***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE This prospect i ve , multicenter study was performed to determine the frequency of symptomatic complications up to 30 months after stroke using prespecified definitions of complications . METHODS We recruited 311 consecutive stroke patients admitted to hospital . Research nurses review ed their progress on a weekly basis until hospital discharge and again at 6 , 18 , and 30 months after stroke . RESULTS Complications during hospital admission were recorded in 265 ( 85 % ) of stroke patients . Specific complications were as follows : neurological-recurrent stroke ( 9 % of patients ) , epileptic seizure ( 3 % ) ; infections-urinary tract infection ( 24 % ) , chest infection ( 22 % ) , others ( 19 % ) ; mobility related-falls ( 25 % ) , falls with serious injury ( 5 % ) , pressure sores ( 21 % ) ; thromboembolism-deep venous thrombosis ( 2 % ) , pulmonary embolism ( 1 % ) ; pain-shoulder pain ( 9 % ) , other pain ( 34 % ) ; and psychological-depression ( 16 % ) , anxiety ( 14 % ) , emotionalism ( 12 % ) , and confusion ( 56 % ) . During follow-up , infections , falls , " blackouts , " pain , and symptoms of depression and anxiety remained common . Complications were observed across all 3 hospital sites , and their frequency was related to patient dependency and duration after stroke . CONCLUSIONS Our prospect i ve cohort study has confirmed that poststroke complications , particularly infections and falls , are common . However , we have also identified complications relating to pain and cognitive or affective symptoms that are potentially preventable and may previously have been underestimated Background Many interventions delivered within the stroke rehabilitation setting could be considered complex , though some are more complex than others . The degree of complexity might be based on the number of and interactions between levels , components and actions targeted within the intervention . The number of ( and variation within ) participant groups and the context s in which it is delivered might also reflect the extent of complexity . Similarly , design ing the evaluation of a complex intervention can be challenging . Considerations include the necessity for intervention st and ardisation , the multiplicity of outcome measures employed to capture the impact of a multifaceted intervention and the delivery of the intervention across different clinical setting s operating within varying healthcare context s. Our aim was to develop and evaluate the implementation of a complex , multidimensional oral health care ( OHC ) intervention for people in stroke rehabilitation setting s which would inform the development of a r and omised controlled trial . Methods After review ing the evidence for the provision of OHC following stroke , multi-disciplinary experts informed the development of our intervention . Using both quantitative and qualitative methods we evaluated the implementation of the complex OHC intervention across patients , staff and service levels of care . We also adopted a pragmatic approach to patient recruitment , the completion of assessment tools and delivery of OHC , alongside an attention to the context in which it was delivered . Results We demonstrated the feasibility of implementing a  complex OHC intervention  across three levels of care . The complementary nature of the mixed methods approach to data gathering provided a complete picture of the implementation of the intervention and a detailed underst and ing of the variations within and interactions between the components of the intervention . Information on the feasibility of the outcome measures used to capture impact across a range of components was also collected , though some process orientated uncertainties including eligibility and recruitment rates remain to be further explored within a Phase II exploratory trial . Conclusions Complex interventions can be captured and described in a manner which facilitates evaluation in the form of exploratory and subsequently definitive clinical trials . If effective , the evidence captured relating to the intervention context will facilitate translation into clinical practice OBJECTIVE To evaluate the effectiveness of home-based oral care training programs on tongue coating ( TC ) , dental plaque ( DP ) , and symptoms of respiratory infection ( SRI ) in stroke survivors . METHODS A single-blind , r and omised , controlled trial conducted in a home-based setting over 2 months . Stroke survivors ( n=48 , experimental group ) and their family caregivers received home-based oral care training programme while a control group of 46 stroke survivors and family caregivers received routine oral care education with swabs .  