Table of Content

20 July 2020, Volume 15 Issue 07

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Focus on Early and Whole-course Rehabilitation after Stroke

HU Xi-Quan

2020, 15(07):  695-699.  DOI: 10.3969/j.issn.1673-5765.2020.07.001

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Stroke Rehabilitation

HU Xi-Quan

2020, 15(07):  700-700. 

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Investigation on Learned Nonuse in Stroke Hemiplegic Patients after Discharge

WEI Xi-Jun, WEI Yi-Xi,ZHOU Ping, QIN Ping, LI Hai, XUAN Chun-Yu, YU Tian-Ci, LI Sai

2020, 15(07):  701-707.  DOI: 10.3969/j.issn.1673-5765.2020.07.002

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Objective To investigate the development of learned nonuse in subacute stroke patients with hemiplegia after discharge, and to analyze the correlations between learned nonuse and related demographic factors, clinical characteristics and functional recovery. Methods This prospective study consecutively enrolled stroke hemiplegic patients who were ready to discharge from Shenzhen Hospital, Southern Medical University from July 2018 to December 2019. Baseline information and clinical characteristics were collected. Motor activity log (MAL) was used to assess learned nonuse at 4, 8, and 12 weeks after discharge. The following assessments were implemented within 3 days before discharge and at 4, 8, and 12 weeks after discharge, including modified Ashworth scale (MAS) for muscle tone of flexors on elbow and wrist, functional test for the hemiplegic upper extremity-Hong Kong version (FTHUE-HK), Fugl-Meyer assessment upper extremity section (FMA-UE) and box and block test (BBT) for upper extremity function, functional independence measure (FIM) for activities of daily living (ADL). Correlations between MAL and other assessments, demographic factors and clinical characteristics were analyzed. Results 47 patients were included, with an average age of 58.74±11.08 years old and 36 males (76.6%), and including 32 (68.1%) ischemic stroke patients and 15 (31.9%) hemorrhagic stroke patients. The mean time since stroke onset was 48.00±28.38 days. Amount of use (AOU)/quality of movement (QOM) of MAL recorded at 4, 8, and 12 weeks were 2.66 (1.38-4.03)/2.87 (1.03-3.56), 3.30 (1.93- 4.41)/3.17 (1.55-3.77) and 3.59 (2.00-4.33)/3.28 (2.00-3.96), respectively; and their difference among the three time points were statistically significant except the AOU between 8 and 12 weeks. Except the muscle tone of flexor on the elbow (P =0.076), other functional assessments all showed significant improvement (all P <0.05). MAL showed positive correlation with age (ρ =0.33-0.39), negative correlation with the time after onset (ρ =-0.49- -0.33), negative correlation with muscle tone of flexors on elbow and wrist (ρ =-0.58- -0.38), positive correlation with ADL (ρ =0.30-0.60), and positive correlation with upper extremity motor function (ρ =0.49-0.76). Conclusions The affected limb of stroke hemiplegic patients showed significant functional improvement after discharge, however, learned nonuse was still a big challenge, which was related to age, time since onset of stroke, muscle tone of flexors on wrist and elbow, ADL and upper extremity function.

A Case of Early and Whole-course Rehabilitation for Patients with Massive Infarction in Left Cerebral Hemisphere

LI Ling, LI Ming-Yue

2020, 15(07):  708-712.  DOI: 10.3969/j.issn.1673-5765.2020.07.003

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Progress of Repetitive Transcranial Magnetic Stimulation in the Treatment of Post-stroke Cognitive Impairment

YIN Ming-Yu, HU Xi-Quan

2020, 15(07):  713-719.  DOI: 10.3969/j.issn.1673-5765.2020.07.004

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Cognitive impairment is a common complication after stroke, which seriously affects the process of rehabilitation and quality of life of patients. Repetitive transcranial magnetic stimulation (rTMS), a new non-invasive electrophysiological technique, alters the action potential of nerve cells to affect metabolism and electrical activity in the brain, which has been gradually used to treat post-stroke cognitive impairment in recent years. At present, rTMS has achieved positive effect in the rehabilitation of executive function, memory, language ability and visuospatial ability after stroke, and it is safe to operate in the range of treatment parameters recommended in relevant guidelines. However, there is still lack of large sample, multicenter, high quality randomized controlled trials to further define its optimal stimulation parameters and effects. Research on rTMS in treatment of post-stroke cognitive impairment is still in the exploratory stage, and further mechanism studies are expected in the future, to provide more strong evidence for rTMS in treatment of post-stroke cognitive impairment.

