Dissertations / Theses: 'Stoke units'

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Wood, Victorine Alexandra. "A critical appraisal of post-acute stroke management in NHS hospitals." Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299734.

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Taylor, Elizabeth Rose. "Therapy on stroke units : an ethnographic study." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/therapy-on-stroke-units(5f47840f-0913-4dcd-911d-6367e8540b39).html.

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Background: Guidelines and audit have been widely adopted as quality improvement strategies in healthcare. A recent stroke guideline states that 45 minutes of each relevant therapy, 5 days per week, should be provided to patients deemed appropriate. National audit data suggest variation across teams in the proportion of patients deemed appropriate, and the quantity and frequency of therapy provided. Reasons for these variations are unknown. Aim: To investigate the ways in which policy, professional judgement and patient need influence the delivery of therapies in stroke units (SUs) in the era of the 45 minute guideline. Method: An ethnographic study, including participant observation and interviews, was conducted in three SUs. Results: Drawing on theoretical concepts of audit society and street level bureaucracy, the study found that the 45 minute guideline was limited in its ability to influence delivery of therapies. The attempt to standardise therapy time was undermined by variation in the roles and remits of SUs and therapists, and varied understandings of ‘what counts’ as therapy. Thus they had different approaches to assessing therapy needs, and adopted different audit reporting practices. In line with the claims of street level bureaucracy, therapists developed routines of practice to simplify and manage their caseloads. In one example, the audit had become a way of categorising patients’ need for therapy and justifying resource allocation. The thesis identifies the role of ‘Street Level Leaders’ in guiding therapists’ attitudes and practices. The thesis provides empirical data to support the theoretical concept of audit society, showing how changes to therapy standards and practice took place in a wider economic and social context. Conclusions: The 45 minute guideline was one of many factors influencing delivery of therapy and was diversely interpreted and implemented. The study’s findings suggest that, in the context of the quasi-marketisation of healthcare, audit may become a tool of commissioner-centred, rather than patient-centred care. Ongoing engagement between strategic leaders, patients and clinicians is needed, to ensure that quality of care does not become secondary to ‘playing the numbers game’.

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Kubik, Sebastian [Verfasser]. "Charakteristik der zertifizierten Stroke Units in Deutschland / Sebastian Kubik." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1113592982/34.

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4

Dahllöf, Oliver, Oliver Dahllöf, Felix Hofwimmer, and Felix Hofwimmer. "Optimal placement of a Mobile Stroke Unit (MSU) to achieve improved stroke care." Thesis, Malmö universitet, Fakulteten för teknik och samhälle (TS), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20525.

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Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra.
Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra.
The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.
The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.

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5

Strand, Tage. "Stroke : patient characteristics, efficacy of a stroke unit and evaluation of hemodilution therapy." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 1986. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-141049.

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Stroke is a major health problem in all developed countries. These studies, performed in a stroke unit at a medical department, were designed to characterize essential clinical features of the different cerebrovascular disorders on admission to hospital, to evaluate the efficacy of admitting unselected stroke patients to a stroke unit and, to evaluate hemodilution as a therapeutical regime in patients with cerebral infarction. A prospective registry included 409 patients admitted to the stroke unit over a five-year period. Modern diagnostic equipment (CT scan and CSF analyses) and strict diagnostic criteria revealed a diagnostic distribution of 11% hemorrhagic, 76% ischemic cerebrovascular lesions and 13% TIAs. Mean age varied between 65.8 and 77.5 years in the various diagnostic groups with the highest in patients with embolic cerebral infarctions. Concomitant disorders affecting the cardiovascular system were highly prevalent and only 14% was free of such diseases prior to the stroke. In a comparative prospective study, over 16 months, no differences were found between patients treated in the stroke unit (n = 110) and the general medical wards (n = 183) regarding prognostic indicators on admission such as age, concomitant disorders and neurological symptoms. The stroke patients treated in the stroke unit had a statistically significant better prognosis regarding functional outcome and the need for long-term hospitalization was reduced up to one year after the stroke when compared to patients treated in general medical wards. All stroke patients seemed to benefit with the possible exception of patients in coma on admission. These results were achieved within the same or shorter length of initial hospital stay for patients in the stroke unit. Neither overall mortality, nor mortality in subgroups of prognostic importance was significantly affected by the stroke unit regime. Rapid hemodilution in the early phase of cerebral infarction by the combination of venesection and administration of dextran 40 was evaluated in a prospective controlled trial. After randomization 52 hemodi- luted and 50 control patients were comparable in prognostic variables. Signs of blood-brain-barrier breakdown and hemorrhagic admixture to the cerebrospinal fluid in the acute phase were less frequent in hemodiluted subjects. The hemodi luted patients showed a significantly higher degree of early improvement and fewer progressions. Neurological and functional disability in survivors and need for long-term hospitalization was significantly reduced at 3 months and at one year after the stroke compared to controls. Mortality was not affected.
digitalisering@umu

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O'Connor, Stephen Edward. "An investigation to determine the nature of nursing care in stroke units." Thesis, University of Southampton, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242688.

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Parekh, Ishita. "Factors influencing functional outcome of stroke patients admitted to a tertiary hospital." University of the Western Cape, 2011. http://hdl.handle.net/11394/5292.

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Magister Scientiae (Physiotherapy) - MSc(Physio)
Stroke is a leading cause of death and disability worldwide. Individuals with stroke often face functional limitations. There are several factors that are associated with functional outcome post stroke. Treatment in a stroke unit with a multidisciplinary approach reduces the likelihood of dependency after stroke. The aim of the present study is to identify factors influencing functional outcome of stroke patients admitted to a South African tertiary hospital. A descriptive, observational, longitudinal quantitative study design was used to obtain the data. Convenience non-probability sampling method was used. The research instruments used to collect the data were National Institute of Health Stroke Scale (NIHSS), Hospital Anxiety and Depression Scale (HADS), Barthel Index and a socio-demographic and medical profile data form. All the instruments were used at admission and discharge while at two months only Barthel Index was used for data collection. The data analysis was done using SPSS v 18 and SAS v 9. Mean, standard deviation, range and percentages were used for descriptive purposes and Tobit analysis was used to determine the association between independent and dependent variables. The descriptive results showed that the mean age was 59.83 years with number of females slightly more than males and hypertension being the most common risk factor. The results of the quantitative analysis revealed four factors that influence functional outcome at either discharge or at two months: age, severity of stroke, functional level at admission. Age and severity of stroke influenced the functional outcome at both the stages. The necessary ethical clearance was obtained in prior to commencement of the study. The outcomes of the study could contribute to enhance rehabilitation of stroke patients at an inpatient settings and awareness among population.

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Yazdi, Hamid R. "The finishing stroke, Edgar Allan Poe's aesthetics of unity." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ62356.pdf.

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Glader, Eva-Lotta. "Stroke care in Sweden : Hospital care and patient follow-up based on Riks-Stroke, the National Quality Register for Stroke Care." Doctoral thesis, Umeå universitet, Medicin, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-94114.

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Stobbart, Lynne. "Conducting randomised controlled trials in an acute stroke unit." Thesis, University of Newcastle upon Tyne, 2013. http://hdl.handle.net/10443/1944.

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Stroke is a major cause of death and disability in the UK. Few treatments exist and those that do, such as thrombolysis (‘clot-busting’ treatment) must be given urgently and are not risk-free. Large scale randomised controlled trials are crucial for the development of safe, effective, acute interventions, but progress has been limited, ostensibly due to ethical and regulatory difficulties. Theoretical work in this area has focussed primarily upon the requirement for prospective informed consent, but has also considered potential conflicts of interests inherent in the dual role of clinicianresearchers, and the notion that research and clinical practice are, can be, and should be conducted separately. Empirical evidence on this topic is lacking. By providing such evidence, this study examines claims made in the literature regarding the difficulties encountered or perceived in conducting emergency research. It also explores whether, how, and to what effect, the distinction between research and clinical activity advocated in the bioethical literature is maintained. Methods Ethnographic methods were employed, including participant observation, semistructured interviews, and audio-recording of research consent interactions in an acute stroke unit. Data were analysed drawing upon constant comparative and framework methods. Results and conclusion Whilst providing empirical evidence supporting some of the theoretical and conceptual literature, the data also furnish a detailed account of pragmatic issues encountered and managed daily by healthcare professionals in the acute stroke environment. Whilst attempts were made at the study site to separate, at least in part, clinical and research activity, it was observed that absolute separation of clinical activities is neither attainable, sustainable, nor desirable. Placement of research nurses within the clinical environment may promote transparency and greater understanding of their role, whilst simultaneously demystifying research concepts. Ultimately this may promote closer working relationships, contributing to enhanced recruitment, retention and management of research participants.

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Roa, Rodrigo. "Ambulansteamets betydelse för att minska tiden från symptomdebut till behandling av stroke : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3011.

