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Acute stroke care and rehabilitation: an analysis of the direct cost and its clinical and social determinants. The Copenhagen Stroke Study.

https://arctichealth.org/en/permalink/ahliterature11045
Source
Stroke. 1997 Jun;28(6):1138-41
Publication Type
Article
Date
Jun-1997
Author
H S Jørgensen
H. Nakayama
H O Raaschou
T S Olsen
Author Affiliation
Department of Neurology, Bispehjerg Hospital, Copenhagen, Denmark.
Source
Stroke. 1997 Jun;28(6):1138-41
Date
Jun-1997
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Cerebrovascular Disorders - economics - rehabilitation - therapy
Comorbidity
Costs and Cost Analysis
Denmark
Female
Humans
Length of Stay - economics
Male
Regression Analysis
Research Support, Non-U.S. Gov't
Abstract
BACKGROUND AND PURPOSE: Stroke represents a major economic challenge to society. The direct cost of stroke is largely determined by the duration of hospital stay, but internationally applicable estimates of the direct cost of acute stroke care and rehabilitation on cost-efficient stroke units are not available. Information regarding social and medical factors influencing the length of hospital stay (LOHS) and thereby cost is needed to direct cost-reducing efforts. METHODS: We determined the direct cost of stroke in the prospective, consecutive, and community-based stroke population of the Copenhagen Stroke Study by measuring the total LOHS in the 1197 acute stroke patients included in the study. All patients had all their acute care and rehabilitation on a dedicated stroke unit. Neurological impairment was measured by the Scandinavian Stroke Scale. Local nonmedical factors affecting the LOHS, such as waiting time for discharge to a nursing home after completed rehabilitation, were accounted for in the analysis. The influence of social and medical factors on the LOHS was analyzed in a multiple linear regression model. RESULTS: The average LOHS was 27.1 days (SD, 44.1; range, 1 to 193), corresponding to a direct cost of $12.150 per patient including all acute care and rehabilitation. The LOHS increased with increasing stroke severity (6 days per 10-point increase in severity; P
PubMed ID
9183339 View in PubMed
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Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome.

https://arctichealth.org/en/permalink/ahliterature48312
Source
Lancet. 1996 Feb 17;347(8999):422-5
Publication Type
Article
Date
Feb-17-1996
Author
J. Reith
H S Jørgensen
P M Pedersen
H. Nakayama
H O Raaschou
L L Jeppesen
T S Olsen
Author Affiliation
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Source
Lancet. 1996 Feb 17;347(8999):422-5
Date
Feb-17-1996
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Body temperature
Cerebral Infarction - epidemiology
Cerebrovascular Disorders - epidemiology - physiopathology - therapy
Confounding Factors (Epidemiology)
Denmark - epidemiology
Female
Fever - epidemiology - physiopathology
Humans
Hypothermia - epidemiology - physiopathology
Male
Prospective Studies
Regression Analysis
Research Support, Non-U.S. Gov't
Risk factors
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
BACKGROUND: In laboratory animals, cerebral ischaemia is worsened by hyperthermia and improved by hypothermia. Whether these observations apply to human beings with stroke is unknown. We therefore examined the relation between body temperature on admission with acute stroke and various indices of stroke severity and outcome. METHODS: In a prospective and consecutive study 390 stroke patients were admitted to hospital within 6 h after stroke (median 2.4 h). We determined body temperature on admission, initial stroke severity, infarct size, mortality, and outcome in survivors. Stroke severity was measured on admission, weekly, and at discharge on the Scandinavian Stroke Scale (SSS). Infarct size was determined by computed tomography. Multiple logistic and linear regression outcome analyses included relevant confounders and potential predictors such as age, gender, stroke severity on admission, body temperature, infections, leucocytosis, diabetes, hypertension, atrial fibrillation, ischaemic heart disease, smoking previous stroke, and comorbidity. FINDINGS: Mortality was lower and outcome better in patients with mild hypothermia on admission; both were worse in patients with hyperthermia. Body temperature was independently related to initial stroke severity (p
Notes
Comment In: Lancet. 1996 May 18;347(9012):1415-68637376
PubMed ID
8618482 View in PubMed
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The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost. A community-based study.

