Admission to hospital of patients 11. 1 ; A person must not be admitted to a hospital as a patient except by an order of the hospital's board or of a person authorized by that board for this purpose. 2 ; When a patient is admitted to a hospital or as soon as practicable after that time, the attending practitioner or practitioners, as the case may be, must report to the board a preliminary diagnosis of the disease or condition for which the patient is receiving health care services.
Thora B Hafsteinsdottir, Univ Med Cntr Utrecht and Julius Cntr--Nursing Sciences, Utrecht, Netherlands; Ale Algra, Univ Med Cntr Utrecht and Julius Cntr--Clinical Epidemiology, Utrecht, Netherlands; Laurens J Kappelle, Univ Med Cntr Utrecht, Utrecht, Netherlands; Maria H Grypdonck; Univ Med Cntr Utrecht and Julius Cntr--Nursing Sciences, Utrecht, Netherlands Background and Purpose. Neurodevelopmental treatment NDT ; is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. In this study the effects of the NDT-approach on the functional status and Quality of Life QoL ; were investigated during one year after stroke onset. Methods. In a prospective, non-randomised, parallel group design, 324 consecutive patients from 12 Dutch hospitals were included in the study between September 1998 and September 2001. In the experimental group N 223 ; , nurses and physiotherapists used the NDT-approach when caring for the patients, whereas conventional therapy was used with the patients in the control group N 101 ; . Primary outcome was poor outcome defined as Barthel index 12 or death after one year. QoL was assessed with the SF-36, SA-SIP30 and the VAS. Results. At 12 months 59 patients in the NDT group 27% ; had a poor outcome and 24 in the non-NDT group 24% ; . The corresponding adjusted odds ratio was 1.7 95% CI 0.8 3.5 ; . At discharge the adjusted odds ratio was 0.8 95% CI 0.4 1.5 ; and after six months 1.6 95% CI 0.8 3.2 ; . The adjusted mean differences of the three QoL measures did not show statistically significant differences between the two study groups at 6 and 12 months after stroke onset. Conclusion. The NDT-approach was not found to be an effective method in the care of hospitalised stroke patients. Health care professionals need to reconsider their current use of the NDT-approach, for example, oral contraceptives.
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Abstract 182 CHRONIC VENOUS DISEASE: THROUGH BODY MASS INDEX Jean Jrome Guex, Pr, Societ Franaise de Phlbologie, Nice, France, Eric Myon, PhD, Charles Taieb, MD, Public Health , Health Economics & Quality of life, I.R.P.F., Boulogne Billancourt, France, Robert Launois, Pr, REES -, Rseau d'Evaluation en Economie de la Sant, Paris, France Introduction: Many studies have confirmed obesity as a Chronic Venous Disease CVD ; risk factor. Few studies have described the pathology through Body Mass Index BMI ; . Objective: To describe the impact of overweight in CVD. Method: Between May and July 2003, 567 GP have recruited 1049 female patients spontaneously consulting for CVD. The patients could fill in a series of validated questionnaires in order to evaluate the consequences of their disease. Results: The results of the study concern 1045 patients with a mean age of 44, 45 years old 10.70 ; min: 18 max: 65 66% have a professional activity. The patients average size was 164.39 cm 5.99 ; for an average weight of 65.2 kg 12.5 ; . The BMI calculation gives an average BMI of 24.17 4.71 ; . The values issued by the WHO have been taken into account: Thinness: 4% -Normal weight 62% - Overweight: 24% - Obesity: 10%. For each of these subgroups, CIVIQ score is respectively of 21.2, 16.6 , 25.8 , 32.1. In order to make easier the analysis, we have reduced to two subgroups BMI 27 vs 27. CIVIQ score is: 29, 8 versus40, 9 p 0.0001 ; . This difference is found through the severity CEAP ; classification: 15% of C0-C2 have a BMI 27, while they represent 26% of the C3-C6 p 0.001 ; . We have tested both subgroups on sedentary lifestyle, family history, underfloor heating, pregnancy risk factors. None of them is significant except sedentary lifestyle 61% vs 76%, p 0.0001 ; Conclusion : A more important CVD severity grade is expected for a BMI 27, for example, generic triphasil.
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G01 VIDEOFLUOROSCOPIC ASSESSMENT OF SWALLOWING IN INFANTS AND CHILDREN. A. De Vriendt 1 ; , C. Hoskens 2 ; , G. Veereman-Wauters 1 ; , T. Mahler 1 ; , M. Van Caillie-Bertrand 1 ; . 1 ; Pediatric Gastroenterology and Nutrition AZ Middelheim ; 2 ; Pediatric Radiology AZ Middelheim. Efficient swallowing transports nutrients and secretions from the mouth to the esophagus, without substances entering the airway. The clinical examination provides information about the oral mechanisms, but a radiological study is necessary when a child is suspected of oropharyngeal swallowing problems. Videofluoroscopic assessment is always preceded by a clinical examination by a gastroenterologist and a clinical evaluation of the oral mechanisms with a feeding observation by a speech pathologist. Videofluoroscopy is performed by a radiologist in cooperation with a speech pathologist. The anatomy of the oral cavity, the pharynx and the cervical esophagus is visualized and their functionality dynamically assessed. The radiologist is specifically trained to see anatomical defects while the speech pathologist has more knowledge of the oropharyngeal movement patterns during swallowing and the therapeutic recommendations for treatment of the multiple disorders. Disorders in movement patterns that control the bolus and cause aspiration or inefficient swallowing can be detected. In the oral phase problems can be observed in tongue movements, tongue-palate contact, collection and propulsion of the bolus, oral transit time and clearance of the mouth. In the pharyngeal phase premature spilling in the valleculae and the piriform sinuses can be observed, as well as the trigger of the pharyngeal swallow, velopharyngeal closure, movement of the hyoid bone, elevation and closure of the larynx, downward movement of the epiglottis, laryngeal penetration or aspiration and the time when it happens, contractility of the hypopharynx, residue in the valleculae, the piriform sinuses or the posterior pharyngeal wall, pharyngeal transit time and the number of swallows to clear the bolus. In the early esophageal phase problems with the opening of the upper esophageal sphincter can be observed. Videofluoroscopic assessment needs to be integrated with findings from clinical and instrumental examinations. Thus, treatment strategies to eliminate aspiration and increase swallowing efficiency can be designed. This will be illustrated with case reports.
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