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Stroke är den näst vanligaste dödsorsaken i världen och den tredje vanligaste orsaken till funktionshinder. I Sverige drabbas cirka 25 000 personer årligen. Patienter med stroke är den enskilda sjukdomsgrupp som står för flest vårddagar på svenska sjukhus. I akut behandling av stroke används termen ”Time is Brain”, då det dör cirka två miljoner hjärnceller vid varje minuts fördröjning. Det har utförts stora ansträngningar i två decennier för att effektivisera akuta vårdkedjan vid stroke. Endast två till 13 procent av patienterna får möjlighet till behandling på sjukhus med trombolys och antalet trombektomi är mycket lägre. Av de patienter som får trombolys är det cirka en till tio procent som får trombolys inom en timme efter symtomdebut. Främsta orsaken till underbehandling är att patienter inte når sjukhuset tillräckligt snabbt för att undersökas och behandlas inom det smala terapeutiska fönstret. I Sverige år 2016 anlände 33 procent av patienterna med stroke inom tre timmar till sjukhus och antalet har inte ökat sedan 2011. Det var angeläget att beskriva befintlig kunskap om hur ambulanspersonal kan påskynda behandlingen för patienter med stroke. Syftet var att belysa ambulansteamets betydelse för att minska tiden från symtomdebut till behandling av stroke Metoden för studien var en litteraturöversikt med 16 vetenskapliga artiklar publicerade mellan åren 2012 och 2017. Artiklarna söktes i databaserna PubMed och Cinahl. Resultatet som framkom av de valda artiklarna kunde sammanställas genom två huvudkategorier och fem underkategorier. Den ena huvudkategorin handlade om ambulanspersonalens omhändertagande av patienter med stroke. Den andra huvudkategorin handlade om ambulanspersonalens kunskap. Resultatet visade att ambulanspersonal kunde genom teamarbete i ett ambulansfordon med en inbyggd röntgenapparat, kallad Mobile Stroke Unit (MSU), förkorta tiden från symtomdebut till behandling. MSU var mellan 25 till 81 minuter snabbare, jämfört med konventionell ambulans. Dörr-till-nål tiderna (tiden från det att patient ankommer till sjukhus till start av trombolys) förbättrades med fem minuter när ambulanspersonal förvarnade sjukhusen med strokelarm. Ambulanspersonal förbättrade inte akuta vårdkedjan med hjälp av telemedicin. Patienter med stroke i bakre cirkulationen hade en timmes prehospitala fördröjningar jämfört med patienter med stroke i främre cirkulationen. Akuta vårdkedjan förbättrades inte när ambulanspersonal fick en timmes föreläsning om stroke. Slutsatsen var att ambulansteamet förkortade tiden från symtomdebut till behandling genom teamarbete i Mobile Stroke Unit. Ambulansteamet förbättrade inte akuta vårdkedjan med hjälp av telemedicin. Det skedde prehospitala fördröjningar för patienter med stroke i bakre cirkulationen. Ytterligare forskning av MSU behövs. Framtida randomiserade studier bör undersöka kliniskt utfall och kostnadseffektivitet. Det bör även forskas i området om hur ambulansteamet kan minska tiden från symtomdebut till behandling av stroke i en konventionell ambulans. Nyckelord: stroke, ambulanspersonal, tid, prehospital trombolys, Mobile Stroke Unit.
Stroke is the second most common cause of death in the world and the third most common reason cause for disability. In Sweden approximately 25000 people are affected annually. Patients whit stroke are the group that accounts for most care days in Swedish hospitals. In acute stroke treatment, the term "Time is Brain" is used, as about two million brain cells die at every minute delay. Despite two decades of substantial efforts to streamline systems of care in stroke, only two to 13 percent of patients receive the treatment thtombolysis in a hospital and the rates of delivery of thrombectomy are far lower. Of the patients who are treated with thrombolysis, approximately one to ten percent receives thrombolysis within one hour after symptom on set. The main reason for such undertreatment is that patients do not reach the hospital quickly enough to be assesed and treated within the narrow therapeutic window. In Sweden 2016, only 33 percent of patients with stroke arrived to the hospital within three-hours after symptom on set and the rates has not increased since 2011. It was important to describe existing knowledge about how the ambulance staff can shorten the time from symptom on set to treatment for stroke patients. The aim was to highlight the importance of the ambulance staff to reduce the time from symptom on set to stroke treatment. The method of the study was a literature review of 16 scientific articles published between the years 2012 and 2017. The articles were searched in the PubMed and Cinahl databases. The results obtained from the selected articles were compiled by two main categories and five subcategories. One main category was about the care of ambulance staff in patients with stroke. The second main category was about the ambulance staff's knowledge. The result showed that ambulance staff can shorten the time from symptom on set to treatment though teamwork in an ambulance with an inbuilt CT-scan, called Mobile Stroke Unit (MSU). MSU was between 25 minutes and 81 minutes faster, compared to conventional ambulance. Door-to-Needle time (time from patient arriving to hospital until start of thrombolysis) improved with five minutes when ambulance staff warned the hospital with a strokealarm. Ambulance staff did not improve the system of care using telemedicine. Patients with stroke in the posterior circulation had one hour of prehospital delays compared with patients with stroke in the anterior circulation. The system of care did not improve when ambulance staff received an hour's lecture on stroke. The conclusion was that ambulance staff shortened the time from symptom on set to treatment through teamwork in the Mobile Stroke Unit. Ambulance staff did not improve the system of care using telemedicine. There where prehospital delays for patients with stroke in the posterior circulation. Further research of MSU is required. Further randomized studies should investigate clinical outcome and cost-effectiveness. It should also be researched in the area of how the ambulance staff can shorten the time from symptom on set to treatment in a conventional ambulance Keywords: stroke, emergency medical service, time, prehospital thrombolysis, Mobile Stroke Unit.

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Suddick, Kitty Maria. "The acute stroke unit as transitional space : the lived experience of stroke survivors and healthcare practitioners." Thesis, University of Brighton, 2017. https://research.brighton.ac.uk/en/studentTheses/e87311ac-cb78-4fe9-b6ee-d61a2dd39414.

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The re-conceptualisation of stroke unit provision towards acute and hyperacute care has been a relatively recent development in the United Kingdom. This hermeneutic phenomenological study aimed to explore how the acute stroke unit (ASU) experience, as the phenomenon of interest, was meaningfully lived from a human lifeworld perspective. Eight participants: four stroke survivors and four healthcare practitioners: took part in semi-structured interviews, and if they agreed, an optional creative element. Interviews were recorded then transcribed. Detailed hermeneutic analysis drawing on interpretative phenomenological analysis (IPA) was undertaken firstly on each person’s account, and then across the collective from each perspective. An additional close textual reading was developed for one stroke survivor and one healthcare practitioner. A particular feature of the analysis was its influence in generating an innovative graphic interpretation of the research findings. The stroke survivors experienced the ASU as a lived space in two differentiated forms. The ASU holding space, through the spatial practices of nurses, and others, including similar others (patients), was understood to provide them with protection and safe haven; holding them intimately but also at a distance, so that they could think, make sense, plan and work towards transition. The transitional space of the ASU was experienced by three of them in more disparate ways, and represented how they transitioned their self (for protection, necessity and for recovery) in response to the stroke, the hospital space and the spatial practices of the ASU. The healthcare practitioners experienced the ASU as a space that they produced and appropriated for themselves and others. This was intertwined with their work as existential project; through their relationships with others, and their contribution to patients’ transitional work, they were understood to experience authenticity and belonging. This project was always in the making, and was undertaken amidst the day-to-day pressures on the unit. As a result, three of the health practitioners looked to make sense, navigate, and survive the vulnerability they experienced in relation to their meaningful work, as part of their ASU experience. Further synthesis of these two horizonal1 perspectives elucidated 3 key areas of new insight and understanding: the spatiality of the lived experience of the acute stroke unit, suffering and thriving as a human being, and the intertwining of multiple selves in time and place. The implications of this new knowledge for clinical practice, education, and research are further discussed in this thesis.

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Bennett, Beverley. "Emotional encounters with stroke : an ethnographic study of nurse-patient interactions in a stroke rehabilitation unit." Thesis, University of Sheffield, 2012. http://etheses.whiterose.ac.uk/3285/.

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Stroke is the third most common cause of death in the United Kingdom and the single greatest cause of severe disability. The effects of stroke are complex but the impact on emotional wellbeing is arguably one of the most problematic aspects of stroke rehabilitation to address. Nurses play a key role in stroke rehabilitation and the ways in which they interact with and respond to the emotional experience of stroke, may be crucial to the well-being of the patient and their relatives. Informed by an interactionist theory of emotion, the aims of this interpretive ethnographic study were to explore the emotional experiences of persons affected by a stroke (patients and relatives), nurses’ interpretations of these experiences and how they used them to inform and influence person-to-person interactions during the period of hospital-based rehabilitation. Taking a case study approach, a purposive sample of 10 cases was selected, with each ‘case’ comprising a patient, their closest relative and the nurses who provide their care. Data were constructed through participant observation, interviews and documentary review. Data analysis revealed that through a complex interplay of core beliefs, personal and professional attributes and interpersonal skills, nurses enabled patients and relatives to access and utilise their own personal attributes in order to recover from stroke. An emergent relationship model explains how the relationships built and sustained between nurses, patients and relatives during their encounters with each other on a stroke rehabilitation unit are central to creating a positive culture of caring which promotes emotional wellbeing and aids recovery. The findings have implications for policy, clinical practice, health care education and research.

