Team Number 3
Royal College of Surgeons in Ireland Patient Safety and Quality in Healthcare Team project
Instructions
1. Complete Complete the form form below below (all fields fields must be filled) filled).. 2. The document name should should be of the form team_number. team_number.doc doc (e.g. team47.doc). team47.doc). Please also change the header to our team number !. "ll te#t must be formatted as as "rial $ 12 point$ point$ blac% colour and ha&e single line spacing. spacing. 'talic$ bold and underline stles are optional. 4. ord count must be completed for sections 1 2 (e#cludes header$ header$ references$ charts charts and tables). of 1* %e references should be cited in the paper. " ma#imum ma#imum of + website references references ma be used in the case 5. " minimum of analsis.
Project Title: Team !.doc Case analysis " Stro#e Team num$er: ! %ate of su$mission: &!'&(')&*5 Team details Student I% num$er:
,tudent 1 ,tudent 2 ,tudent ! ,tudent 4 ,tudent + ,tudent -
14**--!4 14*!1!11 14*!1/2 11**144 11**2-! 12**221-
Ines +dri,+nna -enneth Shuai$ +hmad +hmed
1
%a#hlia +loia reen /eetoo Sha0dan +shry
Team Number 3
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C+S1 +/+23SIS
'n re&iewing the case of 0llen$ a stro%e &ictim$ the adeuac of treatment in ahrain will be assessed in the following re&iew. ,pecification and options for 0llen3s treatment$ her social conte#t$ health care ualit and safet$ as well as ethical considerations are e#plored. +4 Pro$lem Specification:
,tro%es are the third leading cause of death and the primar cause of serious longterm disabilit with more than -*5 of patients burdened with residual neurological deficits1$2. "n ischemic stro%e happens due to lac% of blood flow to the brain and blood clots. 'schemic stro%es are more common in men and accounts for almost /*5 of all stro%e cases!. Chances of de&eloping an ischemic stro%e increase prior to an embolism!. 6iagnosing an ischemic stro%e reuires a few tests and scans4. 6ifferent areas of the brain affected b the stro%e can lead to different results opposing paralsis of facial and limb structures$ speech and &isual impairments$ confusion$ loss of balance$ cogniti&e disabilities headaches and sei8ures ma be present+. Tests such as CTs or 9:' scans can confirm the ischemic stro%e-$7$. ;igure 1 outlines a tpical histor used in diagnosing stro%e &ictims/.
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Figure 1. Algorithm for the diagnosis of acute stroke 9. /ational Institution of /eurological %isorders and Stro#e History 6utline 7.
,tudies ha&e found that increasing lifestle awareness decreased the number of stro%e cases-$2.
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oining a support group in this situation is recommended1. Patients with depression ha&e significantl worse outcomes up to ! months with a &ariable pre&alence of !- months post stro%e1/. 6epression is an important aspect of poststro%e rehabilitation and should be dealt with appropriatel b medical practitioners and communit. ,tarting a rehabilitation program after a stro%e increases the chances of regaining lost abilities2*. The patient3s inabilit to cope with their new lifestle can cause emotional di stress and ma lead to depression1$1. Patients should follow their scheduled c hec% ups with their medical therapists$ and practice selfhelp acti&ities. 'deall$ hospitals should ha&e a stro%e unit specificall dealing with stro%e cases. 'n 0llen3s case$ her primar clinician should followup with her freuentl until con&inced that she is stable. 84 Societal aspect:
9igure *. ;raction of ?aemorrhagic and 'schemic stro%e in males and females within the 9iddle
0ast21$2+$2-$27.
