Revista Científica de la Sociedad de Enfermería Neurológica (English ed.)最新文献

Background

Although cerebral angiography is the reference technique for the diagnosis and treatment of cerebrovascular diseases, it is not without complications.

Objectives

To determine the incidence and risk factors of complications derived from therapeutic cerebral angiography (TCA), as well as to assess the risk factors associated with the appearance of local and intracranial complications.

Methodology

Retrospective cross-sectional study on TCAs carried out in 2018 on admission to the Stroke Unit of the Hospital Clínic de Barcelona. The study was approved by the centre’s ethics committee. Demographic, clinical, analytical, and procedure-derived variables were collected. All patients older than 18 years undergoing TCA were included. Patients undergoing diagnostic cerebral arteriography and/or with a hospital stay less than 24 h were excluded. The Mann-Whitney U test was used for the comparison of quantitative variables and Pearson’s Chi-squared test for the qualitative variables.

Results

Complications were frequent, occurring in almost half of the sample (44%). A longer duration of arteriography was associated with an increase in local complications (p = .005). Intracranial complications occurred in 33% of the patients who underwent mechanical thrombectomy and were associated with older age (p = .012), stent use (associated or not with aspiration) (p = .003), and complete recanalization (p = .02), as well as having a worse functional status at discharge (p = .006).

Conclusions

Complications derived from ACT are frequent. Their importance and incidence must be known to detect those subjects at higher risk for developing them due to their functional implications and increased hospital stay.

Aim

Analyze the relationship between attendance times and health outcomes of people with ischemic stroke treated with intravenous fibrinolysis, comparing those attended from the emergency units of 061 ARAGON with those arriving by other means.

Method

Cross-sectional, retrospective, descriptive and association study based on a consecutive series of patients treated at the Miguel Servet University Hospital in the period 2014−16, analysing the time of care up to fibrinolysis and results of intravenous fibrinolysis, in terms of mortality and functional status at discharge. We also analysed the influence on attendance times of the protocol change that was carried out in 2016 and that included the direct warning to neurologists, instead of the receiving emergency, as before.

Results

A total of 231 patients with stroke were collected and treated with intravenous fibrinolysis. The mean age of the patients was 75.91 (±12.48). Women accounted for 52.8% of those fibrinolysed, the average age of men being lower [74.07 (±13.71) years, compared with 77.55 (±11.07) years for women]. The mean score on the NIHS scale at admission between the two groups presented significant differences (p = 0.006), being greater the affectation among those who arrived with 061 [NIHSS 13.20 ± 6.78 vs 10.7 ± 6.22]. In the comparison of times between patients who arrive or not with 061, the average time to hospital was 91.42 (±59.64) vs 93.20 (±83.73) (p = 0.731), without significant differences. However, there were significant differences in the time door needle (p = 0.046), noting that patients who are brought by 061 Aragon have better in-hospital time until fibrinolysis (better door-needle time) (67.19 (±26.03) vs 77.83 (±38.35).

In the analysis of the door needle time by years, significant differences were observed (p < 0.001), being shorter each year, with a clear shortening in 2016 compared to previous ones, reflecting the impact of the update of protocols in this time period.

Conclusions

The patients brought in by 061 were different (more affected), fibrinolysed in a greater percentage and faster. Direct notice to neurologists significantly shortened attendance times. In terms of mortality and functional status at discharge, there were no differences between the two groups.

Introduction

At the beginning of the SARS-CoV-2 pandemic, health centres were places where there was a high risk of infection, and during the period of lockdown face-to-face health care was substantially reduced, forcing rapid changes in the care of multiple sclerosis patients by the specialised nursing staff in the units and monographic consultations of this disease.

Development

The experience of the nursing staff of multiple sclerosis units and monographic consultations, in 8 Spanish hospitals, is collected from the beginning of the pandemic and in later stages, and the adaptations that they made to continue caring for patients are specifically described. The scientific literature about how the SARS-CoV-2 has affected patients with multiple sclerosis is also reviewed, as well as the experiences of other multiple sclerosis teams in health centres in other countries.

Conclusions

During the lockdown and in later stages, new forms and previously little used forms of care were applied to multiple sclerosis patients. The nursing staff kept contact with them by telephone and online, provided them with information about safety and behaviour in relation to COVID-19. Face-to-face visits, treatments and distribution of medication were adapted. Information was provided about how patients could receive psychosocial support and about how they could maintain their quality of life.

Objectives

To improve language in aphasic patients after a recent ischaemic stroke using computer applications for mobile devices (tablet) for 30 days and to establish whether length of use influences this improvement.

Method

Randomised, prospective, single-centre clinical trial with two intervention groups, one of which was a control group. Aphasic patients were included within a maximum of 7 days after an ischaemic stroke. The intervention group used tablet-specific software for 30 days. Language improvement was assessed using the Mississippi Aphasia Screening Test (MAST).

Results

The sample was 40 patients, mean age 73 years (± 10.2). Fifty percent were women. Patients were equally divided between the 2 groups. Mean device use was 311.8 (±334.6) minutes after the end of 30 days, with a final mean improvement in MAST of 46.5 (±22.3) points in the intervention group and 34.8 (±21.7) in the control group (p = .233). Adjusting for age, the results indicate that the patients who tend to improve the most are those under 65 years of age (43.8 (±30.5) points, p = .205). We were unable to demonstrate significant differences between the two groups.

Discussion and/or conclusions

The results obtained in the study suggest that new technologies can be an effective tool for language recovery, especially in young patients. Multicentre studies with a larger sample size and younger patients may be able to demonstrate the usefulness of this new tool.