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Wallengren, Gustafsson Catarina. "De kan, de vill och de orkar, men... : Studier av närstående till personer drabbade av stroke samt granskning av informationsmaterial från svenska strokeenheter." Doctoral thesis, Karlstads universitet, Avdelningen för omvårdnad, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-4072.

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Aim: The overall purpose of this thesis was to increase the understanding of relatives’ changing life situation during the first six months of a person’s onset of stroke, with focus on learning. Furthermore, the purpose was to evaluate theprinted education materials (PEM) targeted at relatives at Swedish stroke units. Method: In paper I, 16 relatives were interviewed about the meaning of becoming a relative of a person affected by stroke. In paper II, 9 relatives were reinterviewed about what it meant to be a relative of a person affected by stroke. The interviews took place six months after the stroke survivors’ onset of stroke. Data from the two studies were analyzed by Lindseth and Norberg’s hermeneutic phenomenological method of analysis, inspired by Ricoeur. In paper III, 16 and 9 relatives were interviewed about what they wanted to know and understand during the first six months after the onset of the survivors’ strokes. Krippendorff’s method of qualitative content analysis was used to analyse data. In paper IV, 42 PEM:s from 21 Swedish stroke units were examined. Data were analysed by use of descriptive statistics and Krippendorff’s method of qualitative content analysis. Results: Becoming the relative of a person affected by stroke means to experience chaos but also to reach a turning point. The turning point is the start of a febrile activity that shows the relatives’ willingness to seek order in the chaotic situation (I). Being the relative of a person affected by stroke also means to be in a struggle for freedom. Relatives do not want to adapt to the stroke or its consequences. Instead, they prefer to choose their own way of life and to write their own history. Therefore, they strive to integrate the stroke and its consequences to their everyday lives (II). The information that the relatives wished to have was about the stroke survivor, the professionals and themselves. Moreover, the results showed that the relatives’ information quest was related to personal involvement, contextual factors, different knowledge needs and different ways to obtain information (III). The PEM:s, offered at Swedish stroke units, were adequate in terms of quality of suitability and readability. The content of the printed education materials offered to relatives varies with the stroke units. Conclusion: To become a relative of a person affected by stroke means to end up in chaos, but also to reach a turning point (I). At this turning point the person is prepared to adjust arrange his/her life to the new conditions. Therefore, nurses need to learn to identify these turning points and include support for relatives in their changing life situation. Being a relative during the first six months of a survivor’s onset of stroke means to fight for freedom (II) without abandoning the stroke survivor. In this process, it is important that the relatives learn to balance freedom with responsibility and life and care for the survivor with relations to other relatives. Relatives are capable as they are active, committed and social persons (I, II, III). This is why alternative pedagogic methods and approached need to be developed and tested. Nurses need training in using such alternative methods. The content of the printed education materials offered to relatives at Swedish stroke units varies with the unit. As a result, it would be useful to establish a national electronic centre.

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Kobayashi, Junko. "Barton Stone's rejection of Shaker unity." Online full text .pdf document, available to Fuller patrons only, 2003. http://www.tren.com.

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Clarke, David James. "Achieving teamwork : a grounded theory investigation in selected stroke units in the north of England." Thesis, University of Leeds, 2007. http://etheses.whiterose.ac.uk/1673/.

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The development of collaborative interdisciplinary working is a key element of contemporary health policy. Future healthcare workers will need to work. individually, collaboratively and in teams if they are to meet the complex and changing needs of the patients they serve. The literature related to health professional team working identifies many barriers and sources of potential conflict, but there is also evidence that effective interdisciplinary teamwork can be achieved and is associated with improved health outcomes. The specialised and co-ordinated multidisciplinary team care provided in stroke units was considered to contribute directly to the improved patient outcomes seen in these units. However, the ways in which stroke unit team members co-ordinate their work was not clearly understood. This study utilised a grounded theory approach to develop an explanation of the ways in which health professionals in two stroke rehabilitation units in the North of England achieved teamwork. Data were generated through over 200 hours of participant observation and thirty four semistructured interviews with a range of team members. The findings of the study identified a basic social process which was common to team working in both stroke units; this process was termed 'opportunistic dialogue'. This represented an interactional process through which the division of labour in respect of specific rehabilitation activities was worked out and agreed by team members on a day-to-day basis. Co-location of most team members in both units led to repeated engagement in sharing and validating patient information and in exploring different perspectives. Opportunistic dialoguing contributed to mutual learning in the stroke unit teams and explained the shift in thinking and team culture which occurred as team members moved from concern with discrete disciplinary actions to dialogue and negotiations focused on collaboration to meet the needs of stroke patients. Negotiations played a major role in opportunistic dialogue and coming to agreement on the teams' rehabilitation work. The study findings emphasised the interrelatedness and interdependence of these concepts as core interactional processes contributing to the achievement of teamwork in stroke units. The study confirmed the utility of the negotiated order perspective in understanding and explaining workplace interactions, but identified that whilst negotiations were a key feature of opportunistic dialogue, other processes also contributed to achieving and maintaining teamwork. Focussing on dialogue demonstrated that patterned talk-in-interaction processes maximised the contribution of opportunistic dialogue to coordinating the skills and knowledge of the different disciplines participating in stroke rehabilitation. The achievement of teamwork in these units occurred through access to and participation in opportunistic dialogue.

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Sjölund, Björn, and Alex Giang. "An optimization model for the allocation of mobile stroke units : Considering the trade-off between cost and benefit." Thesis, Malmö universitet, Fakulteten för teknik och samhälle (TS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24068.

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Parr, Simon Richard. "High-performance load/store unit for a highly configurable, embedded vector processor." Thesis, Loughborough University, 2008. https://dspace.lboro.ac.uk/2134/33579.

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Voice-over-Internet-Protocol (VoIP) has gained a significant amount of interest due to insatiable demand for improved digital communication in the consumer market. Instead of using the traditional public exchange network telephone companies are now able to offer cheap telephone calls via the internet. The intention of this research is to improve the channel capacity of VoIP networks by researching a novel embedded CPU architecture for accelerating speech coding algorithms. The proposed architecture is a configurable vector coprocessor, closely coupled to a controlling Spare-VS compliant CPU. The design is developed as a System-on-Chip (SoC) component utilising high-performance connectivity. Two speech codecs, provided by the International Telecommunication Union (ITU) and usually found in VoIP applications are the primary workloads studied in this research. By implementing data-level-parallel hardware in the form of custom vector and scalar instructions, the benefit of data-level-parallelism is investigated. The vector instructions are designed to accelerate the inner-loops of the two speech algorithms and results are obtained over a range of vector lengths and different test vectors, provided by the ITU. The final section of this research is the design of a configurable vector Load/Store Unit (LSU). This was implemented at Register Transfer Level (RTL) Very High Speed Integrated Circuit Hardware Description Language (VHDL) and is included in the overall design of the vector coprocessor. Different configurations of the LSU were explored to give the cycle, area and power results across a number of speech workloads.

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Fjærtoft, Hild. "Extended stroke unit service and early supported discharge. : Short and long-term effects." Doctoral thesis, Norwegian University of Science and Technology, Faculty of Medicine, 2005. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-681.

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Effekter av utvidet slagbehandling og samarbeid på tvers av forvaltningsnivå.

Hjerneslag er en av de hyppigste årsaker til alvorlig funksjonshemming og død i Norge, i tillegg at sykdommen medfører betydelige samfunnsmessige kostnader. Forekomsten er ca. 14 000 hjerneslag pr. år, og antallet forventes å øke betraktelig i årene fremover da antall eldre over 65 år vil øke sterkt.

Det er en stor utfordring å organisere helsetjenesten slik at behandlingstilbudet for denne pasientgruppen blir best mulig. Akuttbehandling i slagenhet er i dag det best dokumenterte behandlingstiltak, men effekten av videre rehabilitering og oppfølging har vært et lite prioritert område for forskning.

Hovedhensikten med denne avhandlingen har vært å framskaffe mer kunnskap om hva som kan oppnås for slagpasienter ved en systematisk organisering og samarbeid mellom sykehus og primærhelsetjeneste når det gjelder behandling og rehabilitering etter akuttbehandling i slagenhet. Studien som ligger til grunn for avhandlingen ble gjennomført ved Seksjon for hjerneslag, Medisinsk avdeling, St. Olavs Hospital i perioden 1995-1998.

Intervensjonen var å konstruere en ny behandlingskjede for slagpasienter hvor fokus på bedre samarbeid med primærhelsetjenesten, oppfølging av et ambulerende team, tidlig utreise fra sykehus og rehabilitering med utgangspunkt i hjemmet ble sterkt vektlagt. Den konstruerte behandlingskjeden ble evaluert med tanke på helsegevinst for den enkelte og bedre ressursutnytting sammenlignet med det tradisjonelle behandlingstilbudet.