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hile information is limited regarding the pre&alence of stro%e o&er man ears$ studies ha&e shown a trend in incidence. 'n 1//+$ appro#imatel 4* to 4+ stro%e cases were recorded from a sample population of 1**$*** people in ahrain21$22$2!$24. This suggests that treatment and awareness has impro&ed o&erall in this population. ?owe&er$ studies suggest that the pre&alence of s tro%es in ahrain is becoming eui&alent to that of western countries$ contributing to an o&erall &alue of +.7 million deaths wordwide21$22$2!. 'n "rab countries the incidence and pre&alence of stro%e ranged from 27.+ to -! and 42 to -$ per 1**$*** sample population22. <&erall in "rab countries ischemic stro%e was found to be the most common disease. 'n ahrain$ howe&er cerebral infarctions were found to be the most common (+!5 of incidences)$ followed b cerebral hemorrhage (!*5) and unspecified stro%e tpes (1-.+5)22$24. ;igure 1 outlines 9iddle 0astern countries in 2*1* and their proportion of hemorrhagic and ischemic stro%e cases21$2+$2-$27. 'n additional to the methods and procedures put in place to assist 0llen3s reco&er$ there are other factors to be considered. This includes 0llen3s own age and the health of her support group at home$ primaril her husband2$2/$!*$!1. "ppro#imatel 4+5 of stro%e sur&i&ors return to home care$ while others ma loo% for inpatient rehabilitation admittance. This ma not be an a &ailable option for 0llen2$!2. hen re&iewing the profile of her primar care gi&er$ in this case 0llen3s husband$ his phsical and mental health status should be considered$2$!! . ?er husband or an member of the famil being 0llen3s care gi&er should @oining a support group allows the care gi&ers to release their own newfound frustrations which would benefit their own wellbeing. "lso$ to lessen the stress and responsibilities of the care gi&er an additional famil member ma mo&e i n. Primar care gi&ers$ as well as other &isiting members of the famil should be trained in some form of rehabilitation caring$ utilise suggested resources that will e#plain beha&ioral changes and reco&er strategies2. Through this$ the famil ma de&elop a dnamic$ interdependent approach to caring for 0llen. C4 Health Care Quality and Patient Safety:
ased on guidelines for acute ischemic stro%e management$ 0llen did not recei&e the appropriate treatment!4. Apon smptom onset$ 0llen should reach the hospital within ! hours. 'n fact$ there is a linear relationship between the time the treatment is started and the chances of benefit. 'f patient recei&es thrombolsis while he is outside the strict protocol$ there will be unacceptable complications especiall intracranial haemorrhage!+. 'n addition to the tra&el time$ the call to the BP added to the dela in treatment. 'rrespecti&e of the age or the se&erit$ deli&er of rtP" within 4+ hours results in positi&e outcomes$ studies ha&e also shown rtP" to be successful within - hours deli&er!4$!-. The 0mergenc 6epartment could ha&e had a more streamlined process so that 0llen would ha&e had her CT scan sooner than /* minutes upon arri&al$ ualifing her for tP" treatment!4$!-$!7. 0llen should ha&e been directed to a ,tro%e Anit3 (,A unit)$ being critical and needing close monitoring!-$!7$!. 5
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"merican ,tro%e "ssociation (",") and 0uropean ,tro%e 'nitiati&e (0A,') guidelines stress that stro%e is an emergenc and is time sensiti&e earlier cerebral reperfusion impro&es patient outcome!/. 'nitial care management should includeD •
•
• • • • • • • •
•
" careful clinical assessment including neurological e#amination should be conducted. The use of a stro%e rating scale preferabl the E'?,, (Eational 'nstitutes of ?ealth ,tro%e ,cale) is recommended!.
" CT scan should be conducted 24 hours before starting antiplatelet or anticoagulant therap!. "irwa support and &entilator assistance recommended for the treatment of patient with acute stro%e!. ?perthermia should be identified and treated!. ?po&olemia should be corrected with intra&enous normal saline!. ?poglcemia should be treated!. 'ntraarterial fibrinolsis is recommended and beneficial for stro%es greater than - hours duration4*.
