Team Number 3

Royal College of Surgeons in Ireland

Patient Safety and Quality in Healthcare
Team project
Instructions
1. Complete the form below (all fields must be filled).
2. The document name should be of the form team_number.doc (e.g. team47.doc). Please also change the header to your team
number
3. All text must be formatted as Arial , 12 point, black colour and have single line spacing. Italic, bold and underline styles are
optional.
4. Word count must be completed for sections 1 & 2 (excludes header, references, charts and tables).
5. A minimum of 10 key references should be cited in the paper. A maximum of 5 website references may be used in the case
analysis.

Project Title: Team _3.doc Case analysis Stroke

Team number: 3
Date of submission: 03/04/2015
Team details
Student ID number:
Student 1
14006634
Student 2
14031311
Student 3
14031892
Student 4
11001844
Student 5
11002638
Student 6
12002216

Ines
Adri-Anna
Kenneth
Shuaib
Ahmad
Ahmed

Dakhlia
Aloia
Green
Neetoo
Shaqdan
Ashry

Team Number 3
CASE ANALYSIS
In reviewing the case of Ellen, a stroke victim, the adequacy of treatment in Bahrain will be assessed in the following review.
Specification and options for Ellens treatment, her social context, health care quality and safety, as well as ethical considerations are
explored.
A) Problem Specification:
Strokes are the third leading cause of death and the primary cause of serious long-term disability with more than 60% of patients
burdened with residual neurological deficits 1,2.
An ischemic stroke happens due to lack of blood flow to the brain and blood clots. Ischemic strokes are more common in men and
accounts for almost 90% of all stroke cases3. Chances of developing an ischemic stroke increase prior to an embolism 3. Diagnosing an
ischemic stroke requires a few tests and scans4. Different areas of the brain affected by the stroke can lead to different results; opposing
paralysis of facial and limb structures, speech and visual impairments, confusion, loss of balance, cognitive disabilities headaches and
seizures may be present5.
Tests such as CTs or MRI scans can confirm the ischemic stroke 6,7,8. Figure 1 outlines a typical history used in diagnosing stroke
victims9.

Team Number 3

Figure 1. Algorithm for the diagnosis of acute stroke9.

National Institution of Neurological Disorders and Stroke, History Outline 9.
Studies have found that increasing lifestyle awareness decreased the number of stroke cases 6,2. Other studies have shown that a delay
in treatment causes more damage to the affected area 10.
In the treatment of ischemic strokes, tPA and endovascular procedures are implemented. Tissue plasminogen activator (tPA) is
inserted intravenously to dissolve clots and restore blood flow 10. To reduce chances of future blood clots, antiplatelet therapy like Clopidogrel,
combination of extended-release dipyridamole or aspirin is reccomended11. To reduce future damage of blood vessels, patient can take blood
pressure medication and statins to lower his/her cholesterol level 12,13,14,15 . If Ellen is having difficulty eating on her own, a feeding tube given
within 3 weeks, or a percutaneous endoscopic gastrostomy tube for long term use, may be needed 16. Other surgical treatment methods
include carotid endarterectomy and the applications of angioplasties or stents 17.
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Other effects of stroke may include the onset of Post Stroke Depression (PSD), a psychiatric disease 18.
Depression is defined as the feeling of sadness, apathy, anxiety/panic, and low self-esteem 18. These patients show signs like aphasia, social
isolation, loss of balance, headaches, and slight changes in personality 1. Other variables to keep in mind are old age, financial difficulty, limited
social support, and previous psychiatric illnesses 1,18. To help the patient cope, anti-depressants may be used if necessary18. Joining a support
group in this situation is recommended18.
Patients with depression have significantly worse outcomes up to 3 months with a variable prevalence of 3-6 months post stroke 19.
Depression is an important aspect of post-stroke rehabilitation and should be dealt with appropriately by medical practitioners and community.
Starting a rehabilitation program after a stroke increases the chances of regaining lost abilities20. The patients inability to cope with
their new lifestyle can cause emotional distress and may lead to depression 1,18. Patients should follow their scheduled check ups with their
medical therapists, and practice self-help activities. Ideally, hospitals should have a stroke unit specifically dealing with stroke cases.
In Ellens case, her primary clinician should follow-up with her frequently until convinced that she is stable.
B) Societal aspect:

Figure 1. Fraction of Haemorrhagic and Ischemic stroke in males and females within the Middle
East21,25,26,27.

