Background: Dysphagia is common after stroke. Patients with dysphagia have a higher risk of stroke-associated pneumonia (SAP) and poor outcomes. Early detection of dysphagia is necessary to identify and manage patients at high risk of aspiration. The aim of the study was to assess the impact of the systematic administration of the volume-viscosity swallow test (V-VST) in patients with acute ischaemic stroke. Methods: This was a retrospective observational study that enrolled patients with acute ischaemic stroke in two consecutive time periods: pre-V-VST, when the 30-mL water-swallowing test (WST) was systematically administered, and V-VST, when all patients underwent the WST and the V-VST test was systematically administered if the patient failed the WST. Results: Two hundred and 42 patients were enrolled. The mean age of the participants was 68.8 ± 10.88 years, 61.2% were male, and the median National Institutes of Health Stroke Scale score was 3 (IQR, 1-6). A total of 147 patients were enrolled during the pre-V-VST period and 95 were enrolled during the V-VST period. There was a significant difference in the occurrence of SAP (21.8% vs. 10.5%, p = 0.024) and the rate of nasogastric tube feeding (25.9% vs. 14.7%, p = 0.040) between the two groups, and no differences were found in the length of hospital stay (p = 0.277) or the total cost of hospitalization (p = 0.846). Conclusions: The V-VST was a better clinical screening tool, and it can also provide detailed suggestions regarding dietary modifications to prevent aspiration and SAP.

Background Pulmonary infection is a frequent complication among stroke patients and adversely affects clinical outcomes, increases the length of hospitalization stay and costs, and aggravates the financial burden of the national medical health system. Early identification and management of high-risk patients are necessary and imperative to reduce the incidence of stroke-associated pneumonia (SAP). Aim The evidence-based practice project evaluated the effectiveness of a standard care bundle intervention in preventing the occurrence of SAP. Methods The project was conducted in a neurology department of a teaching hospital. Given the variation in assessment and management standards, evidence-based practice (EBP) methodology was used to establish a process for quality improvement. A thorough literature search was conducted to identify evidence-based interventions to manage and prevent SAP. Thorough critiques of the literature and synthesis of the evidence were completed. A systematic management flow and care bundle interventions were established. The care bundle included interventions, such as the utilization of tools for SAP risk screening; dysphagia screening and rehabilitation; feeding modification, oral care, airway management, position management, and the nursing techniques of traditional Chinese medicine. Results A significant improvement was observed in preventing SAP in patients in the postimplementation group compared with those in the preimplementation group (14.0% vs. 37.2%, p = 0.025). In addition, significantly lower duration of hospitalization, lower rate of aspiration, and improvements in albumin and oral hygiene were found after the implementation of the care bundle. Conclusions Evidence-based care bundles successfully empower nurses to reduce the incidence of SAP. The management flow of SAP prevention could be promoted to other units of the neurology department in the future. The results of the project reflect positively on the capacity to implement EBP in an acute care setting for stroke. The EBP methodology can be utilized to solve other clinical problems.

Background Gestational diabetes mellitus (GDM) is a risk factor for diabetes mellitus. The 75-g, 2-h oral glucose tolerance test is recommended for mothers with a history of GDM to screen for diabetes in the postnatal period. The aim of this study was to investigate the rate of glucose screening within 6 months postpartum among Chinese mothers with a history of GDM, and to identify its predictors. Methods A prospective cohort study was conducted in a regional teaching hospital in Guangzhou, China, between July 2016 and June 2017. The participants were Chinese mothers ( n = 237) who were diagnosed with GDM, were aged 18 years or older with no serious physical or mental disease and had not been diagnosed with type 1 or type 2 diabetes prior to their pregnancy. The revised Chinese version of the Champion’s Health Belief Model Scale and social-demographic and perinatal characteristics factors were collected and used to predict postpartum glucose screening (yes or no). Adjust odds ratio (AOR) and 95% confidence interval (95% CI) were calculated. Results The mean age of the 237 mothers was 32.70 years (range from 22 to 44). Almost half of the mothers (45.6%) were college graduates or higher. Chinese mothers reported a high level of perceived benefits, self-efficacy, and health motivation towards postpartum glucose screening, with a mean score above 3.5. Chinese mothers were more likely to undertake postpartum glucose screening if they were a first-time mother [AOR 2.618 (95% CI: 1.398–4.901)], had a high perceived susceptibility score [AOR 2.173 (95% CI: 1.076–4.389)], a high perceived seriousness score [AOR 1.988 (95%CI: 1.020–3.875)] and high perceived benefits score [AOR 2.978 (95%CI: 1.540–5.759)]. Conclusion The results of this study will lead to better identification of mothers with a history of GDM who may not screen for postpartum glucose abnormality. Health care professionals should be cognizant of issues that may affect postpartum glucose screening among mothers with a history of GDM, including parity, perceived susceptibility, perceived seriousness and perceived benefits. Electronic supplementary material The online version of this article (10.1186/s12884-019-2276-9) contains supplementary material, which is available to authorized users.