Communit wal%ins should be made a&ailable where stro%e patients could easil drop in at an time$ in case of an incidence$ associated depressi&e and suicidal tendencies as well as pro&iding rehabilitation. "dmission within ,As ha&e shown better outcome and reduced morbidit$ mortalit and complication related to stro%e-. The guidelines for stro%e management is established b the :oal College
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"ppro#imatel 1*5 of patients ha&e complete spontaneous reco&er and 1*5 do not benefit from rehabilitation due to se&erit of lesion41. ?owe&er it has been deduced that *5 of the patients do benefit from the rehabilitation41. The main approaches in&ol&ed are phsical acti&ities that strengthen motor s%ills in order to restore damaged muscles and mobilit training that teaches patients to wal% and s upport bod weight with the use of canes4!. The treatment usuall lasts about ! hours per da for a period of + das in a wee%$ depending on the degree of se&erit of the patient4!. %4 1thical Consideration:
'n regarding 0llen3s current state and the &oiced will to die$ her mental wellbeing must be addressed. G"ccording to the 6iagnostic and ,tatistical 9anual of 9ental 6isorders 0dition + (6,9+)$ a diagnosis of 9a@or 6epressi&e 6isorder (966) reuires the person to ha&e fi&e or more of the following smptoms$ for two or more wee%sD 'ncreased or decreased sleeplessness$ depressed mood$ suicidal thoughts$ substantial weight change$ feelings of worthlessness$ inabilit to e#perience pleasure$ fatigue$ pschomotor agitation$ or diminished abilit to concentrateH44. Treatment methods include the use of antidepressants$ an#ioltics and pschotherap in combination4+. 0llen3s famil should be aware that stable effects of treatment reuire appro#imatel four to si# wee%s4-. 'n this time the famil should be considerate of ta%ing on social treatment strategies such as gi&ing 0l len attention$ be open to discussion$ ha&e therapist inter&ention$ create a crisis plan$ build a strong support sstem and to not be afraid to see% professional help4-$47. 0llen herself presents helplessness$ hopelessness$ irritabilit and suicidal attempts contributing to the argument that she is cli nicall depressed with her current state$ howe&er a contro&ersial insight on her condition is whether her current outloo%s will persist as long term or phasic44$4+$4$4/. ,he presents smptoms of post stro%e depression (P,6) as she adheres to the listed smptoms of Gimpaired selfreporting and cognition$ poor insight$ dsphasia leading to poor reco&erH4. ;rom here$ 0llen should be assessed and graded on the se&erit of her current state i n order to categori8e her as a critical or mild concern using screening methods 44$4+$4$4/. 't should be noted that 0llen herself does not seem to ha&e an cogniti&e impairment and that$ in regards to clinical treatment$ to label her as a depressed patient is too general for an effecti&e treatment plan47. Conclusion D
'n conclusion$ 0llen3s case wasn3t treated with the utmost of consideration. ?er location and circumstance does not pro&ide adeuate resources that she needs in allowing herself to trust and benefit from treatment. ith the abo&e considered$ more wor% needs to be done in creating a specific treatment plan.
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Team Number 3
14 Search strategy:
e used some %e words to search on 9edline and combined some results. e limited our search to full te#t onl. ee searched for %ewords that ha&e been inde#ed in the database ( eg. 9esh for 9edline). This %eword is present within different place in the document ("rticle title$ Publication titles$ ,ub@ect heading$ Content notes$ "bstracts). The table below shows the search strateg we used to get the best articles on this topic. Ased 9edline to search for "cute 'schemic ,tro%e treatmentD Searched * ,earch forD "cute 'schemic ,tro%e ) ,earch forD Treatment
9ound
"rticles discuss "cute 'schemic ,tro%e !.;*7.!; "rticles discuss management .(57 5
