Background & Objectives: There is increasing interest in the impact of delirium on mortality and morbidity in stroke patients. Whilst there are published studies assessing this impact, they are primarily focused on the short/long-term physical and cognitive outcomes of stroke survivors. We conducted a systematic review of the literature to determine the impact of delirium on participation in allied health interventions and measurable outcomes immediately following a stroke. Methods and Results: We used a broad search strategy and interrogated three online databases; CINAHL, EMBASE and MEDLINE. Our initial search yielded no results specific to stroke. The search was then expanded to include studiesin any patient population and the final result yielded two publications that fulfilled inclusion criteria. One was a case report of a post-arthroplasty patient, and the second an observational study in an ICU.Both groups concluded that delirium had a negative impact on participation in allied health therapy. Conclusion: The lack of research on the impact of delirium on participation in allied health therapies in stroke patients is surprising. Intuitively, we would assume a negative association but this needs to be studied systematically to identify the incidence, risk factors, and potential interventions aimed at improving outcomes. The overall management of stroke must keep pace with the gains shown in hyperacute stroke management to ensure maximal benefit to stroke survivors.

Pohnpei State’s Division of Primary Health Care implemented enhanced surveillance for early warning and detection of disease to support the 8th Micronesian Games (the Games) in July 2014. The surveillance comprised 11 point-of-care sentinel sites around Pohnpei, Federated States of Micronesia, collecting data daily for eight syndromes using standard case definitions. Each sentinel site reported total acute care encounters, total syndrome cases and the total for each syndrome. A public health response, including epidemiological investigation and laboratory testing, followed when syndrome counts reached predetermined threshold levels. The surveillance was implemented using the web-based Suite for Automated Global Electronic bioSurveillance Open-ESSENCE (SAGES-OE) application that was customized for the Games. Data were summarized in daily situation reports (SitReps) issued to key stakeholders and posted on PacNet, a Pacific public health e-mail network. Influenza-like illness (ILI) was the most common syndrome reported (55%, n = 225). Most syndrome cases (75%) were among people from Pohnpei. Only 30 cases out of a total of 408 syndrome cases (7%) presented with acute fever and rash, despite the large and ongoing measles outbreak at the time. No new infectious disease outbreak was recorded during the Games. Peaks in diarrhoeal and ILI cases were followed up and did not result in widespread transmission. The technology was a key feature of the enhanced surveillance. The introduction of the web-based tool greatly improved the timeliness of data entry, analysis and SitRep dissemination, providing assurance to the Games organizers that communicable diseases would not adversely impact the Games.