Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke

Association between the blood urea nitrogen-to-creatinine ratio and 3-month outcomes in patients with acute ischemic stroke: a secondary analysis based on a prospective cohort study

Introduction

This study aimed to assess the correlation between the blood urea nitrogen (BUN)-to-creatinine (BUN/Cr) ratio and adverse outcomes (AOs) at 3 months in patients with acute ischemic stroke (AIS) in the Korean population.

Methods

This cohort study encompassed 1906 cases of AIS at a South Korean hospital from January 2010 to December 2016. To determine the linear correlation between the BUN/Cr ratio and AOs in AIS, a binary logistic regression model (BLRM) was employed. Additionally, generalized additive models and techniques for smooth curve fitting were utilized to reveal the nonlinear dynamics between the BUN/Cr ratio and AOs in patients with AIS.

Results

The prevalence of AOs was 28.65%, with a median BUN/Cr ratio of 18.96. Following adjustments for covariates, the BLRM disclosed that the association between the BUN/Cr ratio and the risk of AOs in patients with AIS did not attain statistical significance. Nevertheless, a nonlinear relationship surfaced, pinpointing an inflection point at 21.591. To the left of this inflection point, a 31.42% reduction in the risk of AOs was noted for every 1-unit surge in the Z score of the BUN/Cr ratio [odds ratio (OR) = 0.686, 95% confidence interval (CI): 0.519, 0.906, p = 0.008]. On the right side of the inflection point, the effect size (OR = 1.405, 95% CI: 1.018, 1.902, p = 0.039) was determined.

Conclusion

The findings of this study underscore the intricate nature of the relationship between the BUN/Cr ratio and 3-month outcomes in patients with AIS, establishing a robust groundwork for future investigations.

Association of Bun/Cr ratio-based dehydration status with infarct volumes and stroke severity in acute ischemic stroke

BACKGROUND

Only a few clinical research had previously investigated the dehydration status to predict the evolution of the ischemic core. The aim of this study is to clarify the association between blood urea nitrogen (BUN)/creatinine (Cr)ratio-based dehydration and infarct volume measured using DWI (Diffusion-weighted imaging) at admission in patients with AIS (Acute Ischemic Stroke).

METHODS

We retrospectively recruited a total of 203 consecutive patients who were hospitalized through emergency or outpatient services within 72 h of acute ischemic stroke onset between October 2015 and September 2019. Stroke severity was measured by assessing the National Institutes of Health Stroke Scale (NIHSS) on admission. Infarct volume was measured using DWI with MATLAB software.

RESULTS

In this study, 203 patients who met the study criteria were enrolled. Patients in the dehydration group (Bun/Cr ratio>15) had a higher median NIHSS score (6(IQR:4-10) VS. 5(3-7); P = 0.0015)and larger DWI infarct volume (1.55 ml (IQR:0.51-6.79) VS. (0.37 ml (0.05-1.22); P < 0.001) on admission compared with patients in normal group. Further, a statistically significant correlation was found between DWI infarct volumes and NIHSS score with nonparametric Spearman rank correlation (r = 0.77; P < 0.001). The median NIHSS scores for the DWI infarct volumes quartiles were 3 ml (IQR, 2-4), 5 ml (4-7), 6 ml (5-8), and12 ml (8-17) from lowest to highest. However, the second quartile group did not show any significant correlation with the third quartile group (P = 0.4268). Multivariable linear and logistic regression analyses were used to test dehydration (Bun/Cr ratio>15), representing a predictor of infarct volume and stroke severity.

CONCLUSION

Bun/Cr ratio-based dehydration is associated with larger volumes of ischemic tissue measured using DWI and worse neurological deficit assessed by the NIHSS score in acute ischemic stroke.

'I've never drunk very much water and I still don't, and I see no reason to do so': a qualitative study of the views of community-dwelling older people and carers on hydration in later life

Background

dehydration is associated with significant adverse outcomes in older people despite being largely preventable and treatable. Little research has focused on the views of community-dwelling older people on hydration, healthy drinking and the perceived importance of drinking well in later life.

Objectives

to understand community-dwelling older people and informal carers’ views on hydration in later life and how older people can be supported to drink well.

Methods

qualitative study using interviews and a focus group exploring hydration and nutrition in later life (24 older people at risk of malnutrition and dehydration, 9 informal carers) and thematic analysis.

Results

this article presents the findings on hydration alone. Four themes are presented: perceptions of healthy drinking, barriers to and facilitators of drinking in later life and supporting older people to drink well. The perceived importance of adequate hydration in later life was polarised. Concerns about urinary incontinence and knowledge gaps were significant barriers. Consideration of individual taste preference and functional capacity acted as facilitators. Distinct habitual drinking patterns with medications and meals exist within individuals. Many relied on thirst at other times or when fluid demands are greater (such as hot weather), a known unreliable prompt in later life.

Conclusions

older people could be supported to drink well by building upon existing habitual drinking patterns. Primary care and public health should consider individual barriers, facilitators and tailored education. A multidisciplinary approach to promote hydration should be incorporated into care for older people with more complex needs.

Guía para un Plan de egreso en personas con secuelas por Enfermedad Vascular Cerebral

Introducción: Las personas que sufren un Evento Vascular Cerebral (EVC), generalmente quedan incapacitadas para la realización de sus actividades básicas, lo que conlleva a una dependencia. Por consiguiente, es importante la elaboración de un plan de egreso con amplia información sobre los cuidados que facilite al profesional de enfermería brindar educación para la salud, dirigida a familiares y enfermos sobre el cuidado en el hogar tras un EVC. Métodos: El procedimiento utilizado para esta propuesta constó de tres fases, en las cuales se realizó una revisión de la literatura, una delimitación con base en el tema central, para finalmente, elaborar el plan de egreso que aquí se presenta. Resultados: En la primera fase se analizaron 39 estudios, 16 de tipo cualitativo, 11 cuantitativos, ocho Guías de práctica clínica, tres mixtos y dos tesis; posteriormente, en la segunda fase se estableció la delimitación del tema con base en el criterio de evidencia científica y los diagnósticos enfermeros de la NANDA, y finalmente; en la tercera fase, se prescribieron las principales intervenciones de cuidado a implementar tras el egreso de pacientes con EVC. Discusión y conclusiones: El plan de egreso forma parte del cuidado integral y humanizado, requiere llevarse a cabo de forma habitual para facilitar el diálogo sobre las incertidumbres, dudas y angustias presentes, frecuentemente, en el cuidador primario y enfermo tras su egreso. A su vez, las guías de cuidado contribuyen a establecer el plan de egreso al enfermo, con el propósito de disminuir los reingresos hospitalarios, prevenir complicaciones y mejorar su calidad de vida, además de poder seguir innovando la práctica clínica de enfermería.