Advances in the Treatment of Limb Spasticity after Stroke

CHEN Li-Lin, HUANG Mu-Dan, ZHENG Hai-Qing

2020, 15(07):  720-727.  DOI: 10.3969/j.issn.1673-5765.2020.07.005

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Spasticity is one of the most common complications after stroke. Severe limb spasticity not only causes limited range of motion, immobility and abnormal posture, but also leads to irreversible joint contracture, resulting in loss of limb function and disability, which greatly influences the quality of life of patients and increases the burden on caregivers. At present, there is still no consensus on the treatment of post-stroke spasticity. However, in recent years, there has been some progress in the research on the intervention of post-stroke spasticity with pharmacological and non-pharmacological way, especially for non-pharmacological treatment, such as transcranial magnetic stimulation, transcranial electrical stimulation, and novel rehabilitation treatment based on integrated analysis of multi-source information combined with electromyography and mechanomyography, and these approaches are more accurate, effective and highly repeatable. Hence, we summarized the advances in the treatment of limb spasticity after stroke.

Progress of Rehabilitation Therapy for Decannulation in Stroke Patients with Tracheostomy

DENG Bao-Mei,LIANG Li-Si, ZHAO Jia-Xin, HU Xi-Quan

2020, 15(07):  728-733.  DOI: 10.3969/j.issn.1673-5765.2020.07.006

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Tracheostomy is an important method to rescue patients with severe stroke. However, prolonged tracheostomy tube placement may lead to increased risk of complications. Early rehabilitation intervention can promote patients’ early decannulation. This paper summarized the progress of rehabilitation therapy to promote decannulation in stroke patients from the following aspects: respiratory rehabilitation, swallowing rehabilitation, use of speech valves, evidencebased nursing management of airway and cannula and general supportive treatment, so as to provide reference for improving decannulation rate in stroke patients. Airway clearance technique, respiratory muscle training, exercise training and position management can improve patients' respiratory function.The swallowing function of patients can be improved by direct and indirect swallowing function training, saliva management and pharyngeal electrical stimulation. Rational use of speaking valve can promote early decannulation. Airway humidification, cuff management and sputum aspiration care, as well as reasonable fixation, cleaning and disinfection of cannula can reduce complications and prevent infection. The success rate of decannulation can be increased by stabilizing the patient's medical status, giving good nutritional support and psychological rehabilitation. Although there is no unified standard for rehabilitation treatment of decannulation in stroke patients with tracheostomy, multidisciplinary comprehensive rehabilitation treatment can improve the rate of decannulation and promote early rehabilitation of patients.

Correlation between Total Burden of Cerebral Small Vessel Disease and Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke Patients

ZHUO Zi-Liang, NIE Zhi-Yu, LIU Yuan-Hua, ZHEN Guo-Jiang,MAO Xiang-Ru, LIU Meng, LIU Wu-Chao

2020, 15(07):  734-739.  DOI: 10.3969/j.issn.1673-5765.2020.07.007

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Objective To investigate the relationship between the overall burden of cerebral small vessel disease (CSVD) and in-hospital outcomes after intravenous thrombolysis in acute ischemic stroke (AIS) patients. Methods AIS patients who underwent intravenous thrombolysis with rt-PA in Department of Neurology, Tongji Hospital from March, 2012 to January, 2018 were retrospectively analyzed. The total CSVD score was assessed based on brain MRI. 90-day prognosis was evaluated by using mRS, and good prognosis was defined as a mRS score of 0 to 2. Multivariate logistic regression was used to analyze the influencing factors associated with 90-day poor prognosis (mRS score≥3) and inhospital complications after intravenous thrombolysis in AIS patients. Results A total of 178 patients were included, with a mean age of 62.3±10.5 years and 125 males (70.2%). 128 patients (71.9%) had good prognosis at 90 days. Multivariate analysis showed that diabetes (OR 2.919, 95%CI 1.044-8.162, P =0.041), smoking (OR 7.752, 95%CI 2.300-26.192, P =0.001), atrial fibrillation (OR 6.553, 95%CI 1.733-24.785, P =0.006), NIHSS score at admission (OR 1.354, 95%CI 1.224-1.497, P <0.001) and total CSVD score ≥3 points (OR 3.787, 95%CI 1.127-12.728, P =0.031) were independent risk factors for poor prognosis in AIS patients treated with intravenous thrombolysis. NIHSS score at admission (OR 1.266, 95%CI 1.163-1.377, P <0.001) and total CSVD score ≥3 points (OR 4.643, 95%CI 1.562-13.801, P =0.006) were independent risk factors for in-hospital complications in AIS patients treated with intravenous thrombolysis. Conclusions The total CSVD score ≥3 points was independent risk factor for 90-day poor prognosis after intravenous thrombolysis in AIS patients.