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5 Iimit toD ;ull Te#t 0nglish Ianguage
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; Iimit toD ;ull Te#t$ 0nglish Ianguage publication date ;);
from >anuar 2*** till ;ebruar 2*1+
"rticles about treatment of acute ischemic stro%e "rticles about treatment of acute ischemic stro%e in full te#t "rticles about treatment of acute ischemic stro%e in full te#t and 0nglish language "rticles about management of acute ischemic stro%e in 0nglish language$ full te#t and published between 2***2*1+
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Ased 9edline to search for stro%e P,6 (Post ,tro%e 6epression)D Searched
9oun d
* ,earch forD "cute 'schemic ,tro%e
.(57 "rticles discuss "cute 'schemic ,tro%e
) ,earch forD Post ,tro%e 6epression
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! Combine search 12
7
( Iimit toD ;ull Te#t
7
5 Iimit toD ;ull Te#t 0nglish Ianguage
7
; Iimit toD ;ull Te#t$ 0nglish Ianguage publication
7
date from 6ec 2**2 till ;eb 2*14
"rticles discuss Post ,tro%e 6epression "rticles about Post ,tro%e 6epression "E6 acute ischemic stro%e "rticles about Post ,tro%e 6epression "E6 acute ischemic stro%e in full te#t "rticles about Post ,tro%e 6epression "E6 acute ischemic stro%e in full te#t and 0nglish language "rticles about Post ,tro%e 6epression "E6 acute ischemic stro%e in 0nglish language$ full te#t and published between 6ec 2**2;eb 2*14 9
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94 References :
a$b 1. arbara 0. ates$ 96$ 9"$ and all. ;actors 'nfluencing :eceipt of 0arl :ehabilitation "fter ,tro%e. "rchi&es of Phsical 9edicine and :ehabilitation 2*1!/4D2!4/+-. 2. Iee $ ;rane >. Transient ischaemic attac% clinicD "n e&aluation of diagnoses and clinical decision ma%ing . >ournal of Clinical Eeuroscience ### (2*1+) ###J### "rticle in press !. >ohn ?op%ins Ani&ersit. Tpes of ,tro%e and ,tro%e :is%s. >ohn ?op%ins 9edicine$ Eeurolog and Eeurosurger$ 2*1+. KhttpD==www.hop%insmedicine.org=neurolog_neurosurger=centers_clinics=cerebro&ascular=conditions=stro%e.html L 4. Eational 'nstitute of Eeurological 6isorders and ,tro%e. ?istor Ta%ing. The 'nternet ,tro%e Centre$ 2*1+. KhttpD==www.stro%ecenter.org=patients=aboutstro%e=warningsignsofstro%e=L +. "merican 9edical "ssociation. 0ffects of a ,tro%e on the rain. "merican 9edical "ssociation$ 2*1+. KhttpD==www.ama assn.org=ama=pub=phsicianresources=patienteducationmaterials=atlasofhumanbod=braineffectsstro%e.pageL -. eaumont ?ealth ,stem. ?eart and Mascular. eaumont ?ealth ,stem$ 2*14. KhttpsD==heart.beaumont.edu=ischemicstro%eL 7. 'nstitute for Clinical ,stems 'mpro&ement ('C,'). 6iagnosis and treatment of ischemic stro%e. 0&aluation for 'schemic ,tro%e. loomington (9E)D 'nstitute for Clinical ,stems 'mpro&ement ('C,') 2*1* >un. 7* p. . :obin ?oward. 'schaemic stro%e "naesthesia 'ntensi&e Care 9edicine$ Molume 11$ 'ssue /$ ,eptember 2*1*$ Pages !4*!42 /. New F,$ Cheng 0. "cute stro%e diagnosis. "m ;am Phsician. 2**/ *(1)D!!4*. 1*."merican Pschiatric "ssociation. 6iagnostic and statistical manual of mental disorders. ashingtonD "merican Pschiatric "ssociation +th edition 2*1!. 11.>auch 0C$ ,a&er >I$ "dams ?P >r$ runo "$ Connors >>$ 6emaerschal% 9$ Fhatri P$ 9c9ullan P >r$ Oureshi "'$ :osenfield F$ ,cott P"$ ,ummers 6:$ ang 6$ intermar% 9$ Nonas ? "merican ?eart "ssociation ,tro%e Council Council on Cardio&ascular Eursing Council on Peripheral Mascular 6isease Council on Clinical Cardiolog. Buidelines for the earl management of patients with acute ischemic stro%eD a guideline for healthcare professionals from the "merican ?eart "ssociation="merican ,tro%e "ssociation. ,tro%e. 2*1! 44(!)D7*/47. 12.;lint "C$ Famel ?$ Ea&i $ :ao M"$ ;aigeles ,$ Conell C$ Flingman >B$ ,idne ,$ ?ills EF$ ,orel 9$ Cullen ,P$ >ohnston ,C. ,tatin use during ischemic stro%e hospitali8ation is strongl associated with impro&ed poststro%e sur&i&al. ,tro%e 2*124!(1)D1471+4. 