Team Number 3
While information is limited regarding the prevalence of stroke over many years, studies have shown a trend in incidence. In 1995,
approximately 40 to 45 stroke cases were recorded from a sample population of 100,000 people in Bahrain 21,22,23,24. This suggests that
treatment and awareness has improved overall in this population. However, studies suggest that the prevalence of strokes in Bahrain is
becoming equivalent to that of western countries, contributing to an overall value of 5.7 million deaths wordwide 21,22,23.
In Arab countries the incidence and prevalence of stroke ranged from 27.5 to 63 and 42 to 68, per 100,000 sample population 22. Overall
in Arab countries ischemic stroke was found to be the most common disease. In Bahrain, however cerebral infarctions were found to be the
most common (53% of incidences), followed by cerebral hemorrhage (30%) and unspecified stroke types (16.5%) 22,24. Figure 1 outlines
Middle Eastern countries in 2010 and their proportion of hemorrhagic and ischemic stroke cases 21,25,26,27.
In additional to the methods and procedures put in place to assist Ellens recovery, there are other factors to be considered.
This includes Ellens own age and the health of her support group at home, primarily her husband 28,29,30,31. Approximately 45% of stroke
survivors return to home care, while others may look for inpatient rehabilitation admittance. This may not be an available option for Ellen 28,32.
When reviewing the profile of her primary care giver, in this case Ellens husband, his physical and mental health status should
be considered,28,33. Her husband or any member of the family being Ellens care giver should joining a support group allows the care givers to
release their own newfound frustrations which would benefit their own wellbeing. Also, to lessen the stress and responsibilities of the care
giver an additional family member may move in.
Primary care givers, as well as other visiting members of the family should be trained in some form of rehabilitation caring, utilise
suggested resources that will explain behavioral changes and recovery strategies 28. Through this, the family may develop a dynamic,
interdependent approach to caring for Ellen.
C) Health Care Quality and Patient Safety:
Based on guidelines for acute ischemic stroke management, Ellen did not receive the appropriate treatment 34. Upon symptom onset,
Ellen should reach the hospital within 3 hours. In fact, there is a linear relationship between the time the treatment is started and the chances
of benefit. If patient receives thrombolysis while he is outside the strict protocol, there will be unacceptable complications especially
intracranial haemorrhage35.
In addition to the travel time, the call to the GP added to the delay in treatment. Irrespective of the age or the severity, delivery of rtPA
within 4-5 hours results in positive outcomes, studies have also shown rtPA to be successful within 6 hours delivery 34,36.
The Emergency Department could have had a more streamlined process so that Ellen would have had her CT scan sooner than 90
minutes upon arrival, qualifying her for tPA treatment 34,36,37.
Ellen should have been directed to a Stroke Unit (SU unit), being critical and needing close monitoring 36,37,38.
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Team Number 3
American Stroke Association (ASA) and European Stroke Initiative (EUSI) guidelines stress that stroke is an emergency and is time
sensitive; earlier cerebral reperfusion improves patient outcome 39.
Initial care management should include:

A careful clinical assessment including neurological examination should be conducted. The use of a stroke rating scale preferably the
NIHSS (National Institutes of Health Stroke Scale) is recommended 38.

A CT scan should be conducted 24 hours before starting antiplatelet or anticoagulant therapy 38.

Airway support and ventilatory assistance recommended for the treatment of patient with acute stroke 38.
Hyperthermia should be identified and treated 38.
Hypovolemia should be corrected with intravenous normal saline 38.
Hypoglycemia should be treated38.
Intra-arterial fibrinolysis is recommended and beneficial for strokes greater than 6 hours duration 40.
Oral administration of aspirin within 24 to 48 hours after onset is recommended 40.
Patients with suspected pneumonia or UTIs should be treated with appropriate antibiotics 40.
Patients who cannot take solid food and liquids orally should receive NG, nasoduodenal, or PEG tube feedings to maintain hydration
and nutrition35,40.
To prevent a further stroke it is recommended that one should lower BP and cholesterol (statin), and improve lifestyle 35.

