Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke : an explorative observational study

BACKGROUND: People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke. METHODS: The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses. RESULTS: Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08). CONCLUSIONS: Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients' needs and aid peoples' reorientation; this would apply particularly to those with poor coping capacity.

Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

Recording and Using Provenance in a Protein Compressibility Experiment

Very large scale computations are now becoming routinely used as a methodology to undertake scientific research. In this context, `provenance systems' are regarded as the equivalent of the scientist's logbook for in silico experimentation: provenance captures the documentation of the process that led to some result. Using a protein compressibility analysis application, we derive a set of generic use cases for a provenance system. In order to support these, we address the following fundamental questions: what is provenance? how to record it? what is the performance impact for grid execution? what is the performance of reasoning? In doing so, we define a technologyindependent notion of provenance that captures interactions between components, internal component information and grouping of interactions, so as to allow us to analyse and reason about the execution of scientific processes. In order to support persistent provenance in heterogeneous applications, we introduce a separate provenance store, in which provenance documentation can be stored, archived and queried independently of the technology used to run the application. Through a series of practical tests, we evaluate the performance impact of such a provenance system. In summary, we demonstrate that provenance recording overhead of our prototype system remains under 10% of execution time, and we show that the recorded information successfully supports our use cases in a performant manner.

PReServ: Provenance Recording for Services

The importance of understanding the process by which a result was generated in an experiment is fundamental to science. Without such information, other scientists cannot replicate, validate, or duplicate an experiment. We define provenance as the process that led to a result. With large scale in-silico experiments, it becomes increasingly difficult for scientists to record process documentation that can be used to retrieve the provenance of a result. Provenance Recording for Services (PReServ) is a software package that allows developers to integrate process documentation recording into their applications. PReServ has been used by several applications and its performance has been benchmarked.

Shiro, Burt and Phyllis, interviewed by Sam Levine on January 17, 2010: Audio Recording

Some of the themes discussed are: • Occupation—store, The Jefferson Hotel (2, 4-6, 11, 17-18) • Food (2) • Colby—Greek life (3, 7) • Military service (3-4) • Bar Mitzvah (6, 12) • Life in Waterville—Circus (6) • Anti-semitism (10-12) • Occupation—law (8-9) • Occupation—legislature (14) • Jewish education (12) • Synagogue (13) • Civic engagement—United Way (15) • Civic engagement (26-28) • Camp—Modin (18) • College—attendance (19) • Colby—football (20-21, 23, 30)

Hopengarten, Doris, interviewed by Desiree Shayer on January 11, 2009: Audio Recording

Some themes discussed are: • Colby—enrollment (1) • Colby—dating (2, 5) • Colby—Greek Life (2) • Colby—campus life (2-3, 5,8) • Holidays—Christmas (4) • Colby—student interaction with Waterville Jews (4) • Occupation—economics, psychology (6) • Colby—Winter Carnival (8-9)