Relationship between CYP2C19 Genotype and Clopidogrel Resistance

HAO Ya-Nan, SHEN He-Ping,ZHANG Xiao-Ling

2020, 15(07):  740-746.  DOI: 10.3969/j.issn.1673-5765.2020.07.008

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Objective To assess clopidogrel resistance through CYP2C19 gene detection and platelet aggregation rate, to guide the rational drugs use for patients with recurrent cerebral infarction. Methods This prospective study consecutively enrolled recurrent cerebral infarction patients who underwent CYP2C19 gene sequencing from the Second Hospital of Jiaxing from January 2018 to October 2018. According to the gene detection results, 30 patients with fast, medium and slow metabolism genotype were collected, respectively. All three groups were given clopidogrel 75 mg/d, and the platelet aggregation rate was measured before and 7 days after taking clopidogrel.The incidence of clopidogrel resistance was compared among the three groups. Clopidogrel resistance was determined according to the inhibition rate of platelet aggregation. Patients who were resistant to clopidogrel (inhibition rate <10%) switched to cilotazole 100 mg twice a day, and those who were half responsive or sensitive to clopidogrel continued to take clopidogrel 75 mg/d. The relationship between CYP2C19 genotype and clopidogrel resistance were analyzed. The platelet aggregation rate was measured again at 3 months, and endpoint events were observed during 3-month folllow-up (main endpoints: recurrent cerebral infarction; secondary endpoints: cerebral hemorrhage and death). Results Finally, 90 patients were enrolled, with 49 males (54.4%) and an average age of 68.27±10.14 years old (aged 40-89 years old). Clopidogrel resistance occurred in 22 patients (24.4%), and the rest 68 patients (75.6%) were non-resistant to clopidogrel. The rate of clopidogrel resistance in slow metabolism group was higher than that of fast metabolism group (P <0.001)and medium metabolism group (P =0.06). Logistic regression analysis showed that smoking (OR 7.792, 95%CI 1.899-31.968, P =0.004), diabetes (OR 4.466, 95%CI 1.122-17.778, P =0.034) and CYP2C19 slow metabolism genotype (OR 13.713, 95%CI 2.352-79.959, P =0.004) were independent risk factors for clopidogrel resistance. The mean platelet aggregation rate in clopidogrel non-resistance group (49.51%±4.33% vs 63.73%±7.84%, P <0.001) at 3 months was lower than that at 7 days, and so did the clopidogrel resistance group (55.42%±6.63% vs 76.95%±7.42%, P <0.001). The platelet aggregation inhibition rate was higher in clopidogrel resistance group than clopidogrel nonresistance group at 3 months (21.53%±4.30% vs 14.23%±6.90%, P <0.001). No endpoint event occurred in all the patients during the 3-month follow-up. Conclusions Smoking, diabetes mellitus and CYP2C19 slow metabolism genotype were independent risk factors for clopidogrel resistance in patients with recurrent cerebral infarction. Cilostazol can effectively inhibit platelet aggregation and can be used as an alternative drug in clopidogrel resistance patients with recurrent cerebral infarction.

Correlation between Red Blood Cell Distribution Width and Stroke Severity and Prognosis of Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