https://arctichealth.org/en/permalink/ahliterature214843
Source
Stroke. 1995 Jul;26(7):1178-82
Publication Type
Article
Date
Jul-1995
Author
H S Jørgensen
H. Nakayama
H O Raaschou
K. Larsen
P. Hübbe
T S Olsen
Author Affiliation
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Source
Stroke. 1995 Jul;26(7):1178-82
Date
Jul-1995
Language
English
Publication Type
Article
Keywords
Aged
Cerebrovascular Disorders - mortality - therapy
Cost Savings - statistics & numerical data
Denmark - epidemiology
Female
Hospital Costs - statistics & numerical data
Hospital Mortality
Hospital Units - statistics & numerical data
Housing - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Male
Multivariate Analysis
Nursing Homes - statistics & numerical data
Patient Discharge - statistics & numerical data
Prospective Studies
Regression Analysis
Risk factors
Treatment Outcome
Abstract
Treatment of stroke patients in specialized stroke units has become more frequent, yet the effect of this treatment has not been determined.
In a community-based, prospective, and consecutive study of 1241 unselected acute stroke patients, we compared outcome of stroke treatment between two neighboring communities within Greater Copenhagen: the Bispebjerg community, where all acute stroke patients are treated and rehabilitated on a stroke unit, and Frederiksberg community, where all acute stroke patients are treated and rehabilitated on general neurological and medical wards. Except for the different organization of stroke treatment, the two communities and the two patient groups were comparable. Specifically, age, sex, marital status, prestroke residence, and stroke severity were not statistically different between patients treated on the stroke unit and those treated on the general neurological and medical wards. Multivariate regression analyses were used to estimate the independent influence of stroke unit treatment on outcome.
Stroke unit treatment significantly reduced in-hospital mortality (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.34 to 0.74; P
Notes
Comment In: Stroke. 2000 Sep;31(9):2267-810978062
PubMed ID
7604410 View in PubMed
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Orientation in the acute and chronic stroke patient: impact on ADL and social activities. The Copenhagen Stroke Study.

https://arctichealth.org/en/permalink/ahliterature72912
Source
Arch Phys Med Rehabil. 1996 Apr;77(4):336-9
Publication Type
Article
Date
Apr-1996
Author
P M Pedersen
H S Jørgensen
H. Nakayama
H O Raaschou
T S Olsen
Author Affiliation
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Source
Arch Phys Med Rehabil. 1996 Apr;77(4):336-9
Date
Apr-1996
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Acute Disease
Age Factors
Aged
Aged, 80 and over
Aphasia - classification - etiology
Cerebrovascular Disorders - complications - psychology - rehabilitation
Chronic Disease
Denmark
Female
Humans
Male
Orientation
Outcome Assessment (Health Care)
Prospective Studies
Regression Analysis
Research Support, Non-U.S. Gov't
Severity of Illness Index
Sex Factors
Social Adjustment
Abstract
OBJECTIVES: To determine the influence of initially lowered orientation on rehabilitation outcome in stroke patients, and how decreased orientation 6 months after stroke influences ADL and social activities. DESIGN: Prospective, consecutive, and community based. SETTING: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were completed within the unit. PATIENTS: 524 patients with acute stroke. MAIN OUTCOME MEASURES: Basic ADL assessed by the Barthel Index (BI) at discharge; discharge placement; higher level ADL and social functions assessed by the Frenchay Activity Index(FAI) at a 6-month follow-up. RESULTS: The independent influence of orientation in acute stroke on rehabilitation outcome was analyzed with multiple linear and logistic regression models, using initial stroke severity (Scandinavian Neurologic Stroke Scale), initial BI, age, sex, comorbidity, prior stroke, and marital status as covariates. A one-point decrease in orientation decreased BI with 9 points (coefficient b=8.66, SE(b)=1.02,p
PubMed ID
8607755 View in PubMed
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Silent infarction in acute stroke patients. Prevalence, localization, risk factors, and clinical significance: the Copenhagen Stroke Study.

https://arctichealth.org/en/permalink/ahliterature219126
Source
Stroke. 1994 Jan;25(1):97-104
Publication Type
Article
Date
Jan-1994
Author
H S Jørgensen
H. Nakayama
H O Raaschou
J. Gam
T S Olsen
Author Affiliation
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Source
Stroke. 1994 Jan;25(1):97-104
Date
Jan-1994
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Aged, 80 and over
Brain - radiography
Cerebral Infarction - complications - epidemiology - radiography
Cerebrovascular Disorders - complications - physiopathology - radiography
Denmark - epidemiology
Disability Evaluation
Humans
Male
Mental Status Schedule
Middle Aged
Nervous System - physiopathology
Prevalence
Prospective Studies
Regression Analysis
Risk factors
Tomography, X-Ray Computed
Abstract
Our objective was to study age-specific prevalence, computed tomographic (CT) characteristics, risk factors, and the prognostic influence on stroke outcome of silent infarction in acute stroke patients.
The study was prospective and community-based and included 801 acute stroke patients, of whom 587 had first-ever stroke. A CT scan was performed in 500 (85%) of the 587 patients with first-ever stroke. CT was reviewed blindly, and infarcts were classified according to patient history as silent or symptomatic. Patients were evaluated initially with the Mini-Mental State Examination (MMSE) and weekly with both the Scandinavian Stroke Scale (SSS) and the Barthel Index (BI) from the onset of stroke to completion of rehabilitation. CT characteristics, risk factors, and stroke outcome were compared in stroke patients with and without silent infarction.
The prevalence of silent infarction in patients with first-ever stroke and recurrent strokes was similar, at 29% (group aged 0 to 54 years, 16%; 55 to 64 years, 22%; 65 to 74 years, 30%; 75 years or older, 33%). Silent infarcts were small and subcortical. Independent risk factors were increasing age (odds ratio [OR], 1.95 per 25 years; confidence interval [CI], 1.19 to 3.15), hypertension (OR, 1.75; CI, 1.13 to 2.70), claudication (OR, 1.74; CI, 1.01 to 3.00), and male sex (OR, 1.72; CI, 1.12 to 2.64); other stroke risk factors such as atrial fibrillation and former transient ischemic attack were not independent risk factors. Patients with and without silent infarction did not differ in frequency of prestroke home care (P = .2). MMSE (P = .56), initial BI (P = .62) and SSS score (P = .08), BI (P = .85) and SSS score (P = .75) after completion of rehabilitation, or in the speed of recovery (P = .85). Length of hospital stay, mortality rate, and discharge rate to nursing home also did not differ between the two groups.
This community-based study shows that silent infarction in stroke patients is more related to certain stroke risk factors than others and that silent infarction does not seem to influence the prognosis of stroke.
Notes
Comment In: Stroke. 1994 Nov;25(11):2293-47974563
PubMed ID
8266390 View in PubMed
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Stroke in patients with diabetes. The Copenhagen Stroke Study.