Community walk-ins should be made available where stroke patients could easily drop in at any time, in case of any incidence,
associated depressive and suicidal tendencies as well as providing rehabilitation. Admission within SUs have shown better outcome and
reduced morbidity, mortality and complication related to stroke 6.
The guidelines for stroke management is established by the Royal College Of Physicians (UK) 41. Clinicians, family members and
patients can work together to decrease the risk of medical complications 41. On a secondary level, preventive measures such as; life-style risk
factors, and optimization of treatment have been shown to prevent future stroke 17. Multidisciplinary assessment team and treatment plan
reduce the risk of stroke recurrence32,41.
Stroke rehabilitation is all about maximizing physical, social, and vocational potential consistent with physiological and environmental
limitations42. The main goals of the rehabilitation are to prevent, recognize, and manage co-morbidities and medical complications 42.
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Team Number 3
Approximately 10% of patients have complete spontaneous recovery and 10% do not benefit from rehabilitation due to severity of
lesion . However it has been deduced that 80% of the patients do benefit from the rehabilitation 41.
41

The main approaches involved are; physical activities that strengthen motor skills in order to restore damaged muscles and mobility
training that teaches patients to walk and support body weight with the use of canes 43. The treatment usually lasts about 3 hours per day for a
period of 5 days in a week, depending on the degree of severity of the patient 43.
D) Ethical Consideration:
In regarding Ellens current state and the voiced will to die, her mental wellbeing must be addressed. According to the Diagnostic and
Statistical Manual of Mental Disorders - Edition 5 (DSM-5), a diagnosis of Major Depressive Disorder (MDD) requires the person to have five
or more of the following symptoms, for two or more weeks: Increased or decreased sleeplessness, depressed mood, suicidal thoughts,
substantial weight change, feelings of worthlessness, inability to experience pleasure, fatigue, psychomotor agitation, or diminished ability to
concentrate44. Treatment methods include the use of antidepressants, anxiolytics and psychotherapy in combination 45. Ellens family should
be aware that stable effects of treatment require approximately four to six weeks 46. In this time the family should be considerate of taking on
social treatment strategies such as giving Ellen attention, be open to discussion, have therapist intervention, create a crisis plan, build a strong
support system and to not be afraid to seek professional help 46,47.
Ellen herself presents helplessness, hopelessness, irritability and suicidal attempts contributing to the argument that she is clinically
depressed with her current state, however a controversial insight on her condition is whether her current outlooks will persist as long term or
phasic44,45,48,49. She presents symptoms of post stroke depression (PSD) as she adheres to the listed symptoms of impaired self-reporting
and cognition, poor insight, dysphasia leading to poor recovery48.
From here, Ellen should be assessed and graded on the severity of her current state in order to categorize her as a critical or mild concern
using screening methods 44,45,48,49. It should be noted that Ellen herself does not seem to have any cognitive impairment and that, in regards to
clinical treatment, to label her as a depressed patient is too general for an effective treatment plan47.
Conclusion:
In conclusion, Ellens case wasnt treated with the utmost of consideration. Her location and circumstance does not provide adequate
resources that she needs in allowing herself to trust and benefit from treatment. With the above considered, more work needs to be done in
creating a specific treatment plan.

