Finding Positivity Through Adversity in Poststroke Care: Harmony Sierens, MD

 I'm not wasting 4 minutes when this is about acceptance!

The first line of stroke treatment seems to always be "Acceptance" which is fucking bullshit!

Send me hate mail on this: oc1dean@gmail.com. Especially you:Harmony Sierens, MD, I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? I need an explanation of why you are putting out acceptance as your first line instead of recovery?

Finding Positivity Through Adversity in Poststroke Care: Harmony Sierens, MD

The medical director of the Inpatient Rehabilitation Unit at Ascension Genesys Hospital discussed the importance of early intervention, sustained care, and rehabilitation in managing poststroke patients. [WATCH TIME: 4 minutes]

Current Time 1:05

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Duration 4:35

 

"Stroke is common, many people are living with poststroke and have different levels of deficits. I think in stroke, we know early intervention is important, and there's a lot of information out there. There are all these mnemonics that help remember, ‘this could be a stroke, get emergency care, get to the hospital, there's intervention’ and that's wonderful. But I think we don't do a good job of talking about the management(NO, SURVIVORS WANT RECOVERY! DO YOU NOT UNDERSTAND?), poststroke, and how it changes lives and how it changes everybody's life that is involved with a person who's had a stroke.”

Stroke, a widespread disease, greatly impacts the quality of life of an individual, mostly through disability and physical changes, which can bring about different psychological and cognitive processes.¹ Although stroke mortality has declined, research shows that the annual incidence of stroke in the general population is increasing.² As more patients are living poststroke, practicing clinicians practice have the ability to optimize treatment management for their patients to improve outcomes and reduce the risk of other complications of the disease.

According to a review published in the Singapore Medical Journal, researchers recommend that clinicians institute secondary prevention and attention to bowel and bladder problems to reduce medical complications and readmissions.² The researchers also suggested that adequate analgesia, positioning/splinting of limbs, and physiotherapy can also reduce any discomfort and preventable pain in patients.² Stroke clinicians can help patients treat poststroke moods with psychological counseling and can provide additional support for patients by helping them have a more positive outlook on life.

In a recent conversation with NeurologyLive®, Harmony Sierens, MD, a physiatrist and medical director at Ascension Genesys Inpatient Rehab Unit, discussed how society can better address the long-term management and care needs of patients living poststroke(WRONG, WRONG, WRONG!You need to create protocols for 100% recovery. Survivors don't want 'care' and 'management'. They want to get back to their old life! You haven't even defined the problem you need to solve correctly! Talk to me, I can help with that.) She talked about the role that physiatrists play in optimizing rehabilitation for these patients, and how early intervention gaps can be closed. In addition, Sierens spoke about how clinicians can shift the narrative surrounding strokes, from being solely devastating events to opportunities for positive life changes for patients.(So acceptance? I'd scream my head off at any stroke medical person who gives me this crapola!)

New certification system to lift stroke care standards - Australia

WRONG, WRONG, WRONG!

Even stroke associations aren't doing it right. 'Care' NOT RESULTS OR RECOVERY!

Well it is incredibly obvious that stroke survivors don't need 'care'; they need 100% recovery protocols! GET THERE! Solve the correct problem; 100% recovery protocols, 'care' is useless.

 

New certification system to lift stroke care standards - Australia

The Stroke Foundation’s goal of ensuring all Australians can access the best stroke care possible, regardless of where they live, has taken a significant step today with the inaugural National certification of five stroke units.

Stroke Unit Certification is recommended by both the World Health Organisation, the World Stroke organisation and the Federal Government Heart and Stroke Plan as a method of ensuring best possible stroke care. It is commonplace in many countries but has never previously occurred in Australia.

Working with the Stroke Society of Australasia, Stroke Foundation has introduced, for the first time, a national certification program for hospitals to support them to deliver best-practice care for the 39,500 Australians who have a stroke each year.

The Australian Stroke Coalition (ASC) Stroke Unit Certification Project has begun as a 12-month pilot. It encourages hospitals to consistently meet a set of national stroke care criteria including caring for all stroke patients on a single dedicated ward, with specialist staffing, regular training, data monitoring and improvement, and patient involvement in decision making.

Today, the first five hospitals are being commended for making the grade:

• Shoalhaven Hospital (NSW)

• The Alfred Hospital (VIC)

• St John of God Midland Public and Private Hospitals (WA)

• Royal Adelaide Hospital (SA)

• Launceston General Hospital (TAS)

Stroke Foundation Interim Executive Director, Stroke Services and Research, Kelvin Hill, says this will improve outcomes for patients.

