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Lynne Turnerstokes - One of the best experts on this subject based on the ideXlab platform.

  • use of an Integrated Care Pathway a third round audit of the management of shoulder pain in neurological conditions
    Journal of Rehabilitation Medicine, 2003
    Co-Authors: Diana Jackson, Lynne Turnerstokes, Heather Williams, Rana Dasgupta
    Abstract:

    Objectives: To complete a third round audit of management of shoulder pain using an Integrated Care Pathway, to evaluate pro forma documentation and to determine outcome. Subjects and setting: Thirty-four patients with upper limb paresis admitted to a rehabilitation unit during a 22-month period had shoulder pain and were included in the Integrated Care Pathway. Methods: Retrospective review of pro forma documentation against pre-determined standards. Results: Compared with the second round audit, performance against 5 out of 9 standards for initial assessment and documentation had improved, and ranged from 56% to 94%. Achievement of 9 further standards relating to continued management ranged from 44% to 97%. Variance was not always well recorded. Shoulder pain resolved or improved in 18/34 (53%) of patients. Conclusion: Introducing the pro forma improved standards of documentation and demonstrated a positive outcome in over half the patients. Some problems with developing and maintaining Integrated Care Pathways in the context of rehabilitation are discussed.

  • development of an Integrated Care Pathway for the management of hemiplegic shoulder pain
    Disability and Rehabilitation, 2002
    Co-Authors: Diana Jackson, Lynne Turnerstokes, A Khatoon, H Stern, L Knight, A Oconnell
    Abstract:

    Purpose: To improve clinical management of patients with hemiplegic shoulder pain through development of an evidencebased multidisciplinary Integrated Care Pathway (ICP), and to use this to audit quality of Care against predefined standards. Methods: The ICP was developed by a team of medical, paramedical and nursing staff. The evidence base was established through a systematic literature review supplemented by clinical consensus to ensure best practice where scientific evidence was lacking. Following development, performance was assessed against standards in a cohort of stroke patients with hemiplegia (n=32) consecutively admitted to a regional unit providing in-patient rehabilitation for young patients with complex disabilities. Results: Performance showed improvements in assessment and documentation of pain and in initial Care, including analgesia and application of positioning/handling protocols. However, review and response to continuing or changing symptoms were poorly documented. Changes to the ICP were introduced to improve this. Conclusions: Principal benefits have been to raise awareness of shoulder pain, to educate staff and prompt management in line with recommended best practice, but strong leadership is essential to ensure continuity in clinical practice. Future research is needed to establish whether improved quality of Care offsets the substantial investment of staff time in ICP development.

  • a completed audit cycle and Integrated Care Pathway for the management of depression following brain injury in a rehabilitation setting
    Clinical Rehabilitation, 2002
    Co-Authors: Nibras Hassan, Lynne Turnerstokes, Katherine Pierce, F Clegg
    Abstract:

    Objective: To develop an evidence-based multidisciplinary Integrated Care Pathway (ICP) for the management of depression following brain injury in a rehabilitation setting, and to assess its impact on standards of Care and documentation.Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with complex disabilities mainly resulting from brain injury.Methods and design: A completed cycle of audit including:standards set for documentation, assessment, management and review; L an initial retrospective audit of documented patient management against those standards during a five-year period (26 patient records);ICP development by a multidisciplinary team of doctors, psychologists and nurses based on clinical opinion and systematic review of the literature;re-audit from the ICP documentation (48 patient records) over a period of 15 months.Results: The initial audit demonstrated borderline acceptable documentation of baseline mood state and start of medication (54–...

  • depression after stroke a review of the evidence base to inform the development of an Integrated Care Pathway part 1 diagnosis frequency and impact
    Clinical Rehabilitation, 2002
    Co-Authors: Lynne Turnerstokes, Nibras Hassan
    Abstract:

    Background: Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital. This systematic review was undertaken as a preliminary step to explore the available evidence on which to base an Integrated Care Pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting. It is divided into two parts.Aims and objectives: In part 1 we review the frequency of depression in stroke and its impact on functional recovery. Also the different methods for diagnosis and measurement.Methods: Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews.Main findings: PSD is common and is associated with cognitive, functional and social deficits which potentially limit the outcome from rehabilitation. However, diversity of assessment tools and diagnostic crit...

  • shoulder pain after stroke a review of the evidence base to inform the development of an Integrated Care Pathway
    Clinical Rehabilitation, 2002
    Co-Authors: Lynne Turnerstokes, Diana Jackson
    Abstract:

    Background: Shoulder pain is a common complication of stroke. It can impede rehabilitation and has been associated with poorer outcomes and prolonged hospital stay. This systematic review was undertaken to inform the development of an evidence-based Integrated Care Pathway (ICP) for the management of hemiplegic shoulder pain (HSP).Aims and objectives: 1) To provide a background understanding of the functional anatomy of the shoulder and its changes following stroke.2) To review the literature describing incidence and causation of HSP and the evidence for factors contributing to its development.3) To appraise the evidence for effectiveness of different interventions for HSP.Methods: Data sources comprised a computer-aided search of published studies on shoulder pain in stroke or hemiplegia and references to literature used in reviews (total references = 121).Main findings: Although a complex variety of physical changes are associated with HSP, these broadly divide into ‘flaccid’ and ‘spastic’ presentations...

Diana Jackson - One of the best experts on this subject based on the ideXlab platform.

  • use of an Integrated Care Pathway a third round audit of the management of shoulder pain in neurological conditions
    Journal of Rehabilitation Medicine, 2003
    Co-Authors: Diana Jackson, Lynne Turnerstokes, Heather Williams, Rana Dasgupta
    Abstract:

    Objectives: To complete a third round audit of management of shoulder pain using an Integrated Care Pathway, to evaluate pro forma documentation and to determine outcome. Subjects and setting: Thirty-four patients with upper limb paresis admitted to a rehabilitation unit during a 22-month period had shoulder pain and were included in the Integrated Care Pathway. Methods: Retrospective review of pro forma documentation against pre-determined standards. Results: Compared with the second round audit, performance against 5 out of 9 standards for initial assessment and documentation had improved, and ranged from 56% to 94%. Achievement of 9 further standards relating to continued management ranged from 44% to 97%. Variance was not always well recorded. Shoulder pain resolved or improved in 18/34 (53%) of patients. Conclusion: Introducing the pro forma improved standards of documentation and demonstrated a positive outcome in over half the patients. Some problems with developing and maintaining Integrated Care Pathways in the context of rehabilitation are discussed.

  • development of an Integrated Care Pathway for the management of hemiplegic shoulder pain
    Disability and Rehabilitation, 2002
    Co-Authors: Diana Jackson, Lynne Turnerstokes, A Khatoon, H Stern, L Knight, A Oconnell
    Abstract:

    Purpose: To improve clinical management of patients with hemiplegic shoulder pain through development of an evidencebased multidisciplinary Integrated Care Pathway (ICP), and to use this to audit quality of Care against predefined standards. Methods: The ICP was developed by a team of medical, paramedical and nursing staff. The evidence base was established through a systematic literature review supplemented by clinical consensus to ensure best practice where scientific evidence was lacking. Following development, performance was assessed against standards in a cohort of stroke patients with hemiplegia (n=32) consecutively admitted to a regional unit providing in-patient rehabilitation for young patients with complex disabilities. Results: Performance showed improvements in assessment and documentation of pain and in initial Care, including analgesia and application of positioning/handling protocols. However, review and response to continuing or changing symptoms were poorly documented. Changes to the ICP were introduced to improve this. Conclusions: Principal benefits have been to raise awareness of shoulder pain, to educate staff and prompt management in line with recommended best practice, but strong leadership is essential to ensure continuity in clinical practice. Future research is needed to establish whether improved quality of Care offsets the substantial investment of staff time in ICP development.

  • shoulder pain after stroke a review of the evidence base to inform the development of an Integrated Care Pathway
    Clinical Rehabilitation, 2002
    Co-Authors: Lynne Turnerstokes, Diana Jackson
    Abstract:

    Background: Shoulder pain is a common complication of stroke. It can impede rehabilitation and has been associated with poorer outcomes and prolonged hospital stay. This systematic review was undertaken to inform the development of an evidence-based Integrated Care Pathway (ICP) for the management of hemiplegic shoulder pain (HSP).Aims and objectives: 1) To provide a background understanding of the functional anatomy of the shoulder and its changes following stroke.2) To review the literature describing incidence and causation of HSP and the evidence for factors contributing to its development.3) To appraise the evidence for effectiveness of different interventions for HSP.Methods: Data sources comprised a computer-aided search of published studies on shoulder pain in stroke or hemiplegia and references to literature used in reviews (total references = 121).Main findings: Although a complex variety of physical changes are associated with HSP, these broadly divide into ‘flaccid’ and ‘spastic’ presentations...

Nibras Hassan - One of the best experts on this subject based on the ideXlab platform.

  • a completed audit cycle and Integrated Care Pathway for the management of depression following brain injury in a rehabilitation setting
    Clinical Rehabilitation, 2002
    Co-Authors: Nibras Hassan, Lynne Turnerstokes, Katherine Pierce, F Clegg
    Abstract:

    Objective: To develop an evidence-based multidisciplinary Integrated Care Pathway (ICP) for the management of depression following brain injury in a rehabilitation setting, and to assess its impact on standards of Care and documentation.Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with complex disabilities mainly resulting from brain injury.Methods and design: A completed cycle of audit including:standards set for documentation, assessment, management and review; L an initial retrospective audit of documented patient management against those standards during a five-year period (26 patient records);ICP development by a multidisciplinary team of doctors, psychologists and nurses based on clinical opinion and systematic review of the literature;re-audit from the ICP documentation (48 patient records) over a period of 15 months.Results: The initial audit demonstrated borderline acceptable documentation of baseline mood state and start of medication (54–...

  • depression after stroke a review of the evidence base to inform the development of an Integrated Care Pathway part 1 diagnosis frequency and impact
    Clinical Rehabilitation, 2002
    Co-Authors: Lynne Turnerstokes, Nibras Hassan
    Abstract:

    Background: Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital. This systematic review was undertaken as a preliminary step to explore the available evidence on which to base an Integrated Care Pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting. It is divided into two parts.Aims and objectives: In part 1 we review the frequency of depression in stroke and its impact on functional recovery. Also the different methods for diagnosis and measurement.Methods: Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews.Main findings: PSD is common and is associated with cognitive, functional and social deficits which potentially limit the outcome from rehabilitation. However, diversity of assessment tools and diagnostic crit...

  • managing depression in brain injury rehabilitation the use of an Integrated Care Pathway and preliminary report of response to sertraline
    Clinical Rehabilitation, 2002
    Co-Authors: Lynne Turnerstokes, Nibras Hassan, Katherine Pierce, F Clegg
    Abstract:

    Aims: To use data generated from an Integrated Care Pathway (ICP) to describe the characteristics of patients presenting with depression in a brain injury rehabilitation programme and to assess their response to treatment with sertraline.Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with severe complex disabilities.Design: Prospective cohort study of 82 patients admitted to the unit during the 15-month period between between 1 September 1999 and 1 December 2000. Response to sertraline was assessed in an open-label, before-andafter study designMethods and design: All admissions were screened and included in the ICP if there was clinical suspicion of depression, past or present. Anti-depressant medication was prescribed, where appropriate, according to the ICP protocol. Depression was diagnosed on clinical grounds against DSM-IV criteria, and measured where feasible using the Beck Depression Inventory (BDI-II) administered by interview, pretreatment an...

  • depression after stroke a review of the evidence base to inform the development of an Integrated Care Pathway part 2 treatment alternatives
    Clinical Rehabilitation, 2002
    Co-Authors: Lynne Turnerstokes, Nibras Hassan
    Abstract:

    Background: Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital.This systematic review was undertaken as a preliminary step to the development of an evidence-based Integrated Care Pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting, and is divided into two parts. In part 1 we reviewed the frequency of depression in stroke, its impact on functional recovery and the different methods for assessment.Aims and objectives: In part 2, we discuss the rationale for treatment of PSD, appraise the evidence for effectiveness of the different antidepressant drugs, and consider whether we can identify a recommended ”rst-line treatment for use in our ICP.Methods: Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews.Main ” ndings...

R J Prescott - One of the best experts on this subject based on the ideXlab platform.

  • effect of an Integrated Care Pathway on acute asthma wheeze in children attending hospital cluster randomized trial
    The Journal of Pediatrics, 2008
    Co-Authors: Steve Cunningham, Claire Logan, Linda Lockerbie, Mark Dunn, Ann Mcmurray, R J Prescott
    Abstract:

    Objective To determine whether an Integrated Care Pathway (ICP) could improve Care delivered to patients coming to an emergency department only or to patients who were subsequently admitted. Study design Children (age, 2-16 years; n = 298) coming to the ED with acute asthma/wheeze, were randomized by using a cluster design to either standard Care or Care delivered by an ICP. Results Children discharged from the ED who received Care with an ICP (n = 118) received more prednisolone (81%; standard, 63%; P = .03) and increased advice to obtain primary Care review (72%; standard, 33%; P Conclusion An acute asthma/wheeze ICP improved education and prescribing errors, modestly reduced the length of stay when discharge criteria were adhered to, but did not influence recovery time. Further consideration of the effect on staff workload is required.

  • effect of an Integrated Care Pathway on acute asthma wheeze in children attending hospital cluster randomized trial
    The Journal of Pediatrics, 2008
    Co-Authors: Steve Cunningham, Claire Logan, Linda Lockerbie, Mark Dunn, Ann Mcmurray, R J Prescott
    Abstract:

    Objective To determine whether an Integrated Care Pathway (ICP) could improve Care delivered to patients coming to an emergency department only or to patients who were subsequently admitted. Study design Children (age, 2-16 years; n=298) coming to the ED with acute asthma/wheeze, were randomized by using a cluster design to either standard Care or Care delivered by an ICP. Results Children discharged from the ED who received Care with an ICP (n = 118) received more prednisolone (81%; standard, 63%; P = .03) and increased advice to obtain primary Care review (72%; standard, 33%; P P = .36). When a discharge checklist was completed (60 of 94 cases), the mean ICP length of stay was 34.2 hours (range, 30.5-38.4 hours; P = .07 versus standard). An ICP resulted in a 30% reduction in prescribing errors (mean, 10.4; standard, 14.8; P = .002). Eighty-four of 94 children with an ICP received a 48-hour discharge plan (89%) versus 35 of 86 children with standard Care (41%). More clinical contacts were observed in children receiving Care by an ICP (mean, 22, versus standard, 19.2: P = .0004). Conclusion An acute asthma/wheeze ICP improved education and prescribing errors, modestly reduced the length of stay when discharge criteria were adhered to, but did not influence recovery time. Further consideration of the effect on staff workload is required.

F Clegg - One of the best experts on this subject based on the ideXlab platform.

  • a completed audit cycle and Integrated Care Pathway for the management of depression following brain injury in a rehabilitation setting
    Clinical Rehabilitation, 2002
    Co-Authors: Nibras Hassan, Lynne Turnerstokes, Katherine Pierce, F Clegg
    Abstract:

    Objective: To develop an evidence-based multidisciplinary Integrated Care Pathway (ICP) for the management of depression following brain injury in a rehabilitation setting, and to assess its impact on standards of Care and documentation.Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with complex disabilities mainly resulting from brain injury.Methods and design: A completed cycle of audit including:standards set for documentation, assessment, management and review; L an initial retrospective audit of documented patient management against those standards during a five-year period (26 patient records);ICP development by a multidisciplinary team of doctors, psychologists and nurses based on clinical opinion and systematic review of the literature;re-audit from the ICP documentation (48 patient records) over a period of 15 months.Results: The initial audit demonstrated borderline acceptable documentation of baseline mood state and start of medication (54–...

  • managing depression in brain injury rehabilitation the use of an Integrated Care Pathway and preliminary report of response to sertraline
    Clinical Rehabilitation, 2002
    Co-Authors: Lynne Turnerstokes, Nibras Hassan, Katherine Pierce, F Clegg
    Abstract:

    Aims: To use data generated from an Integrated Care Pathway (ICP) to describe the characteristics of patients presenting with depression in a brain injury rehabilitation programme and to assess their response to treatment with sertraline.Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with severe complex disabilities.Design: Prospective cohort study of 82 patients admitted to the unit during the 15-month period between between 1 September 1999 and 1 December 2000. Response to sertraline was assessed in an open-label, before-andafter study designMethods and design: All admissions were screened and included in the ICP if there was clinical suspicion of depression, past or present. Anti-depressant medication was prescribed, where appropriate, according to the ICP protocol. Depression was diagnosed on clinical grounds against DSM-IV criteria, and measured where feasible using the Beck Depression Inventory (BDI-II) administered by interview, pretreatment an...