https://arctichealth.org/en/permalink/ahliterature48428
Source
Stroke. 1994 Oct;25(10):1977-84
Publication Type
Article
Date
Oct-1994
Author
H. Jørgensen
H. Nakayama
H O Raaschou
T S Olsen
Author Affiliation
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Source
Stroke. 1994 Oct;25(10):1977-84
Date
Oct-1994
Language
English
Publication Type
Article
Keywords
Acute Disease
Age Factors
Aged
Blood Glucose - analysis
Cause of Death
Cerebral Hemorrhage - epidemiology
Cerebrovascular Disorders - blood - epidemiology - mortality - radiography - rehabilitation
Comorbidity
Denmark - epidemiology
Diabetes Mellitus - blood - epidemiology
Female
Humans
Hypertension - epidemiology
Male
Prognosis
Prospective Studies
Regression Analysis
Research Support, Non-U.S. Gov't
Risk factors
Tomography, X-Ray Computed
Abstract
BACKGROUND AND PURPOSE: Although diabetes is a strong risk factor for stroke, it is still unsettled whether stroke is different in patients with and without diabetes. This is true for stroke type, stroke severity, the prognosis, and the relation between admission glucose levels and stroke severity/mortality. METHODS: This community-based study included 1135 acute stroke patients (233 [20%] had diabetes). All patients were evaluated until the end of rehabilitation by weekly assessment of neurological deficits (Scandinavian Stroke Scale) and functional disabilities (Barthel Index). A computed tomographic scan was performed in 83%. RESULTS: The diabetic stroke patient was 3.2 years younger than the nondiabetic stroke patient (P
PubMed ID
8091441 View in PubMed
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[Treatment and rehabilitation in an apoplexy unit increases the 5-year survival]

https://arctichealth.org/en/permalink/ahliterature47839
Source
Ugeskr Laeger. 2000 Jun 12;162(24):3450-2
Publication Type
Article
Date
Jun-12-2000
Author
H S Jørgensen
L P Kammersgaard
H. Nakayama
H O Raaschou
K J Larsen
P. Hübbe
T S Olsen
Author Affiliation
H:S Bispebjerg Hospital, neurologsk afdeling. hsj@dadlnet.dk
Source
Ugeskr Laeger. 2000 Jun 12;162(24):3450-2
Date
Jun-12-2000
Language
Danish
Publication Type
Article
Keywords
Aged
Cerebrovascular Accident - mortality - rehabilitation - therapy
Comparative Study
Denmark - epidemiology
English Abstract
Female
Hospital Mortality
Hospital Units - statistics & numerical data
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Regression Analysis
Research Support, Non-U.S. Gov't
Risk factors
Socioeconomic Factors
Treatment Outcome
Abstract
Treatment of stroke patients in specialised stroke units has become more frequent, but the longterm effect of this treatment has not been determined. In this prospective, community-based study of 1241 unselected acute stroke patients we compared outcome between patients geographically randomised to treatment in a stroke unit or in a general neurological/medical ward, from the time of acute admission to the end of rehabilitation. Baseline characteristics were comparable between the two treatment groups regarding age, sex, marital status, pre-stroke residence, and stroke severity. Patients treated in the stroke unit had higher comorbidity with regard to hypertension and diabetes. Multivariate linear and logistic regression analyses were applied to estimate the independent influence of stroke unit treatment on outcome. Stroke unit treatment significantly reduced not only initial mortality, but also mortality within five years from stroke onset. The relative risk of dying within the first five years from stroke was reduced by 40%, p
Notes
Comment On: Ugeskr Laeger. 2000 Jul 31;162(31):4172-310962929
PubMed ID
10918827 View in PubMed
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7 records – page 1 of 1.