be an indicator for dysphagia, i.e. being significantly more drowsy, more dependent in activities of daily living, suffering more often from dysarthria, expressive dysphasia, taking antidepressive medication, staying significantly longer in hospital and being discharged to a higher level of formal care than non-dysphagic patients. The screening method proved to be useful, in that it detected 77% of those with dysphagia using a review of medical charts and continuous observations as a method to check the reliability of the bedside method. It is concluded that most patients with dysphagia can be identified through systematic interviews, observations and test swallows. These have to be repeated and included in nursing care assessment. Overall stroke severity is an indicator of dysphagia.

Survivors of acute leukaemia and highly malignant lymphoma--retrospective views of daily life problems during treatment and when in remission.

Fifty-four former patients, in remission after acute leukaemia or highly malignant lymphoma, responded to a questionnaire covering their physical problems, their view of the help they received, who was most helpful to them during the treatment phase, and the impact of the disease and treatment on their current life. Energy loss and nutritional problems were most troublesome during the treatment phase, signifying many other physical problems. Patients with acute leukaemia had more problems, and thought the care was worse than did patients with highly malignant lymphoma. Serious physical problems correlated with low satisfaction with practical help received, indicating that the nurses failed to meet the needs of those suffering the most. Reduced psychological and sexual energy persisted in remission, showed no correlation with the extent of physical problems during the treatment phase, but correlated with co-existing problems and sensitivity to infections, with a great need for intimate help and counselling and with a low sense of coherence. Family relationships were said to have improved, while work and finances were negatively affected. The results indicate that nursing care should actively focus on physical problems, especially on energy loss and nutritional problems. The overwhelming fatigue hinders patients in taking physical care of themselves, and may be overlooked by the nurse since their motor capability seems intact. The long-term effect of the illness means a reduced psychological and sexual energy and a high degree of existential problems and sensitivity to infections, which indicates the importance of follow-up care, and perhaps especially of counselling for the long-term reactions and disturbance of equilibrium.

Increased CKMB (mass concentration) in patients without traditional evidence of acute myocardial infarction. A risk indicator of coronary death.

A study of 102 patients consecutively admitted to a coronary care unit (CCU) investigated the clinical usefulness of three different immunoenzymometrical CKMB methods: NovoClone CK-MB, ICON QSR CKMB and IMx CK-MB. Blood samples were drawn on admission and then every 6 h for 48 h. The three different methods correlated very well (r = 0.93-0.96). With discrimination levels of 10 micrograms.l-1 for NovoClone CK-MB and 5 micrograms.l-1 for the other two methods, a sensitivity of 1.0 and a still acceptable specificity (> 0.81) were achieved. In the group of patients (n = 53) with suspicion of acute myocardial infarction (AMI) but with no standard criteria for AMI, 14 patients were identified with small but significant increase of serum CKMB (mass concentration) and an increased CKMB (mass concentration)/CK ratio. During a 4 year follow-up nine out of these 14 patients died within 2 years, the majority being coronary deaths, as compared to only two out of the remaining 39 non-AMI patients with suspicion of AMI but with normal CKMB values (chi 2 = 18.47, P < 0.001). The finding of such a high mortality rate among patients with increased CKMB (mass concentration) has an important prognostic value even in patients without standard criteria for AMI.

The effect of beta-blockade on leg blood flow in hypertensive patients with intermittent claudication.

The present study was designed to assess the short-term effects of beta-blocking antihypertensive treatment on leg blood flow in patients with peripheral artery disease. Seven patients with intermittent claudication were randomly allocated to treatment with atenolol 100 mg or pindolol 10 mg. Patients switched therapy after one month of treatment. Venous occlusion plethysmography on the calves was used to assess the effects on leg blood flow after one and two months of treatment. The average 10% reduction of the systolic and diastolic blood pressures was not associated with any reduction of blood flow at rest. There was on average 3.4 ml reduction of peak flow which had no influence on the painfree or total walking distance.

Venous volume in offspring of hypertensive patients.