LI Zhi-Zhang, KONG Yu-Ming, WANG Jia-Hui,ZHANG Dong, YUE Yun-Hua

2020, 15(07):  747-752.  DOI: 10.3969/j.issn.1673-5765.2020.07.009

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Objective To investigate the correlation between red blood cell distribution width (RDW) and stroke severity and prognosis of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis. Methods Data of AIS patients who received alteplase intravenous thrombolysis in Department of Neurology, Yangpu Hospital, Tongji University from January 2016 to May 2019 were retrospectively analyzed. Poor prognosis was defined as a mRS score ≥2 points at 3 months. All the patients were divided into 4 groups according to quartile. The correlation between RDW and NIHSS score at admission was analyzed. Multivariate logistic regression analysis was used to analyze the independent risk factors for poor prognosis. The ROC curve was used to analyze the predictive value of RDW for poor prognosis after intravenous thrombolysis in AIS patients. Results A total of 363 eligible patients were included, with an average age of 71.15±12.42 years (aged 34 to 95 years) and 232 males (63.9%). 207 cases (57.0%) had good prognosis and 156 cases (43.0%) had poor prognosis. RDW was positively correlated with the NIHSS score at admission (ρ =0.224, P <0.001). Multivariate logistic regression analysis showed a history of previous stroke (OR 2.257,95%CI 1.302-3.914, P =0.004), NIHSS score at admission (OR 1.145, 95%CI 1.084-1.209, P <0.001), baseline systolic blood pressure (OR 1.015, 95%CI 1.005-1.024, P =0.002), elder age (OR 1.023, 95%CI 1.002-1.044, P =0.030) and RDW (OR 1.308, 95%CI 1.072-1.694, P =0.011) were independent risk factors for poor prognosis after intravenous thrombolysis in AIS patients. The area under the ROC curve (AUC) of RDW for predicting poor prognosis was 0.618 (95%CI 0.561-0.676, P <0.001), the optimal cut-off value was 12.75%, the sensitivity was 65.4% and the specificity was 55.1%. Conclusions RDW was positively correlated with stroke severity at admission in AIS patients treated with intravenous thrombolysis. RDW was an independent risk factor for poor prognosis at 3 months after thrombolysis in AIS patients.

Epidemiological Characteristics of Acute Cardio-cerebrovascular Events in Jing'an District of Shanghai in 2018

XU Qiu-Xia, WAN Qiu-Ping, ZHANG Xin, XIONG Jian-Jing, Guo Ya-Wen

2020, 15(07):  753-758.  DOI: 10.3969/j.issn.1673-5765.2020.07.010

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Objective To analyze the epidemiological characteristics of acute cardio-cerebrovascular events in Jing'an District of Shanghai in 2018. Methods The data of incidence of acute cardio-cerebrovascular events from Jing'an District registration residents acute cardio-cerebrovascular events monitoring system in 2018 were collected, to analyze the epidemiological characteristics of acute cardio-cerebrovascular events. Results In 2018, the incidence of acute cardiovascular events in Jing'an District was 72.45/105, and the standardized incidence was 40.89/105. The incidence of acute cerebrovascular events was 753.03/105, and the standardized incidence was 353.68/105, of which the incidence of stroke was 420.31/105, and the standardized incidence was 208.36/105; the incidence of lacunar cerebral infarction was 251.48/105, and the standardized incidence was 107.05/105; the incidence of TIA was 81.25/105 and the standardized incidence was 38.28/105. The age-adjusted incidence of acute cardiovascular (66.18/105 vs 16.07/105, P <0.001) and cerebrovascular (410.09/105 vs 299.03/105, P <0.001) events in male were higher than that in female. Of cerebrovascular events, the age-adjusted incidence of stroke in male was higher than that in female (266.27/105 vs 151.35/105, P <0.001), and there were no difference in the incidence of lacunar cerebral infarction (P =0.733) and TIA (P =0.906) between male and female. The difference of the incidence of cardio-cerebrovascular events in different age groups were statistically significant (all P <0.001). The highest incidence of cardio-cerebrovascular events in one year was in November, and the lowest in September. Conclusions The incidence of cardio-cerebrovascular diseases in Jing'an District of Shanghai is grim. Multiple risk factors should be comprehensively controlled and effective measures should be taken to strengthen disease prevention and control.

Risk Factors of Post-stroke Fatigue: a Systematic Review

WANG Xiao-Li, XU Xiao-Ming, LIU Ning,HUANG Xiao-Min, XU Wei-Wei, ZHANG Wen-Juan, HOU Xing-Yue