1!.EQ ChrRinQn 6$ Callal 0I$ 6uggan >$ 9erwic% S$ ?annon E$ ,heehan $ 9arnane 9$ ?organ B$ illiams 0$ ?arris 6$ Fne I$ 9cCormac% P9$ 9orone >$ Brant T$ illiams 6$ 6al I$ Fell P>. "ssociation between acute statin therap$ sur&i&al$ and impro&ed functional outcome after ischemic stro%eD the Eorth 6ublin Population ,tro%e ,tud. ,tro%e 2*11 42(4)D1*211*2/. 14.,andset 0C$ ath P9$ osen B$ >atu8is 6$ FUr& >$ IVders ,$ 9urra B6$ :ichter P,$ :oine :<$ TerWnt "$ Thi@s M$ erge 0 ,C",T ,tud Broup. The angiotensinreceptor bloc%er candesartan for treatment of acute stro%e (,C",T)D a randomised$ placebocontrolled$ doubleblind trial. Iancet 2*11 !77(/7-7)D7417+*. 1+.ang ?$ Tang N$ :ong X$ Ii ?$ Pan :$ ang N$ Peng N. 0ffects of earl blood pressure lowering on earl and longterm outcomes after acute stro%eD an updated metaanalsis. PIo,
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1-.Fessler 6$ 0gan 9$ Fubina I". Peer support for stro%e sur&i&orsD a case stud. 9C ?ealth ,er& :es. 2*14 14D2+-. 17."merican ?eart and ,tro%e "ssociation. eha&ioral Changes "fter ,tro%e. 9a 27th$ 2*14. KhttpD==www.stro%eassociation.org=,T:ournal of ,tro%e and Cerebro&ascular 6iseases$ Mol. 24$ Eo. 2 (;ebruar)$ 2*1+D pp 4/24//. 2*.eb96. Treatment <&er&iewD 0mergenc Treatment. eb96$ ,tro%e ?ealth Center$ 2*1+. KhttpD==www.webmd.com=stro%e=guide=stro%etreatmento&er&iewL 21."l>ishi$ ".".$ 9ohan$ P.F. Profile of stro%e in ahrain. Eeuroscience (:iadh)$ Molume 1 (2***) pp.!*!4. 22.enamer ?T,$ Brosset 6. ,tro%e in "rab countriesD " sstematic literature re&iew$ > Eeurol ,ci (2**/)$ doiD1*.1*1-=@. @ns.2**/.*4.*2/ 2!.orld Iife 0#pectanc. 2*11 KhttpD==www.worldlifee#pectanc.com=bahrainstro%eL 24.Tran >$ 9ir8aei 9$ "nderson I$ Ieeder ,:. The epidemiolog of stro%e in the 9iddle 0ast and Eorth "frica. > Eeurol ,ci. 2*1* 2/+(1 2)D!4*. 2+.'nternational ,tro%e Center. ,tro%e ,tatisticsD A.,. ,tatistics. 2*1+ KhttpD==www.stro%ecenter.org=patients=aboutstro%e=stro%estatistics=L 2-.>anghorbani 9$ ?am8ehiee9oghadam "$ Fachoiee ?. 0pidemiolog of nonfatal stro%e in Ferman$ 'ran. ?amdard 9edicus. 1//7 4*(!)D//. 27.,weileh 9$ ,awalha ";$ "l"ad ,9$ oud ,?$ "l>abi ,. The epidemiolog of stro%e in Eorthern PalestineD a 1ear$ hospital based stud. > ,tro%e Cerebro&asc 6is. 2** 17(-)D4*-11. 2.Fell 9. >ones$ Ph6$Y :ohit hattachar@ee et all. 9ethodolog of the ,tro%e ,elf9anagement :ehabilitation TrialD "n 'nternational$ 9ultisite Pilot Trial >ournal of ,tro%e and Cerebro&ascular 6iseases$ Mol. 24$ Eo. 2 (;ebruar)$ 2*1+D pp 2/7!*! 2/.FZnig ':$ iegler "$ luhm%i 0$ ?ac%e $ ath P9$ ,acco :I$ 6iener ?C$ eimar C Mirtual 'nternational ,tro%e Trials "rchi&e (M',T") 'n&estigators. Predicting outcome after acute ischemic stro%eD an e#ternal &alidation of prognostic models. Eeurolog. 2**4 -2D+1 ++. !*.FZnig ':$ iegler "$ luhm%i 0$ ?ac%e $ ath P9$ ,acco :I$ 6iener ?C$ eimar C Mirtual 'nternational ,tro%e Trials "rchi&e (M',T") 'n&estigators. Predicting longterm outcome after acute ischemic stro%eD a simple inde# wor%s in patients from controlled clinical trials. ,tro%e. 2** !/(-)D12112-. !1.eimar C$ Fonig ':$ Frawin%el F$ iegler "$ 6iener ?C. "ge and Eational 'nstitutes of ?ealth ,tro%e ,cale score within - hours after onset are accurate predictors of outcome after cerebral ischemiaD de&elopment and e#ternal &alidation of prognostic models. ,tro%e 2**4 !+D1+1-2. a$∗ b !2."mal . "bdulsattar and Tare% Bodab Predictors of functional outcome in ,audi "rabian patients with stro%e after inpatient rehabilitation Eeuro:ehabilitation !! (2*1!) 2*/J21!!.,cottish 'ntercollegiate Buidelines Eetwor%. 9anagement of patients with stro%eD 'dentification and management of dsphagia. 0dinburgh ,'BE publication no.11/.2*1* 12
Team Number 3