Aims:To test prospective pathways of a Comprehensive Reminder System based on the Health Belief Model (CRS-HBM), stroke knowledge, health belief in health behaviour, blood pressure (BP) control, and disability in hypertensive ischaemic stroke patients at 6-month postdischarge.Design: A nested cohort study design. Methods: Data were derived from a randomized controlled trial evaluating the effects of the intervention (N = 174, performed during February 2015 -March 2016). Data were collected by questionnaires and analysed in structural equation modelling in Mplus software. Results: The proposed model provided a good fit to the data. This model accounted for 51.5% of the variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. The CRS-HBM had: (a) direct positive effect (β = .391, p < .001) and indirect positive effects (β = .186, p = .002) on health behaviour; (b) direct positive effect (β = .356, p < .001) and indirect positive effects (β = .183, p = .009) on BP control; and (c) indirect negative effect (β = −.146, p = .008) on disability. Being female was linked to better health behaviour. Higher education predicted higher level of stroke knowledge and health belief. Conclusions:The CRS-HBM can not only directly but also indirectly improve patients' health behaviours by improving their health knowledge or health belief. Better health behaviour can improve patients' BP control and reduce disability. Therefore, nurses need to pay more attention to not only patients' health knowledge but also their health belief when providing education. Impact:The CRS-HBM intervention accounted for 51.5% of variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. This research can help nurses improve health education strategies in postdischarge and community contexts to achieve better health results. | 1385ZHANG et Al.

Background There were 28.76 million stroke patients in China, with 3.94 million new strokes annually. Around 70% of survivors live with varying degrees of permanent disability, placing a heavy burden on families and society. Stroke patients have a complex and high need for continuing care services after discharge from the hospital. The study was to evaluate the effectiveness of the continuing care program on the activity of daily life, the degree of disability, stroke recurrence and readmission in patients with stroke, based on the long-term care insurance policy. Methods Eighty-eight stroke patients were recruited from February 2021 to January 2022. They were allocated to either intervention group (N = 44) or control group (N = 44) based on whether the long-term care insurance application was successful. The intervention consisted of discharge education, 3-month in-home care and remote counseling. The activity of daily life, disability, recurrence and readmission of patients were evaluated between the groups before the intervention, at 1, 2, 3 and 6 months after discharge. Results There were no statistically significant differences between the groups in clinical characteristics at baseline. We detected significant interaction effects between time and group (p < 0.001), indicating that the scores of two outcomes changed differently over time in intervention and control groups. It was found that the participants of the intervention group had a statistically significant improvement in activity of daily life and disability than the control group at baseline and follow-up periods. The decrease in readmission of the intervention group was statistically significant than in the control group (χ2 = 6.040, p = 0.014; χ2 = 7.216, p = 0.007) at 1 and 2 months after discharge, but no significant difference was found at 3 and 6 months after discharge. At follow-up, there was no significant difference between groups regarding stroke recurrence rates (p > 0.05). Conclusions This study demonstrates the positive effects of a continuing care program based on the long-term care insurance policy on activity of daily life and disability in people with stroke. The effectiveness and feasibility of this intervention program suggest that its application should be promoted to promote the care and rehabilitation of stroke patients. Trail registration: The trail was not registered as a quasi-experimental trail.