2020, 15(07):  759-765.  DOI: 10.3969/j.issn.1673-5765.2020.07.011

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Objective To systematically review the risk factors associated with post-stroke fatigue (PSF), and to provide reference for the prevention and treatment of PSF and health education. Methods The Cochrane Library, PubMed, web of science, EMBASE, CNKI, Wanfang Data and VIP databases were electronically searched for case-control study, cohort study and cross-sectional study on the risk factors related to PSF. The retrieval time was from the establishment of the database to October 30, 2019. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 14 studies were involved, including 3201 patients. The results of meta analysis showed: pre-stroke fatigue (OR 5.93, 95%CI 3.41-10.32, P <0.001), depression (OR 2.48, 95%CI 1.83-3.36, P <0.001), women (OR 1.67, 95%CI 1.24-2.26, P <0.001), family dysfunction (OR 2.57, 95%CI 1.86-3.57, P <0.001), mRS score (OR 2.65, 95%CI 2.04-3.45, P <0.001], coronary heart disease (OR 3.41, 95%CI 1.97-5.90, P <0.001), inability to take care of oneself (OR 4.32, 95%CI 2.47-7.54, P <0.001), hyperlipidemia (OR 2.27, 95%CI 1.20-4.27, P =0.01), sedative use (OR 4.10, 95%CI 2.14-7.87, P <0.001) may be the risk factors of PSF; regular pre-stroke exercise (OR 0.50,95%CI 0.36-0.70, P <0.001) may be the protective factor of PSF. However, age, anxiety, diabetes and sleep disorders may be not correlated with PSF. Conclusions Current evidence shows that gender (female), pre-stroke fatigue, depression, family dysfunction, mRS score, coronary heart disease, poor self-care ability, hyperlipidemia, sedative use may be risk factors of post-stroke fatigue, while other related risk factors need to be further validated. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusions.

Diagnostic Value of Routine Magnetic Resonance Imaging Sequences in Atypical Subarachnoid Hemorrhage with Negative on Computerized Tomography

WANG Jing-Ye, CHEN Lu-Lu, WANG Kai

2020, 15(07):  766-770.  DOI: 10.3969/j.issn.1673-5765.2020.07.012

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Objective To evaluate the diagnostic value of routine MRI sequences (T1WI, T2WI, FLAIR, DWI) in atypical subarachnoid hemorrhage (SAH) with negative on CT. Methods A retrospective analysis of in-hospital patients diagnosed with SAH in Department of Neurology, the First Affiliated Hospital of Anhui Medical University From January 1, 2016 to October 30, 2019 was performed. All enrolled patients showing negative on CT were confirmed with SAH by lumbar puncture, and also underwent MRI examination. Results A total of 5 patients were included, with 3 males (60.0%) and a mean age of 33.8 years (range: 14-53 years). Based on the initial symptoms, SAH was highly suspected in 1 case (20%), bleeding cannot be excluded in 3 cases (60%) and suspected non-bleeding diseases in 1 case (20%). 1 case (20%) showed false negative on MRI, and 1 case (20%) was misdiagnosed as metastasis by MRI. 4 cases (80.0%), 1 case (20.0%), 0 case and 0 case showed SAH signals on FLAIR, DWI, T2 and T1 weighed imaging, respectively. In the analysis of bleeding causes for 5 patients, 1 case (20%) was infective endocarditis, 4 cases (80.0%) were unidentified. All cases had good prognosis (mRS≤2). Conclusions Routine MRI sequences have a good auxiliary diagnostic value for atypical SAH patients with negative on CT, of which FLAIR sequence is the most sensitive.

Effect of Nursing in Hyperbaric Oxygen in Children with Ischemic Moyamoya Disease

SHA Ying, HE Jian,WANG Qing, XIE Qing, ZHANG Lei.

2020, 15(07):  771-774.  DOI: 10.3969/j.issn.1673-5765.2020.07.013

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Objective To observe the effect of nursing in hyperbaric oxygen (HBO) in children with ischemic moyamoya disease. Methods This retrospective analysis enrolled the children with ischemic moyamoya disease (aged 1 to 16 years old) who were admitted to Department of Hyperbaric Oxygen of Beijing Tiantan Hospital from September 2012 to August 2019. Based on the date of starting HBO nursing in September 2015, all the patients were divided into control group and nursing group. Good prognosis was defined as a mRS score of 0 to 2. The difference in the percentage of completing HBO treatment ≥5 times, adverse reaction, and the percentage of 90-day good prognosis in children who had completed HBO treatment ≥5 times between the two groups were compared. Results A total of 84 cases were included in this analysis. Nursing group: 48 cases, 25 males, 23 females, the age range of 3 to 16 years, and the mean age of 8.81±3.83 years; control group: 36 cases, 18 males, 18 females, the age range of 2 to 16 years, and the mean age of 9.50±3.60 years. The proportion of patients who completed ≥5 times of HBO treatment in nursing group was higher than that in control group (97.9% vs 83.3%, P =0.02). No patients in both two groups suffered from adverse reaction such as barometric injury, decompression sickness, oxygen toxicity and so on during HBO treatment. 47 cases in nursing group and 30 cases in control group completed ≥5 times of HBO treatment, and they in the two groups had no statistical difference in 90-day good prognosis rate (nursing vs control group: 63.83% vs 60.00%, P =0.60). Conclusions Hyperbaric oxygen nursing can help improve HBO treatment compliance in children with ischemic moyamoya disease, while no improvement in 90-day functional prognosis was observed.

The Impact of Optimizing Emergency Pre-examination Triage Process on the Coincidence Rate of Waiting Response Time in Patients with Cerebrovascular Disease

DU Yue, XUE Ning-Ning, HAN Qiang, YU Qiu-Yun

2020, 15(07):  775-779.  DOI: 10.3969/j.issn.1673-5765.2020.07.014

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Objective To explore the impact of optimizing emergency pre-examination triage process on waiting accidents, medical disputes, waiting time, and waiting response time coincidence rate in cerebrovascular disease patients. Methods This retrospective study included patients with cerebrovascular disease from Department of Emergency of Beijing Tiantan Hospital, Capital Medical University from January to October 2019. According to the time point of starting the process optimization in June, 2019, all the subjects were divided into the pre-optimization process group and post-optimization process group. The waiting accidents and medical disputes, waiting time, and coincidence rate of waiting response time of the two groups were compared, and the waiting time of patients entering into the cerebrovascular disease fast track in the two groups were also compared. Results A total of 10 716 patients were included in this study, including 5695 cases in preoptimization process group and 5021 cases in post-optimization process group. Compared with the pre-optimization process group, the post-optimization process group had lower waiting accidents (0.4% vs 2.0%, P =0.038) and medical disputes (0.3% vs 1.3%, P =0.033), shorter waiting time (11.6±1.4 min vs 25.1±3.5 min, P =0.025), higher coincidence rate of waiting response time (89.1% vs 75.2%, P =0.024), and shorter waiting time of entering into fast track (2.2±0.7 min vs 6.6±1.2 min, P =0.032).

Conclusions Optimizing emergency pre-examination triage process can effectively improve the coincidence rate of waiting response time in patients with cerebrovascular disease, reduce the incidence of waiting accidents and medical disputes, and shorten the waiting time of patients.

Neurology: Stride Management Assist Exoskeleton Improve Walking Ability in Persons with Chronic Stroke

YANG Zhong-Hua

2020, 15(07):  780-780.  DOI: 10.3969/j.issn.1673-5765.2020.07.015

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Barbro B. Johansson and Stroke Rehabilitation

John H.Zhang

2020, 15(07):  781-786.  DOI: 10.3969/j.issn.1673-5765.2020.07.016

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A case of Intracranial Hypertension Secondary to Arachnoid Granulations

DAI Shi-Xu, ZHANG Chang-Qing,MO Da-Peng, QU hui, DONG Ke-Hui

2020, 15(07):  787-789.  DOI: 10.3969/j.issn.1673-5765.2020.07.017

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A Case of Upper Cervical Spinal Dural Arteriovenous Fistula Misdiagnosed as Acute Ischemic Stroke and Treated by Thrombolysis

HUANG Liang-Jiang, HUANG Xiao-Jiang, ZHANG Su-Ming

2020, 15(07):  790-794.  DOI: 10.3969/j.issn.1673-5765.2020.07.018

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Progress in Assessment of Post-stoke Depression

LENG Hai-Xia, DING Wei-Jun, ZHANG Wen-Rui,WANG Hong-Xing

2020, 15(07):  795-800.  DOI: 10.3969/j.issn.1673-5765.2020.07.019

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The incidence of post-stroke depression (PSD) is high, and accurate assessment of PSD is helpful for clinical diagnosis and treatment. At present, PSD is assessed by using various scales. For stroke patients with normal speaking, Hamilton depression rating scale, post-stroke depression rating scale, and Montgomery-Asberg depression rating scale are the most widely used, which have high reliability and validity. For stroke patients with aphasia, although multiple PSD assessment scales have been developed, scales that can be used in clinical practice are relatively limited, of which the stroke aphasic depression questionnaire and the aphasic depression rating scale are relatively widely used. The assessment scales for PSD have different suitable population and evaluation indicators, what’s more, when using these scales, the raters pay more attention to depression than the primary disease-stroke, which may make patients feel discomfort and reject these evaluations so that the accuracy of the evaluation may be affected. Therefore, the limitations of these scales need to be resolved according to patients’ need in the future.

Analysis on the Students Source of Cerebrovascular Disease Postgraduate in Beijing Tiantan Hospital from 2017 to 2019

DU Xin, XIAO Jia-Lin, HUO Mo-Fei, REN Yi

2020, 15(07):  801-804.  DOI: 10.3969/j.issn.1673-5765.2020.07.020

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Objective To analyze the students source of cerebrovascular disease postgraduates in Beijing Tiantan Hospital, Capital Medical University, and explore the strategies for improving the quality of students source. Methods The cerebrovascular disease postgraduates in Beijing Tiantan hospital from 2017 to 2019 were selected as subjects. The gender, age, political affiliation, being fresh graduate or not, graduate school and entrance way were analyzed for all the subjects. Results From 2017 to 2019, the total number of students showed continuous growth, which was 35, 41 and 59, respectively. The proportion of female students of 2017-2019 were all higher than that of male students, which was 82.9%, 85.4% and 78.0%, respectively. The fresh graduates and students from Capital Medical University accounted for over 84% and over 56%, respectively. Students from "211" or "985" universities accounted for less than 10%. In the past three years, the proportion of students who were exempt from admission was 14.3%, 12.2% and 22.0%, respectively. The proportion of "5+3" long-term students in Capital Medical University decreased year by year, which was 34.3%, 22.0% and 15.3%, respectively. Conclusions There were some problems in students source of cerebrovascular disease postgraduates in Beijing Tiantan hospital, such as lack of high quality students and loss of high quality students. In order to improve the quality of students source, it is necessary to make some progress in the aspects of expanding enrollment publicity, formulating relevant incentive and supporting policies and improving the training quality.

The Effect of Multi-disciplinary Team Teaching Model in the Training of Refresher Nurses in Stroke Unit

WU Mei-Ru, WANG Cui-Xue, MIAO Ya-Jie, SUN Jin-Ju, SUN Yue, DENG Yong-Mei

2020, 15(07):  805-808.  DOI: 10.3969/j.issn.1673-5765.2020.07.021

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Objective To explore the effect of multi-disciplinary team teaching model in the training of refresher nurses in stroke unit. Methods The refresher nurses in Stroke Unit of Beijing Tiantan Hospital, Capital Medical University from January 2016 to December 2017 were selected as the control group, and refresher nurses from January 2018 to July 2019 were selected as the observation group. Traditional teaching model was used in control group, while a multi-disciplinary team teaching model was used in observation group. The results of theory and technical operation examination before and after the training, and the evaluation and satisfaction of the training model between the two groups were compared. Results After the training, the score of theory examination, and score of technical operation examination of the observation group were both higher than that of the control group (94.68±2.59 points vs 90.70±2.78 points, P <0.001; 93.08±4.01 vs 88.93± 4.08, P <0.001). The evaluation and satisfaction of the training of the observation group were also higher than that of the control group (both P <0.001). Conclusions The multi-disciplinary team teaching model was superior to the traditional teaching model for training the refresher nurses in stroke unit.

Construction of Cerebrovascular Disease Clinical Data Center Based on Hospital Business Information System

ZHANG Hao, ZHANG Lei, WANG Tao

2020, 15(07):  809-812.  DOI: 10.3969/j.issn.1673-5765.2020.07.022

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The number of hospital business information systems is increasing in the new era, and the hospital has accumulated a large amount of clinical data for each business system. However, a large amount of data is not equal to big data. Big data is a large amount of data with inherent logical relationships, which can be used for statistical analysis of standardized data. When constructing a data center, the clinical data were firstly standardized through an integrated platform, then the standardized data were stored in this data center in certain logical categories. The data center is actually a data warehouse and built according to different themes, which can make the data used more effectively. Tiantan Hospital has built a cerebrovascular disease clinical data center, which is designed and constructed for different topics according to this discipline characteristics. The cerebrovascular disease clinical data center can enable centralized management and efficient use of data, improve medical process and medical quality, and optimize the hospital management decision-making and scientific research.