!4.0mberson >$ Iees F:$ Iden P$ lac%well I$ "lbers B$ luhm%i 0$ rott T$ Cohen B$ 6a&is ,$ 6onnan B$ Brotta >$ ?oward B$ Faste 9$ Foga 9$ &on Fummer :$ Iansberg 9$ Iindle :'$ 9urra B$ 9$ Parsons 9$ Tille $ Toni 6$ Tooda F$ ahlgren E$ ardlaw >$ hitele $ del oppo B>$ aigent C$ ,andercoc% P$ ?ac%e ,tro%e Thrombolsis Trialists[ Collaborati&e Broup. 0ffect of treatment dela$ age$ and stro%e se&erit on the effects of intra&enous thrombolsis with alteplase for acute ischaemic stro%eD a metaanalsis of indi&idual patient data from randomised trials. Iancet. 2*14 !4(//+)D1/2/1/!+. !+.?oward :. 'schaemic stro%e "naesthesia 'ntensi&e Care 9edicine. ,eptember 2*1* (11) (/)D !4*2 !-.:ingeleb$ P.".$ ,chellinger$ P.6.$ ,chran8$ C.$ ?ac%e$ . 0merging TherapiesD Thombroltic therap within ! to - hours after onset of ischemic stro%e. "merican ?eart "ssociatation >ournalD ,tro%e$ Molume !! (2**2) pp. 14!7 J 1441. !7.Iecin \ana 9$ 0gido >$ Casado '$ :ibR 9$ 6]&alos "$ 9as@uan >$ Caniego >.I$ 9artQne8 0. Mila$ 6Qe8 Te@edor 0. (Coordinator)$ representing the ad hoc committee of the ,0E ,tud Broup for Cerebro&ascular 6iseasesD. ;uentes (,ecretarQa)$ >. Sl&are8,abin$ >. "renillas$ ,. Calle@a$ 9. Castellanos$>. Castillo$ ;. 6Qa8.C. IRpe8;ern]nde8$ 9. ;rei@o$ >. B]llego$". BarcQaPastor$ ". BilE^n \e8$ ;. Bilo$ P. 'rimia$ ". Iago$>. 9aestre$ >. 9artQ;]bregas$ P. 9artQne8,]nche8$ C. 9olina$ ". 9orales$ ;. Eombela$ ;. Purro$ 9. :odrQgue8Nan \e8$ >. :ouer$ ;. :ubio$T. ,egura$ >. ,erena$ P. ,imal$ >. Te@ada$ >. Mi&ancos > . Buidelines for the treatment of acute ischaemic stro%e. EeurologQa. 2*142/(2)D1*2122 !."dams ?P$ del oppo B$ "lberts 9>. Buidelines for the earl management of adults with is chemic stro%eD a guideline from the "merican ?eart "ssociation="merican ,tro%e "ssociation ,tro%e Council$ Clinical Cardiolog Council$ Cardio&ascular :adiolog and 'nter&ention Council$ and the "therosclerotic Peripheral Mascular 6isease and Oualit of Care une 2*14. eb. * 9ar. 2*1+. 4!.;ai8 F$ ,undseth "$ Thommessen $ :nning <9. Prehospital dela in acute stro%e and T'". 0merg 9ed >. 2*1! !*()D--/-74. 44."merican Pschiatric "ssociation. 6iagnostic and statistical manual of mental disorders. ashingtonD "merican Pschiatric "ssociation +th edition 2*1!. 4+.6ole ;1$ 9cBee ?9$ 6e Ia ?arpe 6$ ,helle 0$ Conro :. The ?ospital "n#iet and 6epression ,cale depression subscale$ but not the ec% 6epression 'n&entor;ast ,cale$ identifies patients with acute coronar sndrome at ele&ated ris% of 1ear mortalit. > Pschosom :es. 2**- -*(+)D4-14-7. 4-.;amilies for 6epression "wareness. ?elping someone who has depressionD ?elpful tips$ what not to do$ uestions for the cinician. ;amilies for 6epression "wareness. KhttpD==www.familaware.org=topdepression=helpsomeonewhohasdepression.htmlL 47.uchanan "0$ 6an (1//) 6eciding for othersD The ethics of surrogate decision ma%ing. Eew Nor%$ END Cambridge Ani&ersit Press. httpD==www.uclou&ain.be=cps=ucl=doc=ebim=documents=0thical_and_Iegal_'ssues_:egarding_Consent_in.14.pdf 13
Team Number 3
4.Fhan ;. Poststro%e depression "ustralian ;amil Phsician.1*
=18SIT1 1>+2?+TI6/
2 websites chosenD @+36 C2I/IC
httpD==www.maoclinic.org=diseasesconditions=stro%e=home=o&c2*1172-4 Her$al Remedies for Stro#e RecoAery
httpD==www.li&estrong.com=article=!*/!7herbalremediesforstro%ereco&er= To e&aluate a website there are 4 criteria to be e&aluate. " reliable and trustworth eb ,ite should meets these criteriaD +uthority +ccuracy Currency 6$jectiAity
The two websites chosen to from the list were the 9ao clinic website and the Ii&estrong website for herbal remedies for stro%e reco&er. The goal is to access the sponsors of the website to e&aluate the presence of an bias and the &alidit of the information pro&ided. The mao clinic website ends with .org$ meaning that an organi8ation is responsible for the website G9ao ;oundation for 9edical 0ducation and :esearchH which has been an acti&e publisher and reliable source of information since 1//. 't is &er eas to identif the organi8ation and domain of the website at the top left corner. The second website ends with .com meaning it is a commercial website$ and Ii&estrong its domain. ,hown on the top of the site is the ?erbal 9edication ,eller and published b author >anet Contursi. The credentials of the authors and editors should be considered when assessing the &alidit of the site3s information. roo%s , 0dwards 9.6 is the founding medical editor of the first site along with other authors. ?e is a certified medical doctor therefore is someone who can be trusted when it comes to medical topics. >anet Contursi is responsible for the second website howe&er her ualifications are not shown. "dditionall personal pages lac% a publisher or a domain owner so the information cannot be &erified. This website3s contact information is missing while the 9ao Clinic website pro&ides an email de&elopmentmao.edu as well as an addressD 6epartment of 6e&elopment 9ao Clinic2** ;irst ,t. ,:ochester$ 9E ++/*+ for the user to contact for further information.
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Team Number 3
The primar focus is on the authors=publishers and their credentials to e&aluate their e#pertise on the topic gi&en. :d. 0dwards is board certified in internal medicine$ c ardiolog$ heart failure$ and transplantation. ?e has been on s taff at 9ao Clinic since 1//$ is a professor of medicine at 9ao 9edical ,chool and has ser&ed as president of 9ao Clinic[s :ochester. ?e is 9ao Clinic.com[s first medical editorinchief. This website presents information that can be trusted$ and is &erified b facts. 't lis ts their sources and includes lin%s to e#ternal resources. The information on the author of the second website is an herbal medicine e#pert but the authors credentials are not shown so e#pertise cannot be analsed. This website directs it3s information to fit in with their organi8ational mission. 'nformation is not based on &erifiable facts$ and does not list sources for presented information or lin%s to other sources. This i nformation is biased as its aim is selling a product. "lso we need to assess the currency of the Be$site. The 9ao clinic site has the date of the information. The date of information written is gi&en$ and was last re&ised on Eo&. 22$ 2*14 (updates are &er important). "dditionall it pro&ides lin%s to other sources The second website was last updated Eo& 1-$ 2*1* and pro&ided bro%en lin%s to resources. Eeither sites pro&ided out dated information howe&er the 9ao clinic website3s information is more reliable. 9ao clinic site also appears modern while the other appears old and unchanged. To access $ias is to analse the information assumed and its purpose. The first site is designed to help patient understand this disease and cope with it b learning selfmanagement ad&ices and the pre&ention of a further. This site also allows the user to ma%e an appointment with an e#pert. 't has a field called G9ore about thatH which goes further in6epth and direct the user to multimedia and other sources. The site is used to gi&e the patient minimum information about this disease$ its diagnostic aspects$ and complications that ma arise. The second site is made specificall for a commercial purpose and was originall written for broadcast on air. 't is created to support onl one point of &iew and pro&ides information in order to promote its product. To e&aluate the websites we need to access the audience for this information3s. The first site is directed to the patient suffering from a stro%e and their relati&es. The other website is tring to sell the product to uninformed patients or patients that do not belie&e in professional medicine. There is one page of information pro&ided and the reader would most li%el not return to this website. The language le&el of both sites is relati&el eas for most readers with few word definitions to find. The 9ao Clinic site seems to be eas to use straightforward$ and interesting to its audience. ith one clic% ou can reach o&er&iew clinical and in&estigation treatment= pre&ention as well as lin%s to &ideos and images. ,ome who ma ha&e disabilities ma find difficult na&igating through this website. The mao clinic site is great and professional and one the reader would return to without uestion.
