Malnutrition and risk of malnutrition in patients with stroke: prevalence during hospital stay.

Background: Although various studies have shown high prevalence of malnutrition in hospitalized patients with stroke, recent studies on how the nutritional status of patients with acute stroke develops during the first weeks of hospital stay are scarce. Information is lacking concerning the identification of patients with stroke who are at risk of malnutrition during an acute hospital stay, because these patients may have a significant chance to improve their nutritional status.

Purpose: This study aimed to investigate the prevalence of malnutrition and risk of malnutrition of patients with acute stroke during the first 10 days of hospitalization.

Preadmission interventions to prevent postoperative complications in older cardiac surgery patients: a systematic review.

Objective(s): The literature on postoperative complications in cardiac surgery patients shows high incidences of postoperative complications such as delirium, depression, pressure ulcer, infection, pulmonary complications and atrial fibrillation. These complications are associated with functional and cognitive decline and a decrease in the quality of life after discharge. Several studies attempted to prevent one or more postoperative complications by preoperative interventions.

Identifying frailty: do the Frailty Index and Groningen Frailty Indicator cover different clinical perspectives? a cross-sectional study.

Background: Early identification of frailty is important for proactive primary care. Currently, however, there is no consensus on which measure to use. Therefore, we examined whether a Frailty Index (FI), based on ICPC-coded primary care data, and the Groningen Frailty Indicator (GFI) questionnaire identify the same older people as frail.

Factors associated with increasing functional decline in multimorbid independently living older people.

Objectives: With increasing age the levels of activities of daily living (ADL) deteriorate. In this study we aimed to investigate which demographic characteristics and disorders are associated with ADL disabilities in multi-morbid older people.

Study Design: We performed a cross-sectional study with baseline patient data from a large Dutch trial in independently living multi-morbid older people combined with the reimbursed healthcare data for the same subjects.

Practical approach to early postoperative management of lung transplant recipients.

Meticulous attention to detail during the early postoperative period after lung transplantation is crucial for the overall success of the procedure. It starts in the intensive care unit with the initiation of immunosuppression, implementation of anti-infective strategies and stabilisation of respiratory function. The subsequent days and weeks on the regular ward focus on titration of immunosuppressive drugs, vigilant fluid management, early mobilisation and initiation of physiotherapy.

Development of a proactive care program (U-CARE) to preserve physical functioning of frail older people in primary care.

Purpose: Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in detail the development process of the U-CARE program to allow its replication.

Self-management: one size does not fit all.

Self-management for people with chronic diseases is now widely recognized as an essential part of treatment. Despite the high expectations and the growing body of evidence in terms of its effectiveness, a wide application of self-management programs is inhibited due to several challenges. Worldwide, a variety of complex and multifactorial interventions have been evaluated in very heterogeneous patient populations leaving healthcare professionals in doubt about what works best and what works in whom.

[Proactive and structured care for the elderly in primary care].

Background: Currently, primary care for the older, vulnerable patient is reactive, fragmented and does not meet patients needs. Given the expected increase of home-dwelling frail elderly people a transition is needed to proactive and integrated care.

Methods: In the described study, we explore two innovative interventions in primary care.

Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed-methods study.

Aim: To report the expectations and experiences of general practitioners and practice nurses regarding the U-CARE programme, to gain a better understanding of the barriers and facilitators in providing proactive, structured care to frail older people and to determine whether implementation is feasible.

Background: Care for older patients with complex care needs in primary care is fragmented, reactive and time consuming. A structured, proactive care programme was developed to improve physical functioning and quality of life in frail older patients.

Identification of high-risk individuals for the development of disability in activities of daily living. A ten-year follow-up study.

Independence in activities of daily living (ADL) is important in an aging population. ADL disability is a multifactorial problem, therefore a multifactorial approach is needed in the prediction of ADL disability. Our objective is to identify predictors for the development of ADL disability over a course of ten years in middle-aged and older persons.

Early tracheal stenosis causing extubation failure and prolonged ventilator dependency.

Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed.

Atherosclerosis and physical functioning in older men, a longitudinal study.

Objective: Functional decline is a major threat to independency, progressing into functional limitations and eventually leading to disability. Chronic diseases, especially cardiovascular diseases, are important determinants of functional limitations and disability. Vascular damage exits long before it is clinically manifest and can have adverse effects on health, physical and cognitive functioning.

