In the United States of America, more than 795,000 people suffer from stroke according to the data of (National Institute of Neurological disorder). It is observed that most of the patients in the post-stroke stage suffer from depression that enhances the physiological problems in the body. Minimizing this condition is the responsibility of the Government. Effective clinical practice guidelines are there those help in the implementation of a proper action plan to reduce the depression in Stroke patients. The post-stroke rehabilitation clinical practice guideline is developed by the health care and policy research institute. Subsequently, with time, the post-stroke rehabilitation guideline has been upgraded according to the need. This guideline is prepared mainly for the medical professionals that will help in enhancing their quality of service. This study mainly focuses on the review of the clinical practice guideline of Stroke rehabilitation patient in community service hospital setting of California. Moreover, evaluation of the clinical practice guideline will be done by using the AGREE system of evaluation. The AGREE system is the Appraisal of Guidelines For research and Evaluation instrument that is developed with the purpose of holistic evaluation of the clinical practice guideline system in the health care setting. Subsequently, the evaluation will be followed by a summary that will include the analysis of the evaluation. The summary section will represent a critical analysis of the results those are found in the evaluation.
Stroke is one of the most significant problems causing the huge rate of morbidity and mortality throughout the world. According to the World Health organization Yearly about 15 million people suffer from a stroke. It is observed that there is a high tendency for post-stroke patients to develop depression and disability (“WHO | World Health Organization”, 2018). The Post-stroke rehabilitation clinical practice guideline aims at maximizing recovery of the patient. Moreover, the Clinical practice health care guide is intended for the medical practitioner’s responsible for the holistic treatment of the patient (Laur, Marcus, Ray & Keller, 2016). According to the data in the MPHS hospital in California, it is stated that 395 patients have been admitted to the hospital with a hemorrhagic stroke and transient ischemic stroke. It is seen that 2% out of the affected 395 patients have been selected for mental health treatment. This step is mainly taken to analyze the holistic mental condition of the patient. According to researchers symptoms of depressions are found in 33% of the stroke patients. This depression has an overall negative effect on the health of the patient (Lea, 2014). The Post-stroke rehabilitation clinical guideline suggests that effective steps should be taken to mitigate depression in the post-stroke patient in healthcare. The effective steps in the clinical guideline include a screening tool by which the mental state of the patient may be evaluated by the medical practitioner in the healthcare (Laur, Marcus, Ray & Keller, 2016). Subsequently, if any sign of depression and anxiety is seen in the patient then efficient intervention must be planned according to the guideline.
According To the AGREE System of evaluation the scope and the purpose of the clinical post-stroke rehabilitation guideline should be assessed. According to the AGREE system of evaluation, there are 6 domains based on which the evaluation of the clinical guideline of Post-stroke rehabilitation patient should be performed in an efficient manner.
This part mainly deals with the evaluation of the overall objective of the clinical guideline, the health questions covered under the described guidelines and the target population. According to the Clinical guideline of Post-stroke rehabilitation patient, particular objectives are clearly mentioned (Stoodley, 2017). The health questions and aspects are mentioned in an appropriate manner. Specific target population is mentioned in the guideline that may help in implementing the quality treatment to the Post-stroke patient. The guideline includes different assessment of the cognitive ability and mental state of the patient (Stoodley, 2017). According to the AGREE method of evaluating, the scope and the purpose of the Clinical post-stroke rehabilitation guideline in health care are efficient and effective. This plan consists of specific screening techniques and the target population. According to researchers, it might get a six score according to the AGREE system of evaluation. The health care cost of a stroke patient with depression is 63% more than that of the normal stroke patient (Stanley & Campos, 2015). Assessment and intervention according to the clinical guideline to Post-stroke rehabilitation might help in the cost-effective treatment of the patient in the MPHS hospital in California.
The second important component that should be evaluated in the clinical health care practice of Post Stroke rehabilitation patients is the stakeholder’s involvement in the process. The stakeholder’s involvement process includes aspects like consultation of different stakeholders group in formulating the clinical guideline for post-stroke rehabilitation in health care (Bishwajit, 2016). The guideline should involve the views and preferences of the stakeholders. Through the guideline, the target users must be clearly defined. According to researchers, it is seen that suicidal tendencies in the post-stroke patient are 14%(Gagliardi, 2014). It is essential to develop a clinical guideline by effectively consulting with the physician and the patients. Every stakeholder’s opinion is valuable in implementing the clinical guidelines in a prominent manner (Bishwajit, 2016). The panel members included in the formulation of the clinical guideline for the post-stroke rehabilitation includes physician and professors of different medical universities of the United States researchers, Managers from the health administration, doctors of multidisciplinary subjects. This implies that a wide variety of highly qualified stakeholders are involved in the formulation of this clinical health care guideline for post-stroke rehabilitation patients (Bishwajit, 2016).
On the other hand opinions from the patient should be taken in the formulation or up gradation of the post-stroke rehabilitation clinical health care guideline. This may help in assessing the needs of the depressed stroke patient in MPHC California. The guideline specifies the target population in an efficient manner (Tsima, Setlhare&Nkomazana, 2016).According to the researchers in the stakeholder involvement parameter, the clinical guideline for post-stroke rehabilitation may get 4 points. Additionally, the guideline needs to be formulated including an opinion from the patient parties to have a holistic approach.
The Rigor of development component includes the evaluation of the systematic methods of assessment those are mentioned in the clinical health care guideline for the Post-stroke rehabilitation patients. This part comprises of the evidence-based methods to assess depression in the stroke patient in an appropriate manner (Murphy, Sarris & Byrne, 2017). According to the Clinical healthcare guideline, there are different scales to asses to depression level in post-stroke patients. Geriatric depression scale, Hospital anxiety and depression scale, Visual analogue mood Scale is a different assessment tool used to assess post-stroke patients in an efficient manner (Murphy, Sarris & Byrne, 2017). A provision for an update of the clinical health care guideline for a post-traumatic patient is also included. It may help the medical practitioners of MPHC hospital to implement the assessment plan in an efficient manner. According to the researchers, the clinical health care guideline may get 7 with respect to the rigor of development (Tsima, Setlhare&Nkomazana, 2016).
The clarity of the presentation includes the specific recommendation provided in the clinical health care guideline for the Post-stroke rehabilitation patients. The unambiguous recommendation may help in improving the overall diagnosis and management of depressed stroke patients in an effective and efficient manner (Murphy, Sarris & Byrne, 2017). Moreover, the clinical healthcare guideline for post-stroke rehabilitation patient consists of a management system for impaired cognition and perceptual deficit for the patients. This is one of the essential components that provide clarity to the doctors of MPHC hospital in implementing efficient diagnostic on depressed stroke patient (DAI, QU, LIU & YU, 2013). According to the researchers, the Clinical health care guideline may get 7 points in the AGREED rating mechanism.
The applicability part is concerned with the application of the recommendation in reality. Besides that, different assessment and diagnosis techniques present in the clinical healthcare guideline of post-stroke rehabilitation patient should be implemented effectively in practice by the physicians (Kafri& Dickstein, 2016). The guideline must include monitoring and auditing the criteria of the assessment and management techniques used to treat the depressed ischemic stroke patient. According to the researchers, there is provision for improvement of Assessment tools and diagnostic management in the health care guideline so it may get 6 in the AGREED system of evaluation for applicability part (Kafri& Dickstein, 2016).
The editorial independence suggests that the professional panel should make the appropriate decision to formulate the health care guidelines in an effective manner. The funding body must not influence the content that may decrease the effectiveness and efficiency of the Guideline (Levitt, 2014). After proper analysis of the healthcare guideline for post-stroke rehabilitation, it is seen that the formulation of the guideline is performed by expert panels. According to researchers Health care guideline may get 6 points. This guideline may be followed by the MPCH hospital to reduce the number of depressed stroke patient by a significant margin (Levitt, 2014).
According to the AGREE system, there are six domains present on which the evaluation are made. After the holistic evaluation of the healthcare guideline of post-stroke rehabilitation patient, it is seen that the scope and the purpose of the guideline are perfect. The objectives and the target audience of the guidelines are clear. In the stakeholder involvement section, the guideline has included a multidisciplinary team of highly efficient professionals like doctors and professors and administrators. On the other hand, public and patient’s party’s opinions should be included in the guideline for the more holistic approach. In the clarity of presentation, the proper management procedures to diagnose the depression in the post-stroke patients (Gagliardi, 2014) are mentioned. Assessment and management are two most significant components of the health care guideline. The assessment part comprises of the different tools like hospital anxiety scale. This helps the physician to implement assessment and effective diagnostic in the practical scenarios. Moreover, the applicability of the health care guideline may be prominently performed by individuals. In formulating the Healthcare guideline for Post-stroke rehabilitation influence of funding authorities is avoided and priorities are given to the ideas of the professional panel delegated for the job.
Reference list
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DAI, B., QU, Z., LIU, H., & YU, B. (2013). Clinical Translation of Neuroimaging Research in Depression: A New Approach to Prevention, Diagnosis and Treatment of Depression. Advances In Psychological Science, 21(6), 1048-1058. doi: 10.3724/sp.j.1042.2013.01048
Gagliardi,R.(2014).Editorial: Depression in post-stroke patients. RevistaNeurociências, 22(02),167-167.doi: 10.4181/rnc.2014.22.02.editorial931.1p
Kafri, M., & Dickstein, R. (2016).External validity of post-stroke interventional gait rehabilitation studies. Topics In Stroke Rehabilitation, 24(1), 61-67. doi: 10.1080/10749357.2016.1176796
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Murphy, J., Sarris, J., & Byrne, G. (2017). A Review of the Conceptualisation and Risk Factors Associated with Treatment-Resistant Depression. Depression Research And Treatment, 2017, 1-10. doi: 10.1155/2017/4176825
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Stoodley, N. (2017). RCPCH clinical guideline, stroke in childhood: an evidence-based guideline for the diagnosis, management, and rehabilitation. Clinical Radiology, 72, S25.doi: 10.1016/j.crad.2017.06.104
Tsima, Setlhare, V., &Nkomazana, O. (2016).Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting. Journal Of Multidisciplinary Healthcare, Volume 9, 347-354. doi: 10.2147/jmdh.s112466
WHO | World Health Organization. (2018). Retrieved from https://www.who.int/
Gagliardi, R. (2014). Editorial: Depression in post-stroke patients. Revista Neurociências, 22(02), 167-167. doi: 10.4181/rnc.2014.22.02.editorial931.1p
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