TC , DP , and SRI were assessed at baseline and after one and two months , with results analysed using Mixed Model ANOVA . RESULTS Poor oral hygiene and overall neglect of home oral care practice s were observed at baseline . TC and DP scores were significantly reduced in the experimental group receiving the home-base oral care training program compared to the control group , who received only routine oral care education ( P<0.001 ) . The groupxtime interaction was significant , with decreased TC and DP scores for both groups at one month and at two months of additional care ( when compared to baseline ) . The SRI scores were not significantly different between groups ( P>0.05 ) . The groupxtime interaction did not correlate with SRI for either group when compared to the baseline and to one month and two months of additional care . No adverse events were encountered and there was no external funding . CONCLUSIONS Home-based oral care training programme had a beneficial effect on oral health as measured by TC and DP scores . The effect on SRI requires further longitudinal study Background and Purpose — Long-term outcome information after transient ischemic attack ( TIA ) and stroke is required to help plan and allocate care services . We evaluated the impact of TIA and stroke on disability and institutionalization over 5 years using data from a population -based study . Methods — Patients from a UK population -based cohort study ( Oxford Vascular Study ) were recruited from 2002 to 2007 and followed up to 2012 . Patients were followed up at 1 , 6 , 12 , 24 , and 60 months postevent and assessed using the modified Rankin scale . A multivariate regression analysis was performed to assess the predictors of disability postevent . Results — A total of 748 index stroke and 440 TIA cases were studied . For patients with TIA , disability levels increased from 14 % ( 63 of 440 ) premorbidly to 23 % ( 60 of 256 ) at 5 years ( P=0.002 ) , with occurrence of subsequent stroke being a major predictor of disability . For stroke survivors , the proportion disabled ( modified Rankin scale > 2 ) increased from 21 % ( 154 of 748 ) premorbidly to 43 % ( 273 of 634 ) at 1 month ( P<0.001 ) , with 39 % ( 132 of 339 ) of survivors disabled 5 years after stroke . Five years postevent , 70 % ( 483 of 690 ) of patients with stroke and 48 % ( 179 of 375 ) of patients with TIA were either dead or disabled . The 5-year risk of care home institutionalization was 11 % after TIA and 19 % after stroke . The average 5-year cost per institutionalized patient was $ 99 831 ( SD , 67 020 ) for TIA and $ 125 359 ( SD , 91 121 ) for stroke . Conclusions — Our results show that 70 % of patients with stroke are either dead or disabled 5 years after the event . Thus , there remains considerable scope for improvements in acute treatment and secondary prevention to reduce postevent disability and institutionalization OBJECTIVES Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia . We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people . DESIGN Survey . SETTING Eleven nursing homes in Japan . PARTICIPANTS Four hundred seventeen patients r and omly assigned to an oral care group or a no oral care group .  INTERVENTION Nurses or caregivers cleaned the patients ' teeth by toothbrush after each meal . Swabbing with povidone iodine was additionally used in some cases . Dentists or dental hygienists provided professional care once a week . MEASUREMENTS Pneumonia , febrile days , death from pneumonia , activities of daily living , and cognitive functions . RESULTS During follow-up , pneumonia , febrile days , and death from pneumonia decreased significantly in patients with oral care . Oral care was beneficial in edentate and dentate patients . Activities of daily living and cognitive functions showed a tendency to improve with oral care . CONCLUSION We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes Background UK adult dental health surveys ( ADHS ) exclude care home residents from sampling . Aim To underst and oral health status of care home residents in Wales using ADHS criteria . Method Cross sectional survey of care home residents in Wales using a question naire and oral examination contemporaneous with , and paralleling , the ADHS 2009 . 