“Treatment on a dedicated stroke unit is proven to make the biggest overall difference of any intervention to patient outcomes following stroke, reducing the risks of both death and disability. Both Australian and international evidence suggests that rigorous stroke centre certification programs improve the quality of stroke care and patient outcomes.”

The need for a certification system comes after Stroke Foundation’s National Acute Services Audit 2021 found that not all Australian hospitals with a self-designated stroke unit meet the requirements for stroke unit care.

“This means some people with stroke are being provided suboptimal care which impacts their recovery and leads to poorer health outcomes. This is unfair. All Australian survivors of stroke deserve the best quality of care regardless of where they are hospitalised. There should be no postcode lottery.” Mr Hill said.

Participation in the program is voluntary and there is no penalty for hospitals that do not meet the criteria but Stroke Society of Australasia president, Professor Tim Kleinig, is optimistic that all Australian hospitals with self-designated stroke units will apply for certification over time, building on the current pilot phase.

“This is an opportunity for all Australian hospitals treating patients with stroke to further enhance the already excellent work their stroke teams deliver. Quality stroke unit care is a human right and all Australians deserve nothing less. We must ensure everyone unfortunate enough to have a stroke has the best possible chance, not only of survival, but also a good post-stroke recovery.”

“I applaud these hospitals for taking the necessary steps in ensuring they meet and maintain a high quality of stroke care. Along with the World Health Organisation and World Stroke Organisation, we hope all hospitals providing stroke care will participate in the certification process.” Professor Kleinig said.

Steps must be taken to address staffing and facilities shortages in stroke rehab, say Lords - England NHS

 WRONG, WRONG, WRONG! Access is not what's needed, First you have  create 100% recovery protocols. Damn it all, do things in the correct order.

Steps must be taken to address staffing and facilities shortages in stroke rehab, say Lords - England NHS

Following a CSP briefing highlighting patchy access to stroke rehab Baroness Wheeler of Blackfriars asked parliamentary under secretary of state Nick Markham about government’s plans to expand the national integrated community stroke service to ensure better access to stroke rehab. 

Baroness Wheeler said: 'Strokes cost the NHS £3.4 billion a year and social care £2.3 billion in year one, with another £2 billion on top of that for every subsequent year.' 

She went on to ask the minister about specific plans to ensure access to specialist rehab immediately following a stroke and about 'the 68 per cent of stroke sufferers who currently do not get an assessment, let alone rehab treatment, after hospital discharge?'

Lord Patel highlighted the increased risk of disability

Lord Patel highlighted the increased risk of disability for people who miss out on rehab while other peers emphasised additional challenges faced by stroke survivors including loss of muscle mass from long hospital stays, and higher levels of depression, anxiety, and loneliness experienced. 

Workforce challenges

Highlighting the 'vital rehabilitation work' by physiotherapists, Lord Markham acknowledged the importance of ensuring that the national integrated community stroke service is 'fully resourced' and the need to 'address the workforce challenges in stroke rehabilitation and community services.'

He confirmed that physio services are an 'important part' of the long-awaited NHS workforce plan and promised to follow up with the NHS to see what plans are in place to monitor uniformity of stroke rehab services. 

Patchy access to stroke rehab

Sara Hazzard, CSP assistant director of strategic communication and co-chair of the Community Rehabilitation Alliance, welcomed the spotlight placed on stroke rehab in parliament.

She said: 'The Lords are right to highlight patchy access to stroke rehab in England. Lack of timely and equitable access increases risk of disability and exacerbates health inequity. Currently many people do not even receive the minimum specialist rehab required following a stroke despite clear evidence it can significantly improve their quality of life and reduce risk of further strokes. 

Parliamentary under secretary of state Nick Markham

'Access to high quality personalised rehab is dependent on suitable rehab space and adequate staffing. So we welcome the minister’s assurance in the discussion that physio services are an important part of the upcoming workforce plan. 

'We are also pleased to hear that he recently met with NHS England CEO Amanda Pritchard, to discuss issues around access to rehab space. We are however concerned that the minister has yet to send his promised letter to all NHS CEOs on the need to provide rehab facilities and would urge him to do so as a matter of urgency'. 

Last month we reported that Lord Markham promised during a Lords debate to write to NHS CEOs to urge the return of rehab facilities that were converted into overspill wards and storage during the pandemic.

Clinical Effect of Acupuncture Combined with Herbal Medicine in Treatment of PSD: A Systematic Review and Meta-Analysis

If you have to treat depression you're doing it all wrong. The correct course is to completely prevent depression by having EXACT 100% REHAB PROTOCOLS!. Your patients will be too busy counting reps and looking forward to recovery.

 Clinical Effect of Acupuncture Combined with Herbal Medicine in Treatment of PSD: A Systematic Review and Meta-Analysis

Journal of Oriental Neuropsychiatry , Volume 31(3) , Pgs. 169-186.

NARIC Accession Number: I248408.  What's this?
Author(s): Dae-kyoo Chung; Jong-Won Sakong; Sang-Ho Kim; Su-Yeon Lim.
Publication Year: 2020.
Abstract: The aim of this study was to provide clinical evidence to support the use of acupuncture combined herbal medicine for post-stroke depression (PSD). To this end, studies were identified by searching PubMed, EMBASE, Cochrane Library, NDSL, RISS, KMbase, KISS, and CNKI. Randomized controlled trials (RCTs) that verified the effects of acupuncture combined with herbal medicine for PSD were included in this study. Literature searches of English, Chinese, and Korean databases were performed. Two authors independently extracted the data and assembled the study quality. Of 698 RCTs screened, 17 RCTs were selected. Most of the studies had unclear risk of bias. Among the 17 RCTs, 10 were meta-analyzed. As for the outcome measurement, the effective rate and the Hamilton Depression Rating Scale (HAMD) were most used. The meta-analysis of the studies revealed that the PSD cure effective rate in the acupuncture combined with herbal medicine group was higher than that in the Western medicine group (RR: 1.23, 95% CI: 1.14 to 1.33, p＜0.00001, I2 =0%). Also, the HAMD in the acupuncture combined with herbal medicine group was significantly different compared to the Western medicine group (MD -5.54, 95% CI -9.80 to -1.29, p=0.01, I2 =99%). The quality of the selected RCTs was low. These results indicate that acupuncture combined with herbal medicine is effective for treating post-stroke depression. However, it is worth noting that the included studies were of relatively poor quality. The sample sizes were also small. Based on the findings of this study, the authors recommend further investigations into the diagnosis and treatment of PSD.
Descriptor Terms: Affirmative action, Developmental disabilities, Hidden disabilities, Intellectual disabilities, Treatment.
Language: Korean
Geographic Location(s): Republic of Korea, South Asia.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: https://doi.org/10.7231/jon.2020.31.3.169.

Citation: Dae-kyoo Chung, Jong-Won Sakong, Sang-Ho Kim, Su-Yeon Lim. (2020). Clinical Effect of Acupuncture Combined with Herbal Medicine in Treatment of PSD: A Systematic Review and Meta-Analysis.  뇌졸중 후 우울증에 대한 침과 한약의 결합 치료 효과: 체계적 문헌 고찰 및 메타분석 연구.  Journal of Oriental Neuropsychiatry , 31(3), Pgs. 169-186. Retrieved 12/21/2022, from REHABDATA database.

Trend Review of Traditional Chinese Medicine Studies on Pharmacopuncture Treatment for Post-Stroke Depression

If you have to treat depression you're doing it all wrong. The correct course is to completely prevent depression by having EXACT 100% REHAB PROTOCOLS!. Your patients will be too busy counting reps and looking forward to recovery.

 Trend Review of Traditional Chinese Medicine Studies on Pharmacopuncture Treatment for Post-Stroke Depression

Journal of Oriental Neuropsychiatry , Volume 32(3) , Pgs. 235-245.

NARIC Accession Number: I248455.  What's this?
Author(s): Geumju Song; Hyunjin Khang; Jiyeon Oh; Jongmin Kim; Sangbeom Kim; Sejin Park; Yeogyeong Lee.
Publication Year: 2021.
Abstract: The aim of this study was to provide clinical evidence of pharmacopuncture treatment for post-stroke depression by reviewing randomized controlled trials on Traditional Chinese medicine pharmacopuncture, a combination of herbal medicine and acupuncture, for post-stroke depression. To this end, randomized controlled trials on pharmacopuncture treatment for post-stroke depression were searched from the China National Knowledge Infrastructure (CNKI), and literature searches of English and Chinese databases were performed. Selected literature was assessed with the Jadad scale. Twelve papers were selected from 20 studies. The following results were obtained: 1) Pharmacopuncture was used for post-stroke depression; 2) Dengzhan-Xixin was the most used injection medicine for post-stroke depression; 3) BaiHui (GV20) was the most used in pharmacopuncture treatment; 4) Based on the Hamilton Depression Rating Scale (HAMD), it was confirmed that all studies using pharmacopunture had significant efficacy. For the treatment of post-stroke depression, Dengzhans-Xixin was commonly used as an injectable medication. Additional research studies on pharmacopuncture including its practical use are needed.
Descriptor Terms: Affirmative action, Developmental disabilities, Hidden disabilities, Intellectual disabilities, Treatment.
Language: Korean
Geographic Location(s): Republic of Korea, South Asia.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: https://doi.org/10.7231/jon.2021.32.3.235.