Studien ble gjennomført som en klinisk randomisert kontrollert studie der 320 pasienter med akutt hjerneslag ble inkludert. 160 pasienter fikk ordinær slagenhet behandling med videre institusjonsrehabilitering og/eller oppfølging av primærhelsetjenesten, mens de øvrige 160 pasienter fikk oppfølging av et ambulerende team i henhold til den nye og konstruerte behandlingskjeden.

I de fire arbeidene som inngår i avhandlingen er det sett på risiko for alvorlig funksjonshemning og død, endring i funksjonsnivå og livskvalitet, samt kostnadsanalyser og ressursforbruk av helsetjenester. Pasientene i de to gruppene ble undersøkt og sammenlignet 6 og 12 måneder etter sykdomsdebut.

Resultatene av studien viste at sammenlignet med tradisjonell behandling oppnådde pasientene i intervensjonsgruppen signifikant bedre funksjonsnivå (p=0.017) og redusert risiko for alvorlig funksjonshemning og død (p=0.044) etter ett år. De viste også tendens til bedret livskvalitet samtidig som initial liggetid i institusjon ble redusert med 40 % (p=0.032). Det var ingen økning i totalt ressursforbruk eller kostnader i intervensjonsgruppen.

Oppsummert viser avhandlingen at en slagbehandlingskjede med fokus på samarbeid på tvers av forvaltningsnivå, oppfølging av et ambulerende team og rehabilitering mens pasientene bor hjemme gir meget positiv effekt.

Den kliniske betydning av disse resultater er at en oppfølging i form av en slagbehandlingskjede i tillegg til akutt behandling i slagenhet bør inngå som en integrert del av behandlingstilbudet for denne pasientgruppen.

Arbeidene er utført ved INM og ISM, Det medisinske fakultet, NTNU. 1.amanuensis, dr.med Bent Indredavik har vært hovedveileder og Professor dr.med Roar Johnsen biveileder.

Extended Stroke Unit Service and Early Supported Discharge. Short and Long-term Effects.

Background and purpose

Stroke imposes a considerable burden for patients, their caregivers and the society worldwide. It is a challenge to organise the healthcare service that can provide effective management of patients who have suffered from stroke. Several trials have shown that stroke unit care improves the outcome for stroke patients. More limited information exists about the most effective way to organise the follow-up care after the acute care in a stroke unit. Stroke patients conventionally receive a substantial part of their rehabilitation in hospital or in other institutions that offer 24 hours-stay.

The primary aim of this thesis was to increase knowledge about the organising of follow-up care for stroke patients after the acute care in a stroke unit. To achieve this we performed a trial to evaluate the short and long-term effects of an extended stroke unit service (ESUS), with early supported discharge from hospital, co-operation with the primary health care, and more emphasize on rehabilitation at home as essential elements.

Methods

We performed a randomized controlled trial in which 320 acute stroke patients admitted to the Stroke Unit at St. Olavs Hospital, Trondheim University Hospital were included and allocated either to ordinary stroke unit care (OSUS) (160 patients) with further in-patient rehabilitation or follow-up from the primary healthcare service, or to stroke unit care with early supported discharge (160 patients). The ESUS consisted of a mobile team which co-ordinate early supported discharge and further rehabilitation.

Included in this thesis are 4 papers based on data from this study population of acute stroke patients followed in one year after the onset of stroke. We wanted to compare the groups in relation to independency, quality of life (QoL) and resource use and costs.

• Functional outcome were measured as the proportion of patients who were independent as assessed by modified Rankin Scale (RS)(RS<2 =global independence) and Barthel Index (BI)(BI>95 = independent in ADL) at 26 weeks and 52 weeks, the differences in final residence and analyses to identify patients who benefited most of an early supported discharge service (paper I and II). All assessments were blinded.

• The outcome of QoL was measured by the Nottingham Health Profile (NHP) at 52 weeks. Other outcomes measured at 52 weeks were differences between the groups according to social activity, depression, cognitive function and the burden for carers’. (paper III).

• The use of all health services during the first 52 weeks was recorded prospectively in both groups; its costs were measured as service costs and represent a combination of calculated average costs and tariffs. Hospital expenses were measured as costs per inpatient day. The secondary objectives were to explore differences in costs between the groups with respect to different types of services, time of service delivery and stroke severity (paper IV).

Results

• Extended stroke unit service with early supported discharge and co-ordination by a mobile team improves functional outcome 6 months and 12 months after stroke. The Odds Ratio for independence at one year was 1.56 (95% C.I, 1.01-to 2.44). It was most beneficial for patients with moderate stroke (papers I and II).

• Extended stroke unit service with early supported discharge can improve long-term quality of life measured by global NHP. The ESUS group had a significant better QoL after one year than the OSUS group (p = 0.048). There were no significant differences between the groups in the secondary outcomes social activity, depression and cognitive function. The caregivers who got their patients early at home did not report an increased burden compared to caregivers whose patients became ordinary stroke unit care (paper III).

• The length of initial institutional stay (hospital and rehab.clinic) were reduced with 40 % for the patients offered extended stroke unit service (18.6 days in the ESUS versus 31.1 days in the OSUS) (p=0.032). There was also a reduction in average number of total inpatient days during the first year in favour of the ESD group (p = 0.012) (paper IV).

• The total health services costs for ESUS was equal or less than costs for ordinary care during the first year after stroke. There was a non-significant reduction in total mean service costs in the ESUS group (EUR 18937 / EUR 21824). The service seemed to be most cost effective for patients with moderate severity of stroke (23% lower mean costs compared to OSUS). The important cost savings caused by reduced length of institutional stay did not lead to an increase in costs for home-based rehabilitation (paper IV).

Conclusion

An extended stroke unit service with early supported discharge improved functional outcome and reduced the length of stay in institutions compared to traditional stroke unit care. It also seems that this service can improve long-term quality of life. The costs are equal or less than costs for ordinary care.

An early, well organised discharge from hospital co-ordinated by a mobile team seems to be an important contribution in the treatment of stroke patients and should be considered, in addition to organised in-patient stroke unit care, as a part of a comprehensive stroke care.

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Brooke, Joanne. "The exploration of self-regulation and transfer anxiety within stroke patients transferred from a hyper acute stroke unit to a ward." Thesis, London Metropolitan University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.595312.

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Stroke services provide patients with immediate assessment and treatment on a hyper acute stroke unit prior to being transferred for intense rehabilitation. Patients' experience of transfer from a hyper acute stroke unit has yet to be explored. A patient's beliefs regarding their illness are important factors that aid a patients' recovery yet these have not been fully explored in patients following a stroke. The aims of this study are to explore the patients' perspectives of transfer from a hyper acute stroke unit to a stroke unit and their itIness beliefs. Data were collected from a purposive sample of patients (n=6) on a stroke unit following transfer from a hyper acute stroke unit. Semi-structured interviews were carried out to explore patients' experience of transfer and their illness beliefs. The interview schedule was based on literature and interviews with a Clinical Nurse Specialist and a stroke patient. Data were analysed using Interpretative Phenomenological Analysis (IPA). The emergent super-ordinate themes included: disassociation from being in the world, search for understanding. strive for independence and acceptance of support, and hope and uncertainty. A chronic illness model of illness representation dimensions emerged; higher reporting of identity, consequences, and timel ine was associated with lower personal and treatment control and an emotional response. Self-regulatory coping strategies and health beliefs within patients following a stroke were identified as important constructs to include in healthcare assessments with the aim of improving psychological, physical and social outcomes.

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Caiazzo, Federica. "Mental Health Interpreting: What is at Stake? - The Case of Mothertongue." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2019. http://amslaurea.unibo.it/17784/.

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Il presente elaborato si propone di esaminare il tema dell’interpretazione nel settore della salute mentale in un panorama internazionale nel quale la migrazione rappresenta un fenomeno sempre più diffuso. Lo scopo è di fornire un’analisi teorica e pratica degli ostacoli e delle implicazioni che derivano dall’utilizzo degli interpreti in questo ambito. La letteratura e le ricerche sull’interpretazione in ambito di salute mentale saranno presentati e affrontati con particolare riguardo al contesto del Regno Unito. Verranno esposte molteplici proposte pratiche con l’obiettivo di fornire una bussola nella creazione di una collaborazione efficace tra interpreti e terapeuti. Il caso pratico di Mothertongue, un’associazione che aveva sede in Regno Unito, servirà infine da esempio di applicazione delle buone pratiche indicate.

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Grohs, Gillian. "THE EFFECTS OF EXERCISE PRECONDITIONING ON FOCAL ISCHEMIC STROKE." UKnowledge, 2017. http://uknowledge.uky.edu/medsci_etds/8.