708 r and omly selected participants from 213 r and omly selected care homes participated including individuals with and without capacity . Results 72.8 % of residents had tooth decay . Compared to older adults examined in the ADHS , residents are less likely to brush teeth/dentures twice a day ( 37 % vs 63 % ) , more likely to only attend a dentist when they have a problem ( 63 % vs 26 % ) , have more teeth with active decay ( 3.1 vs 0.9 ) , more have current dental pain ( 13 % vs 5 % ) and other morbidity ( open pulp , ulceration , fistulae , abscess 27 % vs 10 % ) . High decay is present in both recently admitted and longer term residents . There was some regional variation in levels of oral hygiene . Conclusion Oral health status of older people resident in care homes in Wales is poor . Findings suggest more could be done to improve preventive care both before and after admission to the care home OBJECTIVE To evaluate the effectiveness of oral health promotion interventions on clinical oral health . DESIGN Single-blind r and omized controlled trial conducted over 3 weeks of in-hospital rehabilitation . SETTING Stroke rehabilitation ward in Hong Kong . PARTICIPANTS Patients with stroke ( N=102 ) admitted to the rehabilitation ward . INTERVENTIONS Patients were r and omly assigned either : ( 1 ) oral hygiene instruction , ( 2 ) oral hygiene instruction and chlorhexidine mouthrinse , or ( 3 ) oral hygiene instruction , chlorhexidine mouthrinse , and assisted brushing . MAIN OUTCOME MEASURES Dental plaque , gingival bleeding , and oral functional status were assessed at baseline and review . Development of infectious complications were also monitored during the clinical trial . RESULTS Poor oral hygiene and an overall neglect of oral hygiene practice s were observed at baseline . Reductions in dental plaque were significantly greater in the 2 groups receiving chlorhexidine compared with the group receiving oral hygiene instruction alone ( P<.001 ) . Reductions in gingival bleeding scores were 3- to 4-fold greater in groups receiving chlorhexidine . No cases of pneumonia were observed during the course of the clinical trial . CONCLUSIONS The oral health condition of patients may be safeguarded after acute stroke with the use of chlorhexidine mouthrinse in conjunction with a st and ard mechanical plaque removal tool , such as an electric toothbrush . These interventions are acceptable to the majority of patients , and their administration poses a minimal burden to rehabilitation ward staff Numerous studies have demonstrated that many older adults have problems chewing , pain , difficulties in eating , and problems in social relationships because of oral disorders . However , it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction . Consequently , this paper begins to address the question , ' Does poor oral health compromise the quality of life ? ' . Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults . As at baseline and three-year follow-up , oral health was measured by self-ratings of oral health and five oral health indices .  Psychological well-being and life satisfaction were assessed according to the Morale Index , the  Perceived Life Stress Question naire , The Life Satisfaction Scale , and the General Health Question naire . All oral health variables were significantly associated with scores from the first three of these measures in the expected direction . These associations remained after we controlled for other potential influences on the quality of life . In addition , prospect i ve analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years . These results suggest that poor self-perceived oral health and relatively poor quality of life co-exist in the same subgroup of older adults Purpose : The pilot study purpose was to determine the effects of a new st and ardized oral care protocol ( intervention ) to usual care practice s ( control ) in poststroke patients . Design : This study is a r and omized controlled clinical trial . Method : Fifty‐one subjects were enrolled . Subjects in the intervention group received oral care twice a day including tooth brushing , tongue brushing , flossing , mouth rinse , and lip care while control patients received usual oral care . Findings : Subjects in the control and intervention groups showed improvement in their oral health assessment s , swallowing abilities and oral intake . There were no significant differences between the two groups . Although not statistically significant , overall prevalence of methicillin‐resistant Staphylococcus aureus and methicillin‐sensitiveStaphylococcus aureus colonization in the control group almost doubled ( from 4.8 % to 9.5 % ) , while colonization in the intervention group decreased ( from 20.8 % to 16.7 % ) . Conclusions / Clinical Relevance : These findings demonstrate the importance of oral care in the poststroke patient with dysphagia OBJECTIVES This cluster-r and omised 
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Findings : Oral care tends to be of poor quality and delegated to the least qualified members of the caring team .
Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae .
Conclusion Although there is evidence of an association , there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke .