Regenstrief Institute

About: Regenstrief Institute is a nonprofit organization based out in Indianapolis, Indiana, United States. It is known for research contribution in the topics: Health care & Population. The organization has 742 authors who have published 2042 publications receiving 96966 citations.

Presentation, etiology, and outcome of stroke in pregnancy and puerperium.

Abstract: Purpose: The purpose of this study was to evaluate the presentation, timing, etiology, and outcome of ischemic stroke (IS), hemorrhagic stroke (HS), and cerebral venous thrombosis (CVT) occurring during pregnancy and puerperium at 3 Indianapolis hospitals. Methods: Medical records of patients with a stroke during pregnancy and the puerperium were identified by using International Classification of Diseases (ICD 9) codes and a computerized records database. The records were available from 1992 to 1999 at 2 of the hospitals and from 1994 to 1999 at the third hospital. The records were retrospectively reviewed for presentation, treatment, etiology, and outcome. The sample included all cases of IS, HS, and CVT occurring in our pregnant population and included events up to 12 weeks postpartum. Results: Thirty-six patients were identified, including 21 with IS, 11 with HS, and 4 patients with CVT. The majority of events (89%) occurred in the third trimester and postpartum period, and 16 of 36 (44%) events occurred in postpartum week 1. Of the 8 African American patients in our study, 5 had HS (63%), whereas 18 of the 25 white patients (72%) had IS. A definable cause was identified in 72% of IS and 82% of HS. Some causes of IS include pre-eclampsia or eclampsia (13%), cardioembolism (23%), and a diverse array of other causes, include hypercoagulable states, thrombotic thrombocytopenic purpura (TTP), cerebral vasculitis, cerebrovascular mucormycosis, and migrainous infarction. Pre-eclampsia/eclampsia (37%) and ruptured atriovenous malformation (AVM) (36%) were the primary causes of HS. None of the cases of CVT had a clear etiology other than the pregnant or puerperal state, although risk factors included systemic lupus erythematosus (negative antiphospholipid antibodies and lupus anticoagulant) in 1 patient and dehydration in a second. Hypertensive disorders of pregnancy were the most common comorbid conditions in both IS and HS, affecting 45% of those with IS and 64% of patients with HS. IS presented with focal deficits (76%), whereas HS tended to present with an altered level of consciousness (73%) and headache (64%). All patients with CVT (4/4) presented with a headache, and 2 of 4 patients presented with an altered level of consciousness. The majority of patients with HS were discharged to nursing homes or rehabilitation centers (63%), whereas 73% of patients with IS and 3 of 4 patients with CVT were discharged home. Only 1 death occurred in our study, because of a brain herniation after a massive hemispheric IS. Conclusion: The etiology of stroke in pregnancy and the puerperium is diverse. Strokes are most likely to occur in the third trimester and postpartum period and cluster in the first postpartum week. Copyright © 2001 by National Stroke Association

Factors influencing patients’ preferences and perceived involvement in shared decision-making in mental health care

Abstract: Background: Although research has suggested that patients desire to participate in shared decision-making, recent studies show that most patients take a passive role in their treatment decisions. The discrepancy between patients’ expressed desire and actual behaviors underscores the need to better understand how patients perceive shared decision-making and what factors influence their participation.Aims: To investigate patients’ preferences and appraisals of their involvement in treatment decisions.Methods: Fifty-four qualitative interviews were conducted with veterans receiving outpatient mental health care at a U.S. Veterans Affairs Medical Center. Interviews were analyzed using thematic analysis.Results: Participants outlined several factors that influence their preferences and involvement in treatment decisions. These include the patient–provider relationship, fear of being judged, perceived inadequacy, and a history of substance abuse.Conclusion: Patients’ preferences and willingness to engag...

Racial disparity in cardiac decision making: results from patient focus groups.

Abstract: Background While numerous studies suggest that African Americans receive fewer invasive cardiac procedures than whites, the basis for these treatment differences is not understood. Methods We conducted focus group sessions with patients who had received treatment in the hospital or the emergency department within the preceding 3 months for ischemic heart disease at 2 urban, university-affiliated hospitals. Results Discussions with patients identified the following factors that influenced their decision making: clarity, simplicity, and consistency of treatment recommendations; advice from friends and family about whether to accept recommendations; availability to speak with others who accepted similar recommendations; and having honest and caring physicians. African American patients identified the following additional factors that influenced their decision making: perceptions of health care discrimination; perceptions of undesirable physician behavior; faith in God to control one's destiny; and patient-physician camaraderie. Conclusions Participants identified common issues influencing health care decision making, regardless of race. However, additional factors were expressed only by African American participants. These factors conveyed racial differences in perceptions of the health care system that may, in part, contribute to differences in health care decision making and treatment.

The Meaning and Significance of Self-Management Among Socioeconomically Vulnerable Older Adults

Abstract: Objectives The aim of this study was to describe and contrast perceptions of self-management among socioeconomically vulnerable and nonvulnerable older adults.