Team Number 3

E) Search strategy:
We used some key words to search on Medline and combined some results. We limited our search to full text only. Wee searched for
keywords that have been indexed in the database ( eg. Mesh for Medline). This keyword is present within different place in the document
(Article title, Publication titles, Subject heading, Content notes, Abstracts).
The table below shows the search strategy we used to get the best articles on this topic.
Used Medline to search for Acute Ischemic Stroke treatment:
Searched

Found

1 Search for: Acute Ischemic Stroke

7.459

Articles discuss Acute Ischemic Stroke

2 Search for: Treatment

3.619.36 Articles discuss management

5

3 Combine search 1&2

3.913

Articles about treatment of acute ischemic stroke

4 Limit to: Full Text

634

Articles about treatment of acute ischemic stroke in full text

5 Limit to: Full Text & English Language

631

Articles about treatment of acute ischemic stroke in full text and

English language

6 Limit to: Full Text, English Language & publication date 626
from January 2000 till February 2015

Articles about management of acute ischemic stroke in English

language, full text and published between 2000-2015

Team Number 3

Used Medline to search for stroke PSD (Post Stroke Depression):

Searched

Foun
d

1 Search for: Acute Ischemic Stroke

7.459 Articles discuss Acute Ischemic Stroke

2 Search for: Post Stroke Depression

348

Articles discuss Post Stroke Depression

3 Combine search 1&2

Articles about Post Stroke Depression AND acute ischemic stroke

4 Limit to: Full Text

Articles about Post Stroke Depression AND acute ischemic stroke in full text

5 Limit to: Full Text & English Language

Articles about Post Stroke Depression AND acute ischemic stroke in full text and
English language