Citation: Geumju Song, Hyunjin Khang, Jiyeon Oh, Jongmin Kim, Sangbeom Kim, Sejin Park, Yeogyeong Lee. (2021). Trend Review of Traditional Chinese Medicine Studies on Pharmacopuncture Treatment for Post-Stroke Depression.  뇌졸중 후 우울증의 약침치료에 대한 중의학 임상논문 연구동향.  Journal of Oriental Neuropsychiatry , 32(3), Pgs. 235-245. Retrieved 12/21/2022, from REHABDATA database.

“I was wrong” from Seth Godin

At what point do our stroke leaders say, 'I was wrong', and let stroke survivors run the stroke world? They have been doing it wrong for at least 50 years and haven't solved stroke. No more chances for them. 

“I was wrong” from Seth Godin 

That’s a hard sell.
It’s difficult to get someone (a client, a boss, a voter, a partner) to say those three words. Difficult to say on our own behalf, too.
Which is why we so easily get stuck.
We get stuck defending what we already decided. Because it feels easier to defend than it does to be wrong.
In 1993, in my role as founder of an internet company, I rejected the idea of the world wide web. I saw Mosaic (and then Netscape) and decided it was stupid, a dead end, a technology not worthy of our tiny company’s time.
That decision cost me a billion dollars.
Within nine months, I saw what others were seeing. I saw the power of widespread connectivity and how it was more powerful than a centralized host.
It still wasn’t easy to say, “I was wrong.”
The alternative is, “based on new information, I can make a new decision.”
We can make a new decision on what’s happening to our environment, based on new data and new science. We can make a new decision on corporate governance or on a recent political referendum.
“Why didn’t you tell me that it would lead to all these bad outcomes?”
Not wrong, simply underinformed.
The cost of a do-over is often less than the cost of sticking with a decision that was made in good faith, on insufficient information.
We don’t have to be wrong. But we regularly get a chance to make things more right.

Speech pathologists' practice in post stroke aphasia rehabilitation: Gaps in training and competency in counseling.

If you are focused on counseling rather than coming up with interventions for 100% recovery then you are doing it all wrong. Solve the primary problem, not the secondary problem. Do you not understand cause and effect?

Speech pathologists' practice in post stroke aphasia rehabilitation: Gaps in training and competency in counselling.

 

Psychological care is important in stroke rehabilitation

1

. Counseling is recommended for all stroke survivors and their families

2

/carers for optimal rehabilitation outcomes

including psychosocial wellbeing.

Counselling approaches

in stroke rehabilitation include active education, family counseling, and problem solving

2

.

.

Jasvinder Sekhon

1

, Ian Kneebone

2

, Jennifer Oates

1

, Miranda Rose

1

1

La Trobe University, Australia,

2

University of Technology Sydney.

Speech pathologists (SPs) are trained to work with people with aphasia and are key health professionals in post stroke aphasia rehabilitation.

SPs may utilise counseling as part of their role.

SPs report to utilise a range of counseling and psychosocial approaches to manage the psychological wellbeing of people in post stroke aphasia rehabilitation but report low knowledge, confidence, skill and satisfaction in this practice. SPs attribute this to a lack of training

3

.
Counseling and low level psychosocial approaches with potential to facilitate psychological wellbeing in people impacted by post stroke aphasia were identified.
Variable definitions of counseling incorporating interpersonal ‘communication’ skills and psychosocial interventions hinder understanding and progress in this important area.
SPs receive generic counseling training with limited training to competently manage the psychological wellbeing of people impacted by stroke and aphasia.
SPs may benefit from training in brief psychological interventions to facilitate the psychological wellbeing in this client group. Availability of appropriate supervision and interdisciplinary practice with mental health professionals is recommended4.
The development and evaluation of SP training, including counseling and relevant brief psychological approaches, to facilitate psychological wellbeing of people with post stroke aphasia and their families is required.