Geriatric rehabilitation of stroke patients in nursing homes: a study protocol.

Contains fulltext : 88482.pdf (publisher's version ) (Open Access)BACKGROUND: Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these patients are being discharged back to the community, rather than being transferred to residential care. Nevertheless, factors associated with the successfulness of stroke rehabilitation in nursing homes or skilled nursing facilities are largely unknown. The primary goal of this study is, therefore, to assess the factors that uniquely contribute to the successfulness of rehabilitation in geriatric stroke patients that undergo rehabilitation in nursing homes. A secondary goal is to investigate whether these factors are similar to those associated with the outcome of stroke rehabilitation in the literature. METHODS/DESIGN: This study is part of the Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study in the Netherlands. It is a longitudinal, observational, multicenter study in 15 nursing homes in the Southern part of the Netherlands that aims to include at least 200 patients. All participating nursing homes are selected based on the existence of a specialized rehabilitation unit and the provision of dedicated multidisciplinary care. Patient characteristics, disease characteristics, functional status, cognition, behavior, and caregiver information, are collected within two weeks after admission to the nursing home. The first follow-up is at discharge from the nursing home or one year after inclusion, and focuses on functional status and behavior. Successful rehabilitation is defined as discharge from the nursing home to an independent living situation within one year after admission. The second follow-up is three months after discharge in patients who rehabilitated successfully, and assesses functional status, behavior, and quality of life. All instruments used in this study have shown to be valid and reliable in rehabilitation research or are recommended by the Netherlands Heart Foundation guidelines for stroke rehabilitation.Data will be analyzed using SPSS 16.0. Besides descriptive analyses, both univariate and multivariate analyses will be performed with the purpose of identifying associated factors as well as their unique contribution to determining successful rehabilitation. DISCUSSION: This study will provide more information about geriatric stroke rehabilitation in Dutch nursing homes. To our knowledge, this is the first large study that focuses on the determinants of success of geriatric stroke rehabilitation in nursing home patients

Moisture and temperature dependence of the dielectric properties of pharmaceutical powders

The dielectric properties of pharmaceutical powder–(paracetamol, aspirin, lactose, maize starch, adipic acid) solvent (water) mixtures were measured at 2,450 MHz at a range of moisture contents (0–1.0 kg kg−1, dry basis) and temperatures (20–70 °C). The dielectric constant (ε′), loss factor (ε″) and penetration depth (d p) were found to be dependent on frequency, moisture content, temperature and powder type. For powder–water mixtures, a linear increase in the dielectric properties with moisture content was observed, whilst the temperature dependence was of quadratic form. The penetration depth was also significantly affected by temperature and moisture content. Although, ε″ also increased with increasing temperature, variation with moisture content was temperature dependent. This information on dielectric properties is essential for mathematical description of the pharmaceutical product temperature history during microwave heating and for the design of microwave drying equipment.Scopu

Understanding the mental health of refugees: Trauma, stress, and the cultural context

At the end of 2016, there were a record-high 65.6 million people forcibly displaced according to the United Nations High Commissioner for Refugees (1). With 300,000 new people displaced in 2016, there were 20 people newly displaced every minute of 2016. Most refugees flee their homes with little time to prepare (2) and, in turn, frequently are ill-equipped with the financial, linguistic, and other resources needed to address the challenges of the journey that lies ahead. The nature of the pre-migration and flight experiences for refugees, which are frequently marked by fear, forced departure, and experiences of torture and trauma, distinguishes them from other voluntary migrants. Since 1975 approximately three million individuals have been resettled in the USA (approximately 2 million adults and 1 million children) (3); this represents a significant population to respond to clinically. Importantly, status as a forcibly displaced person seeking refuge is not in itself a psychiatric condition – refugee status is a sociopolitical phenomenon with common downstream psychosocial effects (4). As refugees resettle in third party countries, often after prolonged stays in refugee camps in a country or countries outside of their home, many experience mental health problems associated with past trauma, ongoing stress, or both. In order to effectively serve resettled refugee and migrant communities, mental health professionals including, researchers, clinicians, educators, and policy makers need to understand the impact of the refugee experience and cultural contexts on psychosocial functioning. This chapter will review the unique mental health challenges and culturally-responsive assessments and treatments targeting some of the world’s most vulnerable and resilient populations