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Cleaved fragments of the extracellular matrix protein perlecan have been shown to promote neuroprotection and repair after ischemic stroke. The cysteine proteases cathepsin B and L as well as the metalloprotease bone morphogenic protein 1 (BMP-1) are capable of releasing the biologically active C-terminal laminin-like globular domain (LG3) of perlecan. Exercise, a known method of reducing stroke risk and severity, has been shown to increase the expression of some proteases associated with perlecan processing. Using a transient distal middle cerebral artery occlusion (MCAo) model for focal ischemic stroke we show that while 7 days of running only slightly decreased infarct volume, BMP1 and perlecan (HSPG2) RNA expression in skeletal muscle was significantly increased in 3-month-old male wild type C57/BL6 mice. Moreover, elevated levels of BMP1 RNA were still detectable after 3 days of detraining, suggesting a prolonged effect of exercise on BMP1 expression. Levels of LG3 in the blood were below the limit of detection in the current study, however it is likely that a more sensitive method would enable analysis of serum. These preliminary findings suggest that LG3 could be a molecular mediator of neuroprotection afforded by exercise though further studies are required.

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Mansoor, Alsulami Aali. "Numerical Simulation of 2D Incomperssible Navier-Stokes Flow Driven by Rotlets in a Unit Disk." Kent State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=kent1500818090455148.

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Callahan, Justin. "Prediction of the Performance of a Flexible Footing on a Stone-Column Modified Subgrade." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4450.

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When foundations are designed on weak clay layers, it is a common practice to modify the subgrade by installing stone columns. Currently used methods for determining the level of ground modification, represented by the percentage of soil replaced (replacement ratio), assume a rigid foundation. These analytical methods provide the designer with the potential settlement reduction based on the compressibility parameters of the subgrade and the replacement ratio. The deficiencies of these methods are the assumption of rigidity of the foundation and the consideration of the settlement reduction as the only design criterion. Furthermore, they do not consider the effects that ground modification has on differential settlement, moments, and shear forces within the slab. In order to determine the effects of ground modification on the overall performance of a flexible foundation, a computer program was formulated which compares a multitude of design parameters of the modified subgrade to those of the unmodified subgrade to determine the impact of ground modification. By performing this investigation, correlations were found between the replacement ratio and the settlement reduction factors. Similarly, correlations were also found between the ratio of the length of the foundation to the radius of relative stiffness, and the moments and shear forces generated within the slab. The use of the findings of this thesis would allow the design to make more informed decisions when designing foundations on modified subgrade resulting in safer and more economical designs.

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Bakrac, Pinar [Verfasser]. "Intravenöse Lysetherapie bei akut ischämischem Schlaganfall: eine Analyse der Stroke Unit der Klinik Biberach / Pinar Bakrac." Ulm : Universität Ulm, 2020. http://d-nb.info/120664625X/34.

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McManus, Lindsay A. "Using EMG spectral analysis as a quantitative measure of motor unit recruitment to evaluate stroke motor recovery." [Gainesville, Fla.] : University of Florida, 2006. http://purl.fcla.edu/fcla/etd/UFE0015780.

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Baghdo, Simon. "Game Telemtry : Store, Analyze and Improve UX in Game from Player-Choices." Thesis, Luleå tekniska universitet, Institutionen för konst, kommunikation och lärande, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-64185.

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During this project, the main objective was to store and analyze the user choices through game telemetry, in the game Bloodlines. With the goal to adjust the game for each member personally, for an improved user experience. This was done through a constructed database. By saving metrics of player choices and events such as: Most used weapon, attempts per session, session time periods, amount of deaths and highest rate of death cause. The results got analyzed with the control group settings in mind. Adjustments made were based on a fundamental foundation. In addition a web application with the functionality to enter and change the settings metrics in real time.
Bloodlines

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28

Guenifi, Soraya. "I.F. Stone, journaliste politique independant. Parcours au coeur de réseaux militants." Thesis, Paris 3, 2012. http://www.theses.fr/2012PA030092.

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La carrière d’I.F. Stone (1907‐1989) le place en témoin privilégié des grands événements du XXe siècle. Par‐delà le sacro‐saint principe d’objectivité comme neutralité, ce journaliste politique indépendant s’implique personnellement dans les grandes causes radicales de la gauche américaine et internationale, d’abord au sein de la Old Left des années 1930 et 1940, puis contre le maccarthysme et la guerre froide dans les années 1950, et enfin, aux côtés de la jeunesse radicale de la New Left dans les années 1960 et 1970. À la fois observateur et participant, Stone favorise une méthode d’investigation proche de celle des muckrakers du tournant du XXe siècle, en particulier dans les pages de son propre journal I.F. Stone’s Weekly (1953‐1971), dans le but de révéler les discours mensongers du pouvoir et de dynamiser le débat démocratique. À travers l’étude du parcours d’I.F. Stone, cette thèse revêt un double enjeu : il s’agit d’abord de rendre compte d’une carrière restée en marge des récits historiques et marquée à la fois par le radicalisme et l’indépendance. Puis, parce qu’elle est jalonnée d’étapes constitutives de l’expérience radicale, l’historicisation de ce parcours permet de restaurer les aspects de continuité et de cohérence d’un engagement à la fois individuel et collectif, bien souvent présenté de façon tronquée. Grâce à une perspective enrichie par l’observation des réseaux militants proches de Stone, l’expérience formatrice des années 1930 résonne jusque dans les années 1960, confirmant au passage l’existence d’une résistance politique opposée au maccarthysme et au conformisme des années 1950
The career of I.F. Stone (1907‐1989) placed him at the center of the great events of the 20th century. Questioning American journalism’s equation of objectivity with neutrality, this independent political reporter was personally involved in all the great left‐wing, radical struggles both in the US and internationally. He was part of the Old Left of the 1930s and 1940s, an opponent of McCarthyism and the Cold War in the 1950s, and finally stood alongside the radical youth of the New Left in the 1960s and 1970s. Playing the role both of an observer and of a participant, Stone favored an investigation method similar to that used by the muckrakers at the beginning of the 20th century, especially in his own newspaper, I.F. Stone’s Weekly (1953‐1971). His goal was to expose the government’s fibs and lies, and energize the democratic debate. By studying I.F. Stone’s trajectory, this dissertation attempts to chart a career that has been kept on the margins of historical discourse, and which was characterized by both radicalism and independence. The dissertation also places Stone’s contribution in the constitutive stages of the radical experience in the U.S. The historicization of Stone’s career allows us to restore key elements of continuity and consistency to a set of political commitments which were both individual and collective, and often depicted in a disconnected manner. Our perspective is enriched by the analysis of militant networks Stone related to, revealing that the formative experience of the 1930s continued to resonate through the 1960s, marking a political resistance to McCarthyism and the conformism of the 1950s

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Stuart, Shawn Michael. "A Review of EMS Systems and Their Integration with Physicians and Advanced Practice Providers." Ohio Dominican University Honors Theses / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=oduhonors1620119577520755.

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Parfait, Claire. "Les editions americaines d'uncle tom's cabin, de harriet beecher stowe, de 1852 a 1999." Paris 7, 2000. http://www.theses.fr/2000PA070004.

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Cette recherche se situe dans le cadre de l'histoire du livre. Il s'agit d'etudier pourquoi et comment uncle tom's cabin, roman anti-esclavagiste de harriet beecher stowe, est redige, publie en feuilleton et en livre, puis reedite et presente au public americain de 1852 a 1999. En amont de la publication, ce travail examine les debuts de carriere de stowe, la genese du roman, et l'interaction entre l'auteur, l'editeur et le lecteur dans la creation du feuilleton. La publication en livre est replacee dans le contexte de la periode de transition que connait l'edition americaine au milieu du dix-neuvieme siecle. Elle inclut les negociations avec le premier editeur et la promotion du roman. Entre 1852 et 1878, le paratexte auctorial (prefaces, postfaces et introductions) uncle tom's cabin estun lieu de dialogue entre auteur, lecteur et critique. Il induit des protocoles de lecture qui varient en fonction du public cible, et revele l'evolution du regard que l'auteur porte a son oeuvre. L'etude detaillee du nombre d'editions et des chiffres de vente pendant la periode de duree du copyright (18521893) fait ressortir les variations de la popularite du roman et l'evolution du statut du texte. Elle indique le role essentiel des strategies editoriales. La part jouee par l'auteur dans le suivi du roman se degage de l'examen des rapports entre l'auteur et l'editeur. Les fluctuations de la popularite du roman de 1893 a 1999 s'expliquent en partie a la lecture des paratextes editorial et allographe. Ceux-ci revelent les bouleversements de la societe et les grands mouvements d'idees. A travers la place et le role que le paratexte assigne au texte au fil des editions, le texte apparait comme un objet culturel, que chaque generation s'approprie et relit a sa facon. En exposant la nature proteiforme et polysemique du texte, le paratexte contribue par ailleurs a expliquer son caractere controverse.

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Liebl, Diana Andrea [Verfasser]. "Delir auf Stroke-Unit und neurologischer Intensivstation : Analyse von Vitalparametern, Risikofaktoren und Diagnosen im klinischen Setting / Diana Andrea Liebl." Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2020. http://d-nb.info/1238074170/34.