15
Team Number 3
!
T1+@ PR6C1SS
roup ! Team Profile
16
Team Number 3
H8PS roup ! +ttendance Role and @eeting Tas# Sheet
9eeting 1
9eeting 2 9eeting ! 6ateD 6ateD 6ateD ;ebruar ;ebruar ;ebruar $ 2*1+ 17$ 2*1+ 24$ 4D** P9 !D!* P9 2*1+ Ie ,ol 4P9 Cafe Tas%D Tas%D Tas%D 6iscuss 6iscuss 6iscuss Pro@ect wor% on wor% on :euireme Case Case nts "nalsis "nalsis ,tudent ;irst name 1 14**--! 'nes 4
Iast Eame 6a%hlia
2 14*!1!11 "dri "nna
"loia
! 14*!1/ 2
Fenneth Breen
4 11**144 ,huaib
+ 11**2-! "hmad - 12**221
"hmed
Eeetoo
,hada n "shr
9eetin g4 6ateD 9arch 4$ 2*1+ 4P9
9eetin g+ 6ateD 9arch 1*$ 2*1+ 4P9
9eetin g6ateD 9arch 1-$ 2*1+ 4P9
9eetin g7 6ateD 9arch !1$ 2*1+ 4 P9
9eeting
Tas%D 6iscuss wor% on Case "nalsi s
Tas%D Present and discuss draft
Tas%D 0diting of content and word limit
Tas%D 0diting of content and word limit
Tas%D 6iscuss Turn't'n :eport from 1st ,ubmission
6ateD "pril $ 2*1+
:ole (s) Chair Compan or%er Team or%er ,haper 9onitor 0&aluator ;inisher
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
:esource 'n&estigato r Plant Plant
X
X
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Team Number 3
8el$in Role SurAey Results
The elbin role sur&e results for Broup ! are depicted in the chart below. The chart shows that Compan or%er was the most popular first choice and Coordinator (Chair) was the most common second choice. Team or%er was the least common second choice. Completer ;inisher was not the first or the second choice role for an of the fi&e members of the group.
Team Strengths
This team is disciplined$ reliable$ c onfident$ focused$ moti&ated$ and enthusiastic. There is good communication between the members of the team and the group has a good understanding of the pro@ect guidelines. Team =ea#nesses
Team wea%nesses include eagerness for deadlines$ which ma result in miss details. Eone of the members had Complete ;inisher as their first or second choice role.
Team Number 3
Plan of +ction
The team3s plan is to implement a sstem of communication that allows all of the members of the group to share$ continuall contribute upto date information$ and remain moti&ated. Team Composition
"fter discussing the abo&e results$ the team decided on the following allocation of rolesD Ines %a#hlia $ Chair Compan or%er ('mplementer) and Team or%er +dri,+nna +loia $ ,haper and Completer ;inisher -enneth reen $ Coordinator (Chair) and 9onitor 0&aluator Shuai$ /eetoo :esource 'n&estigator +hmed +shry$ Plant$ +hmed Sha0dan Plant 4.
Reflections on Turnitin
'n submitting our report to Turnitin$ we ha&e found a similarit of ____5. ,imilarit ma ha&e been due to man other submissions which used the same resources or due to the similarit of material to address the uestions presented in the abo&e case. "ll material highlighted b the program was found to be properl sourced with the proper reference or uotations where reuired. 'n reediting our pro@ect$ some rephrasing and source chec%ing reuired attention prior to our resubmission. The last submission found a similarit of ____5. e impro&ed our similarit score b ____5 with our described edits and efforts. 'n completion of this pro@ect$ our team has learned the importance of communication and wor% specification in sourcing material. 6uring our discussion and wor% presentation and editing$ we had issues in organi8ing prior sources with the wor% cited list$ in regards to number referencing. :esource &alidation and credibilit had to be ta%en into consideration and obser&ed b all members of the group. The group made a strong effort in sourcing materials other than those online$ as we found that most of our materials at first were as such. 'n the end$ our reference list included boo%$ @ournal and online material.
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