6 Limit to: Full Text, English Language & publication

date from Dec 2002 till Feb 2014

Articles about Post Stroke Depression AND acute ischemic stroke in English
language, full text and published between Dec 2002-Feb 2014
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F) References :
a,b
1. Barbara E. Bates, MD, MBA,
and all. Factors Influencing Receipt of Early Rehabilitation After Stroke. Archives of Physical Medicine
and Rehabilitation 2013;94:2349-56.
2. Lee W, Frayne J. Transient ischaemic attack clinic: An evaluation of diagnoses and clinical decision making . Journal of Clinical
Neuroscience xxx (2015) xxxxxx Article in press
3. John Hopkins University. Types of Stroke and Stroke Risks. John Hopkins Medicine, Neurology and Neurosurgery, 2015.
<http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/cerebrovascular/conditions/stroke.html >
4. National Institute of Neurological Disorders and Stroke. History Taking. The Internet Stroke Centre, 2015.
<http://www.strokecenter.org/patients/about-stroke/warning-signs-of-stroke/>
5. American Medical Association. Effects of a Stroke on the Brain. American Medical Association, 2015. <http://www.amaassn.org/ama/pub/physician-resources/patient-education-materials/atlas-of-human-body/brain-effects-stroke.page>
6. Beaumont Health System. Heart and Vascular. Beaumont Health System, 2014. <https://heart.beaumont.edu/ischemic-stroke>
7. Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of ischemic stroke. Evaluation for Ischemic Stroke.
Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); 2010 Jun. 70 p.
8. Robin Howard. Ischaemic stroke Anaesthesia & Intensive Care Medicine, Volume 11, Issue 9, September 2010, Pages 340-342
9. Yew KS, Cheng E. Acute stroke diagnosis. Am Fam Physician. 2009; 80(1):33-40.
10. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association;
5th edition 2013.
11. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott
PA, Summers DR, Wang DZ, Wintermark M, Yonas H; American Heart Association Stroke Council; Council on Cardiovascular Nursing;
Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute
ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke.
2013; 44(3):870-947.
12. Flint AC, Kamel H, Navi BB, Rao VA, Faigeles BS, Conell C, Klingman JG, Sidney S, Hills NK, Sorel M, Cullen SP, Johnston SC. Statin
use during ischemic stroke hospitalization is strongly associated with improved poststroke survival. Stroke 2012; 43(1):147-154.
13. N Chrinn D, Callaly EL, Duggan J, Merwick , Hannon N, Sheehan , Marnane M, Horgan G, Williams EB, Harris D, Kyne L,
McCormack PM, Moroney J, Grant T, Williams D, Daly L, Kelly PJ. Association between acute statin therapy, survival, and improved
functional outcome after ischemic stroke: the North Dublin Population Stroke Study. Stroke 2011; 42(4):1021-1029.
14. Sandset EC, Bath PM, Boysen G, Jatuzis D, Krv J, Lders S, Murray GD, Richter PS, Roine RO, Ternt A, Thijs V, Berge E; SCAST
Study Group. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled,
double-blind trial. Lancet 2011; 377(9767):741-750.
15. Wang H, Tang Y, Rong X, Li H, Pan R, Wang Y, Peng Y. Effects of early blood pressure lowering on early and long-term outcomes after
acute stroke: an updated meta-analysis. PLoS One. 2014; 9(5):e97917.
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16. Kessler D, Egan M, Kubina LA. Peer support for stroke survivors: a case study. BMC Health Serv Res. 2014; 14:256.
17. American Heart and Stroke Association. Behavioral Changes After Stroke. May 27th, 2014.
<http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/EmotionalBehavioralChallenges/BehaviorChanges-After-Stroke_UCM_309752_Article.jsp>
18. Fary Khan, Poststroke depression Australian Family Physician Vol. 33, No. 10, October 2004
19. Abraham W. Aron, BS,* Ilene Staff, PhD and all. Prestroke Living Situation and Depression Contribute to Initial Stroke Severity and
Stroke Recovery . Journal of Stroke and Cerebrovascular Diseases, Vol. 24, No. 2 (February), 2015: pp 492-499.
20. WebMD. Treatment Overview: Emergency Treatment. WebMD, Stroke Health Center, 2015.
<http://www.webmd.com/stroke/guide/stroke-treatment-overview>
21. Al-Jishi, A.A., Mohan, P.K. Profile of stroke in Bahrain. Neuroscience (Riyadh), Volume 1 (2000); pp.30-34.
22. Benamer HTS, Grosset D. Stroke in Arab countries: A systematic literature review, J Neurol Sci (2009), doi:10.1016/j. jns.2009.04.029
23. World Life Expectancy. 2011 <http://www.worldlifeexpectancy.com/bahrain-stroke >
24. Tran J, Mirzaei M, Anderson L, Leeder SR. The epidemiology of stroke in the Middle East and North Africa. J Neurol Sci. 2010; 295(12):38-40.
25. International Stroke Center. Stroke Statistics: U.S. Statistics. 2015 <http://www.strokecenter.org/patients/about-stroke/stroke-statistics/>
26. Janghorbani M, Hamzehiee-Moghadam A, Kachoiee H. Epidemiology of non-fatal stroke in Kerman, Iran. Hamdard Medicus. 1997;
40(3):89-98.
27. Sweileh WM, Sawalha AF, Al-Aqad SM, Zyoud SH, Al-Jabi SW. The epidemiology of stroke in Northern Palestine: a 1-year, hospitalbased study. J Stroke Cerebrovasc Dis. 2008; 17(6):406-11.
28. Kelly M. Jones, PhD,* Rohit Bhattacharjee et all. Methodology of the Stroke Self-Management Rehabilitation Trial: An International,
Multisite Pilot Trial Journal of Stroke and Cerebrovascular Diseases, Vol. 24, No. 2 (February), 2015: pp 297-303
29. Knig IR, Ziegler A, Bluhmki E, Hacke W, Bath PM, Sacco RL, Diener HC, Weimar C; Virtual International Stroke Trials Archive (VISTA)
Investigators. Predicting outcome after acute ischemic stroke: an external validation of prognostic models. Neurology. 2004; 62:581585.
30. Knig IR, Ziegler A, Bluhmki E, Hacke W, Bath PM, Sacco RL, Diener HC, Weimar C; Virtual International Stroke Trials Archive (VISTA)
Investigators. Predicting long-term outcome after acute ischemic stroke: a simple index works in patients from controlled clinical trials.
Stroke. 2008; 39(6):1821-1826.
31. Weimar C, Konig IR, Kraywinkel K, Ziegler A, Diener HC. Age and National Institutes of Health Stroke Scale score within 6 hours after
onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke
2004; 35:158-162.
a,
b
32. Amal B. Abdul-sattar
and Tarek Godab Predictors of functional outcome in Saudi Arabian patients with stroke after inpatient
rehabilitation NeuroRehabilitation 33 (2013) 209216
33. Scottish Intercollegiate Guidelines Network. Management of patients with stroke: Identification and management of dysphagia.
Edinburgh SIGN publication no.119.2010
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34. Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Grotta J, Howard G, Kaste M,
Koga M, von Kummer R, Lansberg M, Lindley RI, Murray G, Olivot JM, Parsons M, Tilley B, Toni D, Toyoda K, Wahlgren N, Wardlaw J,
Whiteley W, del Zoppo GJ, Baigent C, Sandercock P, Hacke W; Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment
delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of
individual patient data from randomised trials. Lancet. 2014; 384(9958):1929-1935.
35. Howard R. Ischaemic stroke Anaesthesia & Intensive Care Medicine. September 2010 (11) (9): 340-2
36. Ringeleb, P.A., Schellinger, P.D., Schranz, C., Hacke, W. Emerging Therapies: Thombrolytic therapy within 3 to 6 hours after onset of
ischemic stroke. American Heart Associatation Journal: Stroke, Volume 33 (2002); pp. 1437 1441.
37. Lecin ana M, Egido J, Casado I, Rib M, Dvalos A, Masjuan J, Caniego J.L, Martnez E. Vila, Dez Tejedor E. (Coordinator),
representing the ad hoc committee of the SEN Study Group for Cerebrovascular Diseases:B. Fuentes (Secretara), J. lvarez-Sabin, J.
Arenillas, S. Calleja, M. Castellanos,J. Castillo, F. Daz-Otero, J.C. Lpez-Fernndez, M. Freijo, J. Gllego,A. Garca-Pastor, A. Gil-Nn
ez, F. Gilo, P. Irimia, A. Lago,J. Maestre, J. Mart-Fbregas, P. Martnez-Snchez, C. Molina, A. Morales, F. Nombela, F. Purroy, M.
Rodrguez-Yan ez, J. Roquer, F. Rubio,T. Segura, J. Serena, P. Simal, J. Tejada, J. Vivancos J . Guidelines for the treatment of acute
ischaemic stroke. Neurologa. 2014;29(2):102122
38. Adams HP, del Zoppo G, Alberts MJ. Guidelines for the early management of adults with ischemic stroke: a guideline from the American
Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention
Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working
Groups. Stroke. 2007; 38:1655-1711.
39. Klijn C, Hankey G. Guidelines from the American Stroke Association and European Stroke InitiativeAmerican Stroke Association and
European Stroke Initiative. The Lancet Neurology November 2003;Vol 2:698-701.
40. Ministry of health,Malaysia.Guideline for acute ischemic stroke. General recommendation management for acute ischemic stroke.
<http://www.moh.gov.my/attachments/7496.pdf>
41. Stroke Rehabilitation Long Term Rehabilitation After Stroke. NICE Clinical Guidelines,
No. 162. National Clinical Guideline Centre
(UK). London: Royal College of Physicians (UK); 2013 May 23.
42. Mayo Clinic Staff. "Stroke Rehabilitation: What to Expect as You Recover."From Stroke. Mayo Clinic, 11 June 2014. Web. 08 Mar. 2015.
43. Faiz KW, Sundseth A, Thommessen B, Rnning OM. Prehospital delay in acute stroke and TIA. Emerg Med J. 2013; 30(8):669-674.
44. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association;
5th edition 2013.
45. Doyle F1, McGee HM, De La Harpe D, Shelley E, Conroy R. The Hospital Anxiety and Depression Scale depression subscale, but not
the Beck Depression Inventory-Fast Scale, identifies patients with acute coronary syndrome at elevated risk of 1-year mortality. J
Psychosom Res. 2006; 60(5):461-467.
46. Families for Depression Awareness. Helping someone who has depression: Helpful tips, what not to do, questions for the cinician.
Families for Depression Awareness. <http://www.familyaware.org/top-depression/help-someone-who-has-depression.html>
47. Buchanan AE, Dan WB (1989) Deciding for others: The ethics of surrogate decision making. New York, NY: Cambridge University
Press. http://www.uclouvain.be/cps/ucl/doc/ebim/documents/Ethical_and_Legal_Issues_Regarding_Consent_in.14.pdf
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48. Khan F. Poststroke depression Australian Family Physician.10 October 2004 (33): 831-834.
49. Mutai H, Furukawa T, Araki K, Misawa K , Hanihara T Long-term outcome in stroke survivors after discharge from a convalescent
rehabilitation ward Psychiatry and Clinical Neurosciences 2013; 67: 434440
2