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Barrois, Rémi. "Gait quantitative phenotyping of brain-injured subjects : gait measurement in the doctor’s office using inertial measurement units." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB008/document.

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Si les neurosciences connaissent d’importants progrès dans l’imagerie et le génotypage, le phénotypage repose encore largement sur des échelles visuelles. Le phénotype chez l’homme repose principalement sur son style perceptivo-moteur qui donne une empreinte à la marche, la posture, l’équilibre, l’habilité des membres supérieurs, les mouvements oculaires etc. La marche, fonction complexe et fondamentale de l’être humain, implique l’ensemble du système musculo-squelettique, le système nerveux central et périphérique ainsi que les organes sensoriels. Elle est le produit d’un patron de marche automatique et inconscient modulé par le tronc cérébral, les noyaux gris centraux et par des retours sensitifs (visuels, proprioceptives, vestibulaires et épicritiques). Enfin, la marche est aussi sous contrôle volontaire. Le phénotypage quantitatif de la marche suppose la construction préalable de bases de données de signaux de marche d’un nombre élevé (centaines) de sujets et de patients. Ceci peut être mené à bien grâce à des outils de mesure simples d’utilisation et adaptés à la pratique médicale de routine. Il existe plusieurs moyens pour phénotyper la marche mais le capteur inertiel, en raison de son prix, de sa souplesse d’utilisation et de l’accès aux données brutes est un outil particulièrement adapté pour l’étude de la marche en consultation de routine. Les capteurs inertiels permettent le calcul de nombreux paramètres. L’exercice de marche de 10 m aller/retour à vitesse de confort départ arrêté donne accès aux différentes phases de la marche (initiation, croisière, demi-tour) dans des conditions de consultation de routine. Ainsi, l’objectif de ce travail est d’approcher les mécanismes d’adaptation des personnes à des perturbations à différents niveaux anatomiques des structures impliquées dans la marche. Nous abordons cette question par un phénotypage quantitatif à partir du signal de capteurs inertiels recueilli sur des patients au cours d’un exercice de marche de 10 m aller/retour en consultation clinique de routine. Nous avons étudié successivement la marche de patients atteints d’arthrose du membre inférieur comme modèle d’adaptation de la marche à la douleur, puis la marche dans la maladie de Parkinson comme modèle d’atteinte du système de la mise en place des procédures motrices, enfin, la locomotion des patients hémiparétiques à la suite d’un accident vasculaire cérébral hémisphérique comme modèle d’atteinte de la commande volontaire. Nous montrons que la douleur dans l’arthrose du membre inférieur mène à une rigidification globale de la cinématique corporelle. Cette rigidification est prépondérante sur le membre atteint. Elle traduit la perte des synergies musculaires par la mise en place de boucle-réflexe anti-douleur. Nous démontrons que ces modifications sont corrélées à la sévérité clinique de l’arthrose. Pour analyser la régularité de la marche dans la maladie de Parkinson indépendamment des variabilités inter-individuelles du patron de marche nous avons développé un outil de visualisation de l’exercice de marche. La maladie de Parkinson affecte en particulier la régularité de la marche. Notre travail apporte la preuve que cette irrégularité est corrélée à la sévérité des symptômes chez les patients atteints de la maladie de Parkinson. Nous montrons enfin qu’une lésion du cortex dans l’accident vasculaire hémisphérique provoque un changement de stratégie dans le demi-tour. Comme d’autres, nous faisons l’hypothèse que les stratégies de demi-tours sont en partie stockées dans le cortex frontal et que les hémisphères droit et gauche ne jouent pas un rôle symétrique. Nous montrons que le choix de stratégie de demi-tour est corrélé avec la survenue de chutes à 6 mois et pourrait constituer un nouvel élément pour orienter la rééducation. (...)
In the field of neurosciences, significant improvement has been made in the last decades in imaging and genotyping. However, phenotyping remains stagnant at the state of visual observation or visual grading scales. The human phenotype is made up of locomotion (gait, posture and displacement of daily living), upper-limb fine and rough movements, eye movements, language, cognition and complex social behaviors. Gait is a central function in humans, implying volitional, emotional and automatic processes. It involves the whole musculoskeletal system as well as the central and the peripheral nervous system including sensory organs. Building a gait phenotyping system implies setting up a database of gait signals of many (hundreds) of subjects and patients. This goal can be achieved with user-friendly devices deployed in routine medical practice. For instance, inertial measurement units (IMUs) are a valid tool to measure spatio-temporal gait parameters and are adapted to routine medical use. The 10-meter walking test forward and back at self-selected walking speed is adapted to routine testing at the doctor’s office. It allows for measuring gait initiation, gait cruise, gait termination and a 180° turn. In that context, beyond technical challenges, the aim of this work was to address the question How does the central nervous system adapt to an external alteration on various levels in the command chain of gait? To answer this question, we studied sequentially the IMU signal of gait spatio-temporal kinematics in lower-limb osteoarthritis as a model of gait affected by pain, in Parkinson disease as a model of a lesion of the central nervous system muscle tone regulator and finally, in post-hemispheric stroke as a model of lesions of brain structures responsible for volitional locomotion. Secondary clinical questions were How can the severity of a disease be objectively graded with gait kinematics? and How can locomotion kinematics participate in the fall risk prediction in frail populations? In osteoarthritis, we showed that pain in lower-limb osteoarthritis led to a global stiffness of the body during locomotion. This stiffness was preponderant on the affected limbs and led to the loss of muscular synergies by the establishment of anti-pain reflexes as a reaction to pain. This change was correlated with the severity of lower-limb osteoarthritis. In Parkinson disease, to analyze gait regularity independently from inter-individual gait signature, we constructed a novel gait visualization tool and show that a lesion of the muscle tone regulator in Parkinson disease affects gait regularity. This regularity was associated with disease symptoms. Finally, in stroke, we showed that a lesion in the cortex implied a change in the 180° turning stepping, a volitional task. In line with other authors, we hypothesized that locomotion patterns could be generated in the frontal cortex and that the right and left frontal cortex did not have a symmetric role. We showed specific stepping patterns associated more with risk of fall, which could constitute a new argument to orientate rehabilitation. Altogether then, this work suggests that simple measuring hardware (here IMUs), with appropriate signal processing, allowed for decomposing and quantifying complex behavioral tasks (here locomotion) in daily hospital settings

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33

Cobb, Richard. "The failure of the Murch-Witty unity movement in the Stone-Campbell tradition, 1937-1947 was the church in the way? /." Theological Research Exchange Network (TREN), 1996. http://www.tren.com.

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34

Andersson, Maria. "Är euron en internationell valuta?" Thesis, Uppsala University, Department of Economics, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5976.

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Denna uppsats syfte är att ta reda på om euron är en internationell valuta och om

euron kan konkurrera med dollarn om titeln som världens ledande valuta. Teori om

valutamarknaden, en valutas uppgifter och vad som avgör vilken valuta som används

internationellt behandlas och för att kunna svara på uppsatsens frågeställningar (syfte)

redogörs siffror på eurons internationella användning. Sådana siffror visar att euron är

en internationell valuta då den används i valutans funktioner internationellt, men att

dollarn fortfarande är den världsledande valutan utan att vara särsklit hotad i sin

ställning av euron.

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35

Drapal, Cynthia Susan. "Oral Care Practice Guidelines for the Care-Dependent Hospitalized Adult Outside of the Intensive Care Unit Setting." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/409.

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Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations of relationship-based care and the logic model. A 14 member interdisciplinary team of institutional stakeholders from 2 acute care hospitals identified an evidence-based oral assessment tool, developed policy and practice guidelines to inform oral care, and developed both implementation and evaluation plans to pilot the project. The short-term goal of the project was to increase staff knowledge, evaluated with direct observation of assessments and documentation reviews. The long-term goal of this project was to reduce the risk of aspiration and resulting complications as evidenced by discharge diagnosis. The standards developed in this project create a process to ensure that care-dependent adults outside of the intensive care unit setting will receive an oral assessment daily, or every shift, as determined by the oral assessment score. The project advances nursing practice by addressing a gap in practice and promotes positive social change by improving the quality of care provided to all care-dependent patients. Improvement of patient outcomes from reduced risk for aspiration and reduced financial burden of unnecessary resources used to care for patients who aspirate and suffer complications are additional outcomes expected of this initiative.

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Balch, Maria Helen Harley. "Acute Mechanisms of Skeletal Muscle Decline and Rehabilitative Recovery Following Ischemic Stroke." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu159558748119711.

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Hütwohl, Daniela [Verfasser], and Martin [Akademischer Betreuer] Grond. "Verbesserung der Detektion von Vorhofflimmern durch die automatische Herzrhythmusanalyse SRAclinic(R) im klinischen Alltag einer deutschen Stroke Unit / Daniela Hütwohl ; Betreuer: Martin Grond." Marburg : Philipps-Universität Marburg, 2020. http://d-nb.info/1204199795/34.

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Brand, Jannik [Verfasser]. "Präklinische Diagnostik und Therapie in einer Mobilen Stroke Unit zur Verkürzung der Zeit bis zur intravenösen Thrombolyse beim akuten ischämischen Schlaganfall / Jannik Brand." Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2020. http://d-nb.info/1219507865/34.

