Eating and Grooming Abilities Predict Outcomes in Patients with Early Middle Cerebral Infarction: A Retrospective Cohort Study

Factors and prediction model associated with resumption of social outings in stroke survivors 6 months after onset: a multicenter prospective study

OBJECTIVES

To identify factors associated with the resumption of social outings 6 months after stroke onset and develop a simple clinically practical prediction model.

MATERIALS AND METHODS

Participants were recruited from first-ever stroke survivors admitted to three rehabilitation wards, and resumption of social outings 6 months after stroke onset was assessed using the Japanese version of the Frenchay Activities Index. The association of physical and cognitive functions with activities of daily living at admission to the rehabilitation ward and resumption of social outings 6 months after stroke onset was examined using logistic regression and decision trees.

RESULTS

Notably, 63.2% of the 57 stroke survivors who participated in this study had lower Frenchay Activities Index scores for social outings 6 months after stroke onset than before. Logistic regression analysis revealed that attention deficit and grooming on the Functional Independence Measure (FIMTM) were significantly associated with decreased social outing scores 6 months after stroke onset. A decision tree model was created to predict the resumption of social outings using the presence or absence of attention disorders and FIMTM grooming score (>2 or ≤ 2).

CONCLUSIONS

The results of this study suggest that attention deficit and beyond a certain level of independence in grooming (FIMTM >2) at admission to the rehabilitation ward are associated with recovery to the pre-stroke level of social outings 6 months after stroke onset. The decision tree created in this study holds promise as a simple model to predict the resumption of social outings among stroke survivors.

Personalized diet order compliance is associated with an improved functional independence measure (FIM) score in elderly patients: An eight-week follow-up study in a convalescent hospital

It is important to establish the relationship between appropriate nutritional intake and improvements in activities of daily living (ADLs) in elderly hospitalized patients. This prospective observational study aimed to investigate diet order compliance (DOC) during 8 weeks of hospitalization and calculate the odds of improved functional independence measure (FIM) scores for high- and low-DOC groups using covariate-adjusted models in geriatric convalescent hospitals. The study subjects were elderly inpatients (>65 years old) with degenerative disease who consumed prescribed oral meals (Functional Oral Intake Scale (FOIS) = 6/7) and who did not receive physical/occupational therapy. The personalized diet order was prescript, and the DOC was calculated using dietitian-monitored daily intake data. The 73 patients were divided into a low-DOC group (< 84.0%, n = 35) and a high-DOC group (≥ 84.0%, n = 38) on the basis of the median DOC (84.0%, average for 8 weeks). Twenty (52.6%) high-DOC patients and nine (25.7%) low-DOC patients experienced motor-FIM improvements (P = 0.017). After 8 weeks, the change in motor-FIM in the high-DOC group (1.6±0.3) was greater than that in the low-DOC group (0.3±0.1; P = 0.001). According to the baseline and nutrition-intake-adjusted model of multiple logistic regression analysis, in the high-DOC group, the motor-FIM improvement OR was 5.102 (95% CI: 1.100-16.233, P = 0.036), and the total-FIM improvement OR was 5.273 (95% CI: 1.102-25.238, P = 0.037). High compliance with individualized nutritional prescriptions can increase FIM scores in clinical settings. Thus, comprehensive approaches to increase dietary compliance are needed for elderly long-term care patients.

The clinical efficacy of compound Danshen injection on acute cerebral infarction and on the changes in the CRP, D-dimer, and IL-6 levels

OBJECTIVE

To study the clinical curative effect of compound Danshen injection on acute cerebral infarction (ACI) patients and its impact on the CRP, D-dimer, and IL-6 levels.

METHODS

116 patients with ACI admitted to our hospital were randomly placed in an observation group (n=58) or a control group (n=58). The control group received rosuvastatin tablets (10 mg/time, qd) in addition to the standard treatment. The observation group received compound Danshen injection in addition to the standard treatment. The treatment continued for 21 days. The clinical treatment efficacy, the CRP, D-dimer, and IL-6 levels, the NIHSS scores (to evaluate the degree of neurological impairment), the Fugl-Meyer scores (to access patients' motor function), the ADL scores, the sleep quality (the PSQI and AIS scores), and the complication incidence rates were compared between the two groups.

RESULTS

After the treatment, the effective rate in the observation group (89.66%) was significantly higher than it was in the control group (74.14%) (P<0.05). After the treatment, the serum CRP, D-dimer, and IL-6 levels in the two groups were lower than they were before the treatment, and the levels were lower in the observation group than they were in the control group (all P<0.05). After the treatment, the NIHSS scores in the observation group were lower than they were in the control group, and the Fugl-Meyer and ADL scores were higher than they were in the control group (all P<0.05). Compared with the control group, the PSQI and AIS scores in the observation group were lower than they were in the control group after the treatment (P<0.05). The severe diarrhea, bedsore, urinary tract infection, liver and kidney function injury, skin allergic reactions and other total adverse reaction incidence rates in the observation group were lower than they were in the control group.

CONCLUSION

Rosuvastatin combined with compound Danshen injection is effective in ACI treatment. It is able to effectively improve the clinical symptoms, reduce the incidence of complications, improve the recovery of the IL-6, CRP, and D-dimer levels and enhance patients' sleep quality.

Nutrition in the First Week after Stroke Is Associated with Discharge to Home

Malnutrition is associated with poor clinical outcomes in stroke patients. The effect of early nutritional intake after admission on home discharge is unclear. We evaluated the impact of energy intake in the first week of hospitalization of acute stroke patients on home discharge and activities of daily living (ADL). A retrospective cohort study was conducted with 201 stroke patients admitted to an acute care hospital in Japan. The energy and protein intake during the first week were evaluated. Multivariate models were used to estimate variables related to discharge destination and ADL at discharge. The cut-off point of nutritional intake for determining the discharge destination was evaluated using the receiver operating characteristic curve. Out of 163 patients included in the analysis, 89 (54.6%) and 74 (45.4%) were discharged home and elsewhere, respectively. Those discharged home had higher energy and protein intake than those discharged elsewhere. In multiple regression analysis, energy intake was independently associated with ADL at discharge and home discharge (odds ratio 1.146). Those with energy intake >20.7 kcal/kg/day had higher ADL at discharge and more patients discharged home than those with energy intake <20.7 kcal/kg/day. Energy intake during the first week affected home discharge in acute stroke patients.