WEBSITE EVALUATION
2 websites chosen:

MAYO CLINIC
http://www.mayoclinic.org/diseases-conditions/stroke/home/ovc-20117264
Herbal Remedies for Stroke Recovery
http://www.livestrong.com/article/308937-herbal-remedies-for-stroke-recovery/
To evaluate a website there are 4 criteria to be evaluate. A reliable and trustworthy Web Site should meets these criteria:
Authority
Accuracy
Currency
Objectivity
The two websites chosen to from the list were the Mayo clinic website and the Livestrong website for herbal remedies for stroke
recovery. The goal is to access the sponsors of the website to evaluate the presence of any bias and the validity of the information provided.
The mayo clinic website ends with .org, meaning that an organization is responsible for the website Mayo Foundation for Medical
Education and Research which has been an active publisher and reliable source of information since 1998. It is very easy to identify the
organization and domain of the website at the top left corner. The second website ends with .com meaning it is a commercial website, and
Livestrong its domain. Shown on the top of the site is the Herbal Medication Seller and published by author Janet Contursi.
The credentials of the authors and editors should be considered when assessing the validity of the sites information. Brooks S
Edwards M.D is the founding medical editor of the first site along with other authors. He is a certified medical doctor therefore is someone who
can be trusted when it comes to medical topics. Janet Contursi is responsible for the second website however her qualifications are not
shown. Additionally personal pages lack a publisher or a domain owner so the information cannot be verified.
This websites contact information is missing while the Mayo Clinic website provides an email development@mayo.edu as well as an address:
Department of Development Mayo Clinic200 First St. SWRochester, MN 55905 for the user to contact for further information.

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Team Number 3
The primary focus is on the authors/publishers and their credentials to evaluate their expertise on the topic given.
Rd. Edwards is board certified in internal medicine, cardiology, heart failure, and transplantation. He has been on staff at Mayo Clinic since
1989, is a professor of medicine at Mayo Medical School and has served as president of Mayo Clinic's Rochester. He is Mayo Clinic.com's first
medical editor-in-chief. This website presents information that can be trusted, and is verified by facts. It lists their sources and includes links to
external resources.
The information on the author of the second website is an herbal medicine expert but the authors credentials are not shown so
expertise cannot be analysed. This website directs its information to fit in with their organizational mission. Information is not based on
verifiable facts, and does not list sources for presented information or links to other sources. This information is biased as its aim is selling a
product.
Also we need to assess the currency of the website.
The Mayo clinic site has the date of the information. The date of information written is given, and was last revised on Nov. 22, 2014
(updates are very important). Additionally it provides links to other sources
The second website was last updated Nov 16, 2010 and provided broken links `to resources. Neither sites provided out dated
information however the Mayo clinic websites information is more reliable. Mayo clinic site also appears modern while the other appears old
and unchanged.
To access bias is to analyse the information assumed and its purpose.
The first site is designed to help patient understand this disease and cope with it by learning self-management advices and the
prevention of a further. This site also allows the user to make an appointment with an expert. It has a field called More about that which goes
further in-Depth and direct the user to multimedia and other sources. The site is used to give the patient minimum information about this
disease, its diagnostic aspects, and complications that may arise.
The second site is made specifically for a commercial purpose and was originally written for broadcast on air. It is created to support
only one point of view and provides information in order to promote its product.
To evaluate the websites we need to access the audience for this informations.
The first site is directed to the patient suffering from a stroke and their relatives. The other website is trying to sell the product to
uninformed patients or patients that do not believe in professional medicine. There is one page of information provided and the reader would
most likely not return to this website. The language level of both sites is relatively easy for most readers with few word definitions to find. The
Mayo Clinic site seems to be easy to use straightforward, and interesting to its audience. With one click you can reach overview clinical and
investigation treatment/ prevention as well as links to videos and images. Some who may have disabilities may find difficulty navigating
through this website. The mayo clinic site is great and professional and one the reader would return to without question.

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TEAM PROCESS

Group 3 Team Profile

16

Team Number 3

HBPS Group 3 Attendance, Role, and Meeting Task Sheet

Meeting 1

Meeting 2 Meeting
3
Date:
Date:
Date:
February
February February
8, 2015
17, 2015 24,
4:00 PM
3:30 PM
2015
Le Sol
4PM
Cafe
Task:
Task:
Task:
Discuss
Discuss
Discuss
Project
work on
work on
Requireme Case
Case
nts
Analysis
Analysis
Student #
1 1400663
4

First
name
Ines

2 14031311 AdriAnna
3 1403189
2

Aloia

Kenneth Green

4 11001844 Shuaib

5 11002638 Ahmad
6 1200221
6

Last
Name
Dakhlia

Ahmed

Neetoo

Shaqda
n
Ashry

Meetin
g4
Date:
March
4, 2015
4PM

Meetin
g5
Date:
March
10,
2015
4PM

Meetin
g6
Date:
March
16,
2015
4PM

Meetin
g7
Date:
March
31,
2015
4 PM

Meeting 8

Task:
Discuss
work on
Case
Analysi
s

Task:
Present
and
discuss
draft

Task:
Editing
of
content
and
word
limit

Task:
Editing
of
content
and
word
limit

Task:
Discuss
TurnItIn
Report
from 1st
Submission

Date:
By April 8,
2015

Role (s)
- Chair
- Company
Worker
- Team
Worker
- Shaper
- Monitor
Evaluator
- Finisher

- Resource
Investigato
r
- Plant
- Plant

17

Team Number 3
Belbin Role Survey Results
The Belbin role survey results for Group 3 are depicted in the chart below. The chart shows that Company Worker was the most popular first
choice and Coordinator (Chair) was the most common second choice. Team Worker was the least common second choice. Completer
Finisher was not the first or the second choice role for any of the five members of the group.

Team Strengths
This team is disciplined, reliable, confident, focused, motivated, and enthusiastic. There is good communication between the members of the
team and the group has a good understanding of the project guidelines.
Team Weaknesses
Team weaknesses include eagerness for deadlines, which may result in miss details. None of the members had Complete Finisher as their
first or second choice role. One member indicated Team Worker as her second choice role. There are too many strong heads in the group.
Some members will need to perform two roles. Some members may become overwhelmed with the double roles.
18

Team Number 3
Plan of Action
The teams plan is to implement a system of communication that allows all of the members of the group to share, continually contribute up-todate information, and remain motivated.
Team Composition
After discussing the above results, the team decided on the following allocation of roles:
Ines Dakhlia , Chair Company Worker (Implementer) and Team Worker;
Adri-Anna Aloia, Shaper and Completer Finisher;
Kenneth Green, Coordinator (Chair) and Monitor Evaluator;
Shuaib Neetoo, Resource Investigator;
Ahmed Ashry, Plant,
Ahmed Shaqdan Plant
4.

Reflections on Turnitin
In submitting our report to Turnitin, we have found a similarity of ____%. Similarity may have been due to many other submissions
which used the same resources or due to the similarity of material to address the questions presented in the above case. All material
highlighted by the program was found to be properly sourced with the proper reference or quotations where required.
In re-editing our project, some rephrasing and source checking required attention prior to our re-submission. The last submission found
a similarity of ____%. We improved our similarity score by ____% with our described edits and efforts.
In completion of this project, our team has learned the importance of communication and work specification in sourcing material. During
our discussion and work presentation and editing, we had issues in organizing prior sources with the work cited list, in regards to number
referencing. Resource validation and credibility had to be taken into consideration and observed by 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. In the end, our
reference list included book, journal and online material.

19