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Müller, Katja [Verfasser]. "Analyse von Entzündungsparametern im Rahmen der Routinediagnostik in der Akutphase des Schlaganfalls : eine retrospektive Kohortenstudie der Stroke Unit der Neurologischen Universitätsklinik Ulm / Katja Müller." Ulm : Universität Ulm. Medizinische Fakultät, 2011. http://d-nb.info/1018707271/34.

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Avery, Stephanie. "Attending to Values at Stake When a Child is Dying: A Study of Pediatric Intensive Care Unit Nursing from the Perspectives of Bereaved Parents." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39206.

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Existing literature has identified that health care providers significantly shape the experiences of parents at the end-of-life in the pediatric intensive care unit. However, there is a gap in the literature of the specific nursing influence on parental experiences of a child’s death in this context. Employing the interpretive descriptive methodology, this qualitative study was designed to explore parents’ moral experiences of nursing care at the end-of-life in the pediatric intensive care unit, and was analyzed through a lens of nursing ethics. Face-to-face, semi-structured interviews were conducted with eleven parents (six mothers and five fathers) of six children who died in a pediatric intensive care unit at a university-affiliated tertiary hospital in Eastern Canada. Study results revealed close connections between parents’ abilities to meaningfully parent a child through their death and the nursing care that they received at the end-of-life, and highlighted the varying helpful guiding roles that nurses adopted at different moments in parental experiences. Results also indicated that parents attributed immense value to feeling that nurses cared-for-and-about their child and the parents themselves, since this made parents feel that their child’s death mattered to the nurses whom they had formed relationships with. This study enhances our understanding of the individualized nature of parents’ moral experiences of nursing care at the end-of-life in the pediatric intensive care unit, and study results suggest implications for nursing practice, education, and research.

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Kelly, Jesse. "Numerical solution of the two-phase incompressible navier-stokes equations using a gpu-accelerated meshless method." Honors in the Major Thesis, University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1277.

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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.
Bachelors
Engineering and Computer Science
Mechanical Engineering

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Skřek, Daniel. "Polyfunkční dům, Brumov - Bylnice." Master's thesis, Vysoké učení technické v Brně. Fakulta stavební, 2020. http://www.nusl.cz/ntk/nusl-410090.

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The subject of this diploma thesis is the design of a multifunctional building, which consists of parking lots, store section, office as well as dwelling units. Multifunctional building has four above-ground floors, full basement and a flat roof. During processing, emphasis was placed on layout solutions to be designed according to legislation and standards. In the basement there are parking lots, the ground flood is used as a store section, the first floor consists of office units designed for start-up companies. The third and fourth floor consists dwelling units from one-bedroom to three-bedroom apartments. The building has a concrete frame structure combined with a masonry system from Porotherm ceramic pieces. Horizontal load bearing system is designed of two way reinforced concrete slabs. Walls bellow the ground level are made from core-filled reinforced concrete blocks. The building is supported by the spread footing concrete system. Multifunctional building is situated in flat terrain in the city of Brumov-Bylnice.

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Gronemann, Christian [Verfasser], Rüdiger [Gutachter] Braun-Dullaeus, and Ulf [Gutachter] Schminke. "Empfehlung und Einsatz der Antikoagulation auf einer universitären Stroke-Unit zur Sekundärprävention des Schlaganfalls nach Zulassung der neuen oralen Antikoagulanzien / Christian Gronemann ; Gutachter: Rüdiger Braun-Dullaeus, Ulf Schminke." Magdeburg : Universitätsbibliothek Otto-von-Guericke-Universität, 2020. http://d-nb.info/1219966274/34.

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Gronemann, Christian Verfasser], Rüdiger [Gutachter] Braun-Dullaeus, and Ulf [Gutachter] [Schminke. "Empfehlung und Einsatz der Antikoagulation auf einer universitären Stroke-Unit zur Sekundärprävention des Schlaganfalls nach Zulassung der neuen oralen Antikoagulanzien / Christian Gronemann ; Gutachter: Rüdiger Braun-Dullaeus, Ulf Schminke." Magdeburg : Universitätsbibliothek Otto-von-Guericke-Universität, 2020. http://nbn-resolving.de/urn:nbn:de:gbv:ma9:1-1981185920-331021.

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45

Goos, Ira [Verfasser]. "Medikamentöse Sekundärprävention in Form einer Thrombozytenaggregationshemmung des ischämischen Schlaganfalls nach vorausgegangener Stroke-Unit-Behandlung an der Kreisklinik Biberach im Beobachtungszeitraum 2004-2007. "Leitliniengetreue Behandlung auf allen Ebenen?" / Ira Goos." Ulm : Universität Ulm. Medizinische Fakultät, 2015. http://d-nb.info/1068262974/34.

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Danteur, Thibault. "Pour une analyse complexe de la mondialisation. Socio-anthropologie comparative du cas de la grande distribution alimentaire au Maroc, en France et aux États-Unis." Phd thesis, Université Paul Valéry - Montpellier III, 2012. http://tel.archives-ouvertes.fr/tel-00735600.

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À la lumière de nombreux travaux récents, la conception, dans le champ des sciences sociales, de la mondialisation économique et culturelle comme une force d'uniformisation semble perdre de sa prégnance. L'objectif de cette thèse de doctorat est donc de se saisir de l'exemple de l'industrie de la grande distribution, en tant qu'éminente représentante de ce phénomène, pour vérifier, à travers le prisme particulier des pratiques et des représentations alimentaires, si l'on peutencore se contenter de comprendre le processus de mondialisation uniquement comme un vecteur d'éradication des différences culturelles. Procédant selon une méthodologie inductive et une approche comparative, nous avons voulu décrire cette industrie et ses implications sur les modalités du choix alimentaire, en prolongeant au Maroc nos analyses basées sur l'étude des cas français et américain. Suivant les préceptes méthodologiques de la socio-anthropologie et la stratégie de la mosaïque d'études de cas, nous avons, selon le modèle itératif prôné notamment par la grounded theory, sans cesse cherché à mettre nos hypothèses à l'épreuve du terrain à travers une constante extension des cas et une variation des objets étudiés. Cela nous a autorisé à viser une plus grande généralisation de nos théories et ainsi arguer en faveur d'une conception moins simplificatrice des processus de mondialisation en ancrant empiriquement notre plaidoyer pour une perspective complexe des phénomènes culturels et sociaux qui en sont issus.

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47

Makowski, Nathaniel Steven. "The Feasibility of an Upper Extremity Poststroke Neuroprosthesis." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1370619715.

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48

Truncer, James. "Steatite vessel manufacture in Eastern North America /." Oxford, England : Archaeopress, 2004. http://books.google.com/books?id=NSVmAAAAMAAJ.

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Milde, Sonja. "Versorgungsqualität im Krankenhaus, Sekundärprophylaxe, Kosten." Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2011. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-71236.

