***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND PURPOSE We sought to evaluate the effect of setting on the rate of medical complications during  stroke rehabilitation .  METHODS A study of the frequency and nature of medical complications in stroke rehabilitation  was undertaken in 245 patients managed either on a stroke rehabilitation unit ( n = 124 ) or on general medical wards ( n = 121 ) . The stroke unit setting was characterized by established protocol s for prevention , early diagnosis , and management of complications ( eg , aspiration , infections , thromboembolism , pressure sores , depression , stroke progression ) . Similar protocol s did not exist on general medical wards except for thromboembolism , pressure sores , and secondary stroke prevention . RESULTS Medical complications were documented in 147 patients ( 60 % ) and were more common in patients with severe strokes ( 97 % ) . The frequency of reported complications was similar in both setting s. Aspiration ( 33 % versus 20 % ; P < .01 ) and musculoskeletal pain ( 38 % versus 23 % ; P < .05 ) were more commonly documented on the stroke unit , whereas urinary problems ( 18 % versus 7 % ; P < .01 ) and infections ( 49 % versus 25 % ; P < .01 ) were more commonly seen on general medical wards . The reported frequency of deep vein thrombi , pressure sores , and stroke progression was similar in both setting s. Although depression was reported equally in both setting s ( 34 % on the stroke unit versus 27 % on general wards ) , patients on the stroke unit were more likely to be treated compared with general wards ( 67 % versus 36 % ; P < .05 ) . CONCLUSIONS The study shows that inpatient stroke rehabilitation  is a medically active service . Management on specialist units is associated with earlier detection and management of stroke-related problems and prevention of potentially life-threatening complications Aims : To use data generated from an integrated care pathway ( ICP ) to describe the characteristics of patients presenting with depression in a brain injury rehabilitation programme and to assess their response to treatment with sertraline . Setting : A regional rehabilitation unit providing inpatient rehabilitation for young patients ( 16–65 ) with severe complex disabilities . Design : Prospect i ve cohort study of 82 patients admitted to the unit during the 15-month period between between 1 September 1999 and 1 December 2000 . Response to sertraline was assessed in an open-label , before- and after study design Methods and design : All admissions were screened and included in the ICP if there was clinical suspicion of depression , past or present . Anti-depressant medication was prescribed , where appropriate , according to the ICP protocol . Depression was diagnosed on clinical grounds against DSM-IV criteria , and measured where feasible using the Beck Depression Inventory ( BDI-II ) administered by interview , pretreatment and at 6–8 weeks . Results : Of 82 admissions 41 ( 50 % ) were managed using the ICP and 27 ( 64 % ) were either started on or changed to sertraline – 21 for depression ± lability and six for emotional lability only . All of the depressed patients improved clinical ly at some level and no signi”cant side-effects were observed . The BDI-II was assessable in 17/21 who showed a mean improvement of 14.5 ± 9.7 ( con”dence interval ( CI ) 9.3–19.7 , p < 0.001 ) . Eleven patients ( 52 % ) had previously failed to respond with a different selective serotonin re-uptake inhibitor ( SSRI ) agent but still made a signi”cant response when changed to sertraline with a mean reduction in BDI-II of 16.3 ± 10.9 ( CI 8.4–24.11 , p < 0.001 ) . Conclusions : The ICP was practical to use and provided systematic data on assessment of depression and response to treatment in ‘ real-life ’ clinical practice in a brain injury rehabilitation setting . Sertraline appears to be useful and well-tolerated in this context . A full placebo-controlled study is now required BACKGROUND Several lines of evidence indicate that depression is importantly associated with cardiovascular disease end points . However , little is known about the role of depression in stroke mortality . METHODS This study examined the association between depressive symptoms and stroke mortality in a prospect i ve study of behavioral , social , and psychological factors related to health and mortality in a community sample of 6676 initially stroke-free adults ( 45.8 % male ; 79.1 % white ; mean age at baseline , 43.4 years ) from Alameda County , California .  Depressive symptoms  were assessed by the 18-item Human Population Laboratory Depression Scale . Cox proportional hazards regression models were used to evaluate the impact of depressive symptoms after controlling for age , sex , race , and other confounders . RESULTS A total of 169 stroke deaths occurred during 29 years of follow-up . Reporting 5 or more depressive symptoms at baseline was associated with increased risk of stroke mortality , after adjusting for age , sex , and race ( hazard ratio , 1.66 ; 95 % confidence interval , 1.16 - 2.39 ; P<.006 ) . This association remained significant after additional adjustments for education , alcohol consumption , smoking , body mass index , hypertension , and diabetes ( hazard ratio , 1.54 ; 95 % confidence interval , 1.06 - 2.22 ; P<.02 ) . Time-dependent covariate models , which allowed changes in reported depressive symptoms and risk factor levels during follow-up , revealed the same pattern of associations . CONCLUSIONS This population -based study provides the strongest epidemiological evidence to date for a significant relationship between depressive symptoms and stroke mortality . These results contribute to the growing literature on the adverse health effects of depression Objective : To investigate the influence of depression on functional recovery after stroke . Design : Multicentre cohort study of 85 patients admitted for clinical rehabilitation . A two-stage case-finding procedure was used to identify patients with depression . For the control group , consecutive nondepressed stroke patients were enrolled . Patients were interviewed at 3–6 weeks and six months after stroke onset . Setting : Three rehabilitation centres in the vicinity of Amsterdam . Main outcome measures : Functional outcome was determined by the Functional Independence Measure ( FIM ) and the Rehabilitation Activities Profile ( RAP ) . Results : The prevalence of depression ( 35 % ) was comparable with the findings of earlier studies in other setting s. Patients classified as depressed according to DSM III R criteria ( American Psychiatric Association Diagnostic and statistical manual of mental disorders ) had a significantly lower functional score , both at onset and after follow-up ( FIM and RAP ) . There was , however , no significant difference in functional improvement between the depressed and the nondepressed group . Mean functional improvement in the six patients treated with antidepressants was 30 % better than in the untreated ( depressed ) patients ; numbers were too small for the results to attain statistical significance . Subset analysis showed a significantly higher outcome for nondepressed patients for the FIM subitems personal care and transfers . However , functional improvement was not significantly different for any of the subitems in depressed versus nondepressed patients . Conclusion : Stroke patients with depression have significantly lower functional scores both at onset and after six months . Our results suggest under-recognition of post-stroke depression and a possible beneficial effect of antidepressant medication in depressed stroke patients . Further studies are required to determine the effect of antidepressants 
    Output:
    
Conclusions : This ICP raised staff awareness of depression , leading to improved documentation and possibly also st and ards of care