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To: Journal of PRACTICAL NEUROLOGY Letters

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Editorial: T W J Watson, J E Simon, and A M Buchan Stroke care: the way forward J Neurol Neurosurg Psychiatry 2003; 74: 411-412 [Full text] [PDF]

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Care for stroke patients: the more, the better

Stefano Ricci   (1 April 2003)

Care for stroke patients: the more, the better 1 April 2003
Stefano Ricci, Neurologist Stroke Service, USL 2, Perugia, Italy Send letter to journal: Re: Care for stroke patients: the more, the better istitaly{at}unipg.it Stefano Ricci	Dear Editor I would like to comment on the table which appeared on page 412 of the editorial by Watson et al.[1] There is no evidence that what is needed is "access to a monitored bed with one-to-one nursing". In fact, it is not clear what monitoring means: in my country (Italy), monitoring means some mechanical control of blood pressure, heart rate, oxygen, etc; however, British colleagues seem to consider that good specialised nursing is "monitoring". There is only one small trial on mechanical monitoring, and no firm conclusion can be drawn; monitoring might save nursing time, but could also cause delay in rehabilitation (which, I do agree, must be "aggressive"). In my region, small peripheral hospitals admit a high number of stroke patients (up to 100 in an average 20-30 bed medical unit); nursing is usually based on a one-to-8 (or 10) rate. To say that stroke patients need a one-to-one nursing rate would therefore mean that nothing would change in the future (because of obvious lack of resources), apart perhaps for very specialised units in large hospitals, where the lucky patient would happen to be admitted. A more reasonable project is needed, to improve the care of all stroke patients everywhere. For instance, our new regional health plan states that each hospital should have a few "stroke beds" (4 to 8) with a nursing 1 to 4 rate, applying the principle that more care is better than nothing. We should aim at the possible progress in the shorter time, not just to perfection. Reference (1) TWJ Watson, JE Simon, AM Buchan. Stroke care: the way forward. J Neurol Neurosurg Psychiatry 2003;74: 411-412.