Twenty normotensive healthy male offspring of hypertensive patients were compared to 20 adequate controls regarding venous volume, the effect of ouabain on venous volume and signs of left ventricular hypertrophy. Among offspring there were slightly increased amplitudes in the orthogonal ECG as compared to controls but the differences were not statistically significant. Using a plethysmographic technique we found a significantly lower venous volume of the forearm in the offspring than in controls. There was, however, no effect of ouabain on the venous volume. The decreased venous distensibility among normotensive offspring might be an early manifestation of essential hypertension.

Serum LD-1 activity in suspected acute myocardial infarction.

We have studied the diagnostic value of measuring lactate dehydrogenase (LD) isoenzyme 1 in serum of 331 cases of suspected acute myocardial infarction (AMI). At a discriminatory level of 200 U/L (Scandinavian Committee on Enzymes, recommended method for the determination of LD) LD 1 verified the diagnosis in 96% of the AMI cases and excluded it in 96% of the not-AMI cases when samples were drawn 24-72 h after onset of pain. The correlation between 24-h S-LD-1 and 16-h S-CK B activities was 0.94 in the AMI cases. We found that quantitation of serum LD-1 is diagnostically more reliable than the serum LD-1/LD ratio.

Left ventricular function at rest and during exercise in coronary insufficiency--a simultaneous evaluation by means of radionuclide angiocardiography and catheterization.

Left ventricular function was assessed simultaneously with heart catheterization and equilibrium radionuclide angiocardiography at rest and during supine exercise in ten patients with effort angina. At rest all had normal haemodynamics. During exercise all developed angina with signs of left ventricular dysfunction in the form of high left ventricular filling pressure, 31 +/- 2 mm Hg (mean +/- SEM) and pathological decreases in left ventricular ejection fraction (11 +/- 1% units). Left ventricular end-systolic volume increased significantly (43 +/- 7%), but the increase in left ventricular end-diastolic volume (13 +/- 7%) was not significant. The discordance between the changes in left ventricular filling pressure and the changes in left ventricular end-diastolic volume is discussed. Radionuclide angiocardiography revealed left ventricular dysfunction as frequently as did heart catheterization.

Left ventricular function after myocardial infarction.

We assessed simultaneously left ventricular filling pressure and stroke index with left ventricular ejection fraction in 22 patients who had had their first transmural myocardial infarction about 11 days before the examination. Eleven were classified as anterior myocardial infarctions and 11 as inferior. Left ventricular ejection fraction was determined by equilibrium radionuclide angiocardiography. Significant correlations between left ventricular ejection fraction and left ventricular filling pressure or stroke index were obtained both at rest and during exercise. Left ventricular dysfunction was more severe in patients with anterior myocardial infarction whose left ventricular ejection fraction at rest was 34.9+/-3.4% as compared to 52.6+/-2.1% in inferior myocardial infarction. We conclude that the radionuclide method is as sensitive as catheterization for detecting left ventricular dysfunction at rest and during exercise in patients with myocardial infarction.

Blood pressure, cardiac output and systemic vascular resistance during rest, muscle work, cold pressure test and psychological stress. A study of male offspring from families with a history of essential hypertension for at least two generations.

Haemodynamic changes in the early phases of hypertensive diseases have mainly been described in so-called borderline hypertensives. Their cardiac output (CO) has mostly been found to be elevated, but the peripheral vascular resistance (PRI) normal. In this study of the offspring (26 subjects) of hypertensive individuals, CO and intravascular pressures were measured during rest, muscular work, psychological stress and cold pressure test. For comparison, the same measurements were performed in a control group of healthy volunteers without known hypertension in their families. The offspring had higher blood pressure at rest than the controls throughout the study except during the cold pressure test and the highest dynamic work loads. Although there was no statistically significant difference between offspring and controls as regards PRI, the resistance was slightly higher in the group of offspring throughout the study. Arterial blood pCO2 in offspring was significantly lower at rest, during psychological stress and dynamic muscle work. Possible mechanisms behind this finding are considered.