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1. Ziel Schlaganfall ist mit deutschlandweit jährlich bis zu 200.000 neuen Fällen ein weit verbreitetes Krankheitsbild. Schlaganfall führt häufig zu neurologischen Schädigungen, Pflegebedürftigkeit oder zum Tod. Das Statistische Bundesamt beziffert die Ausgaben für Schlaganfälle (Hirninfarkte, Schlaganfälle, die nicht als Blutung oder Infarkt bezeichnet werden, Subarachnoidalblutungen und intrazerebrale Blutungen) auf 5,875 Milliarden Euro im Jahr (2008). In entwickelten Ländern entfallen ca. 3% der Gesundheitsausgaben auf Schlaganfall. Vor diesem Hintergrund interessiert, welche Faktoren Sterblichkeit und Pflegebedürftigkeit nach Schlaganfall sowie die Versorgungskosten von Schlaganfallpatienten beeinflussen. Die vorliegende Analyse setzte sich zum Ziel, diese Frage anhand einer retrospektiven, empirischen Analyse von fast 13.000 hessischen Schlaganfallpatienten der Jahre 2005 bis 2007 zu beantworten. Im Einzelnen wird analysiert, (1) welche Faktoren schlechtes Outcome nach der akutstationären Versorgung beeinflussen, (2) welche Faktoren hinsichtlich akutstationärer Versorgungsqualität bzw. hinsichtlich der nachstationären Versorgung das Überleben nach Schlaganfall beeinflussen und (3) welche Aspekte die aus Sicht der Kranken- und Pflegeversicherung entstehenden Versorgungskosten von Schlaganfallpatienten determinieren. Eine retrospektive Analyse der Versorgungsrealität für hessische Schlaganfallpatienten wird unter anderem folgende Detailfragen beantworten: Welche (patientenspezifischen) Faktoren begünstigen die Umsetzung von akutstationären Qualitätsindikatoren? Welche Aspekte verkürzen oder verlängern die Zeit zwischen Schlaganfall und Krankenhausaufnahme (Prähospitalisierungszeit)? Welche Patienten werden in Krankenhäusern mit neurologischen Fachabteilungen betreut und welche Patienten erhalten Rehabilitationsmaßnahmen? Darüber hinaus wird aufgezeigt, wie die Umsetzung von Empfehlungen zur medikamentösen Sekundärprophylaxe erfolgt. 2. Forschungsstand Für Deutschland wurden bereits mehrere Studien zum Outcome nach Schlaganfall durchgeführt. In den meisten Studien wurde das Outcome drei Monate nach Krankenhausentlassung analysiert [z. B. Schneider u. a. (2009), Marquart (2009),Weimar und Diener (2003), Audebert u. a. (2006)], wobei dann die untersuchte Stichprobe aufgrund des Erfassungsaufwandes jeweils bei maximal 3.000 Patienten lag. Einige Studien bewerteten dagegen das Outcome bei Krankenhausentlassung [z. B. Heuschmann u. a. (2004)]. Diesen Studien liegen zumeist Daten aus krankenhausbasierten Registern zugrunde, die eine breite Datenbasis bieten. Wenig Aussagen gibt es dagegen zur Umsetzung der Sekundärprophylaxe nach Schlaganfall [vgl. Schneider u. a. (2009)], gar keine zu deren Einfluss auf die Überlebenswahrscheinlichkeit. Verschiedene Qualitätsregister erfassen seit geraumer Zeit Qualitätsindikatoren für die akutstationäre Versorgung des Schlaganfalls. Inwieweit diese Qualitätsindikatoren jedoch Faktoren abbilden, die mittel- und/ oder langfristige Auswirkungen auf Outcome, Überlebenszeit oder Versorgungskosten haben, ist bisher nicht analysiert worden. Auch zu den Versorgungskosten des Schlaganfalls existieren aktuell nur wenige Studien, in denen eine detaillierte Darstellung von Teilkosten etwa für Pflegebedürftigkeit oder Krankhausaufenthalte aufgrund von Folgeerkrankungen fehlt. Eine Studie, in der Daten krankenhausbasierter Schlaganfallregister mit Abrechnungsdaten der Sozialversicherung verknüpft wurden, ist bisher nicht publiziert worden. 3. Vorgehensweise Die in vorliegender Analyse durchgeführte Verknüpfung der zwei genannten Datenquellen (krankenhausbasiertes Schlaganfallregister - Gesellschaft für Qualitätssicherung Hessen (GQH) und Daten eines Kostenträgers - AOK Hessen) ermöglicht neben einer externen Validierung der Daten die Auswertung von Langzeitdaten (hier: bis 2 Jahre) zu Mortalität und Kosten für eine große Stichprobe von Schlaganfallpatienten. Im Einzelnen werden folgende Fragestellungen untersucht: - Sind die zugrunde liegenden Daten valide? - Sind die hier betrachteten, bei der AOK Hessen versicherten Patienten mit den hessischen Schlaganfallpatienten vergleichbar? - Wie hoch ist die Neuerkrankungsrate bezüglich Schlaganfall? - Welche Prognose hat ein Schlaganfallpatient? - Wie teuer ist ein Schlaganfallpatient? - Welche Bedeutung hat Versorgungsqualität (Struktur- und Prozessqualität) in der akutversorgenden Einrichtung für Outcome und Überlebenszeit nach dem Schlaganfall? bzw. Sind die Indikatoren, die die Versorgungsqualität aktuell abbilden, prognoserelevant für Outcome und Überlebenszeit nach dem Schlaganfall? - Welche Kriterien beeinflussen die Prähospitalisierungszeit und die Wahl der akutversorgenden Einrichtung? - Welche Faktoren beeinflussen die Versorgungsqualität im Krankenhaus? - Wie beeinflusst die der akutstationären Versorgung folgende Versorgung (Rehabilitation, medikamentöse Sekundärprophylaxe, Integrierte Versorgung) die Prognose nach dem Schlaganfall? - Wie beeinflussen Versorgungsqualität und die der akutstationären Versorgung folgende Versorgung (Rehabilitation, medikamentöse Sekundärprophylaxe, Integrierte Versorgung) die Versorgungskosten nach dem Schlaganfall? - Welche Empfehlungen können für die Qualitätssicherung in der akutstationären Versorgung und die Nachbetreuung von Schlaganfallpatienten abgeleitet werden? Die Beantwortung der genannten Fragestellungen erfolgt unter Nutzung multivariater Regressionsmodelle zur Prognose nach dem Schlaganfall und zu den Versorgungskosten nach dem Schlaganfall. Ergänzend werden LOGIT-Modelle eingesetzt, mit deren Hilfe Faktoren ermittelt werden, die die Wahrscheinlichkeit schnell in einem Krankenhaus hoher Strukturqualität (d.h. in einem Krankenhaus mit neurologischer Fachabteilung) versorgt zu werden und die Wahrscheinlichkeit einer qualitativ hochwertigen Versorgung (gemessen in Qualitätsindikatoren) beeinflussen. Außerdem erfolgt eine detaillierte Analyse der Umsetzung medikamentöser Sekundärprophylaxe nach einem Schlaganfall oder einer Transitorischen Ischämischen Attacke (TIA). 4. Ergebnisse Die vorliegende Analyse ist geeignet, die Versorgungsrealität für Schlaganfall- und TIA-Patienten anhand einer vergleichsweise großen Teilgesamtheit dieser Patienten und über einen vergleichsweise großen Follow-Up-Zeitraum zu beschreiben und so Empfehlungen für weitergehende Analysen abzuleiten. Über ein Fünftel der hessischen Schlaganfall- und TIA-Patienten im Betrachtungszeitraum wurden im Median 556 Tage nach Schlaganfall, knapp 60% der Patienten wurden über einen Zwei-Jahreszeitraum analysiert. Im Rahmen der Analyse konnte gezeigt werden, dass die aus dem krankenhausbasierten Register stammenden Angaben zur medikamentösen Sekundärprophylaxe sich nur in geringem Ausmaß durch Abrechnungsdaten bestätigen lassen. Die Chance auf eine, gemessen an den erfassten Qualitätsindikatoren, hohe akutstationäre Versorgungsqualität ist deutlich höher, wenn die akutstationäre Versorgung in Krankenhäusern mit neurologischer Fachabteilung erfolgt. Erfolgt die Einlieferung ins Krankenhaus durch den Rettungsdienst, ist die Chance, innerhalb von drei Stunden nach dem Schlaganfall in einem solchen Krankenhaus behandelt zu werden, gegenüber Einlieferung durch einen anderen Arzt, ein anderes Krankenhaus oder Selbsteinweisung, deutlich erhöht. Fast alle von der GQH erfassten Qualitätsindikatoren haben hinsichtlich des Outcomes bei Krankenhausentlassung Prognoserelevanz. Einzelne Qualitätsindikatoren haben darüberhinaus direkten Einfluss auf die Überlebenszeit nach Schlaganfall. Innerhalb des ersten Jahres nach Schlaganfall verstirbt fast ein Fünftel der betrachteten Patienten, das sind gegenüber Menschen der gleichen Alters- und Geschlechtsgruppe mehr als dreimal so viele Todesfälle. Auf Basis der in der Analyse ermittelten Werte zur Neuerkrankungsrate bei Versicherten der AOK Hessen kann deutschlandweit von 250.000 neuen Schlaganfällen und TIAs ausgegangen werden. Bei Bewertung mit den in der Analyse ermittelten Ein-Jahres-Versorgungskosten ergeben sich für diese Patienten jährlich Kosten von 4,03 Mrd. EUR. Die Betreuung im Rahmen des hessischen Vertrags zur Integrierten Versorgung führte - das konnte die vorliegende Analyse zeigen - zu einer Verlängerung der Überlebenszeit nach Schlaganfall. Die Effekte der Integrierten Versorgung ergaben sich jedoch im Wesentlichen aus einer besseren Umsetzung der medikamentösen Sekundärprophylaxe und häufigeren rehabilitativen Maßnahmen. Aktuell gibt es insbesondere hinsichtlich der Umsetzung medikamentöser Sekundärprophylaxe Probleme an der Schnittstelle zwischen Krankenhausentlassung und der nachfolgenden Versorgung. Eine bessere Abstimmung an dieser Schnittstelle kann die Überlebenszeit nach Schlaganfall verlängern und zusätzlich zu Kosteneinsparungen (aus Sicht der Sozialversicherung) führen. Die Letalität nach Schlaganfall ist, gegenüber der Allgemeinbevölkerung, insbesondere im ersten halben Jahr nach Schlaganfall deutlich erhöht. In diesem Zeitraum entsteht auch der mit Abstand größte Teil der Versorgungskosten. Daher sollten sich Maßnahmen zur Optimierung der Sekundärprophylaxe auf diesen Zeitraum konzentrieren.

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Listermar, Karin. "När vården blir sjuksköterskans ansvar. : sjuksköterskors upplevelser av att ge palliativ vård i livets slut på en strokeenhet." Thesis, Sophiahemmet Högskola, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1367.

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Dissertations / Theses on the topic 'Stoke units'

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