Barriers and motivators of adherence to prophylactic treatment in haemophilia: a systematic review.

Long-term adherence to prophylactic therapy is the key to successful prevention of bleeds in severe haemophilia. The present study aims to provide a systematic review of the literature on the determinants of adherence to prophylaxis in haemophilia. A literature search in the largest medical databases in Oct 2011 yielded 880 articles, which were reduced to 72 by further selection on title.

Physical functioning is related to both an impaired physical ability and ADL disability: a ten year follow-up study in middle-aged and older persons.

Objective: Identification of measures of physical function that mediate or link impaired physical ability with disability in activities of daily living (ADL) is necessary to facilitate the development of interventions to prevent or delay the onset of ADL disability. We examined whether measures of physical function at baseline are determinants of the Short Physical Performance Battery, as measure of physical ability, and disability, at ten years follow-up.

Study Design: Prospective cohort study in 625 middle-aged and older persons.

Long-term outcomes of bilateral lobar lung transplantation.

Objectives: Lobar lung transplantation is an option that provides the possibility of transplanting an urgent listed recipient of small size with a size-mismatched donor lung by surgically reducing the size of the donor lung. We report our short- and long-term results with bilateral lobar lung transplantation (BLLT) and compare it with the long-term outcomes of our cohort.

Methods: Retrospective analyses of 75 lung transplant recipients who received downsized lungs with a special focus on 23 recipients with BLLT performed since January 2000.

The diagnostic value of the numeric pain rating scale in older postoperative patients.

Aims And Objectives: To measure the diagnostic value of the Numeric Rating Scale by comparing it to a Verbal Rating Scale in older patients.

Background: Pain management in older patients is an important challenge because of their greater susceptibility to adverse effects of analgesics. Nurses play an important role in applying guidelines for postoperative pain treatment.

Domains contributing to disability in activities of daily living.

Objective: The WHO International Classification of Functioning, Disability, and Health (ICF)-model describes disability in activities of daily living (ADL) as a multifactorial concept. According to this model, ADL disability is influenced by health conditions, body function and structures, environmental and personal factors, and participation. Current research on ADL disability often focuses on one domain and the contribution of multiple domains is not taken into account.

Feasibility of a nursing rehabilitation guideline for patients with stroke: evaluating the use by nurses.

Purpose: To determine the feasibility of the Clinical Nursing Rehabilitation Stroke-guideline (CNRS-guideline) in the care of stroke patients in terms of the experiences, views and attitudes of nurses towards the guideline and their adoption of the guideline and how often the recommendations were used.

Method: A four phase cross sectional design was used. Demographic data were collected from nurses (n=30) and patients (n=105).

Evaluation of Quality of Life instruments for use in COPD care and research: a systematic review.

Objective: Quality of Life (QoL) measurements to quantify disease burden have become an important outcome measure in Chronic Obstructive Pulmonary Disease (COPD) research and treatment. A large variety of QoL instruments is available. The objective of this review was to comprehensively evaluate content and psychometric properties of available QoL instruments used in COPD care and research.

How to increase activity level in the acute phase after stroke.

Aims And Objectives: To study how patients with acute stroke spend their day and to determine whether activity levels of patients with acute stroke in a Dutch university hospital increase after the implementation of interventions to stimulate activity.

Background: Previous studies suggest that patients with acute stroke are prone to inactivity. Early mobilisation and increasing levels of activities are part of several guidelines for patients with stroke.

Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data.

Background: A general frailty indicator could guide general practitioners (GPs) in directing their care efforts to the patients at highest risk. We investigated if a Frailty Index (FI) based on the routine health care data of GPs can predict the risk of adverse health outcomes in community-dwelling older people.

Methods: This was a retrospective cohort study with a 2-year follow-up period among all patients in an urban primary care center aged 60 and older: 1,679 patients (987 women [59%], median age, 73 years [interquartile range, 65-81]).

Practical approach to emergencies in lung transplant recipients: how we do it.

Lung transplant recipients (LTRs) are prone to medical complications and emergencies due to the transplanted organ being in constant direct contact with the environment and the need for life-long profound immunosuppression (IS). As a result of these specific circumstances, the medical and surgical management of LTRs frequently differs from usual standard care. Therefore, we outline here some of the principles we take into account when dealing with the most frequent medical emergencies encountered in our lung transplant cohort in Zurich.