Latest & greatest articles for stroke

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Top results for stroke

1. Feasibility and preliminary effects of an integrated hospital-to-home transitional care intervention for older adults with stroke and multimorbidity: A study protocol. (PubMed)

Feasibility and preliminary effects of an integrated hospital-to-home transitional care intervention for older adults with stroke and multimorbidity: A study protocol. Stroke is a major life-altering event and the leading cause of death and disability in Canada. Most older adults who have suffered a stroke will return home and require ongoing rehabilitation in the community. Transitioning from hospital to home is reportedly very stressful and challenging, particularly if stroke survivors have (...) adults (≥55 years) with a confirmed stroke diagnosis, ≥2 co-morbid conditions, and referred to a hospital-based outpatient stroke rehabilitation centre. The 6-month transitional care intervention will be delivered by an interprofessional (IP) team and involve care coordination/system navigation, self-management education and support, home visits, telephone contacts, IP team meetings and a web-based app. Primary evaluation of the intervention will be based on feasibility outcomes (e.g. acceptability

2019 Journal of comorbidity Controlled trial quality: uncertain

2. PreSSUB II: The prehospital stroke study at the Universitair Ziekenhuis Brussel II. (PubMed)

PreSSUB II: The prehospital stroke study at the Universitair Ziekenhuis Brussel II. Stroke is a time-critical medical emergency requiring specialized treatment. Prehospital delay contributes significantly to delayed or missed treatment opportunities. In-ambulance telemedicine can bring stroke expertise to the prehospital arena and facilitate this complex diagnostic and therapeutic process.This study evaluates the efficacy, safety, feasibility, reliability and cost-effectiveness of in-ambulance (...) telemedicine for patients with suspicion of acute stroke. We hypothesize that this approach will reduce the delay to in-hospital treatment by streamlining the diagnostic process and that prehospital stroke care will be improved by expert stroke support via telemedicine during the ambulance transportation.PreSSUB II is an interventional, prospective, randomized, open-blinded, end-point, single-center trial comparing standard emergency care by the Paramedic Intervention Team of the Universitair Ziekenhuis

2019 Journal of translational internal medicine Controlled trial quality: uncertain

3. Essen Risk Score in Prediction of Myocardial Infarction After Transient Ischemic Attack or Ischemic Stroke Without Prior Coronary Artery Disease

Essen Risk Score in Prediction of Myocardial Infarction After Transient Ischemic Attack or Ischemic Stroke Without Prior Coronary Artery Disease Background and Purpose- More intensive secondary prevention with newer drugs may be cost-effective in patients with coronary artery disease (CAD). Whether some subgroups of patients who had a transient ischemic attack (TIA) or ischemic stroke, but no prior CAD are at similar high risk of myocardial infarction as those with prior CAD remains unclear. We (...) determined whether the Essen score identified a subset of TIA/stroke patients without known prior CAD who, nevertheless, had a high risk of myocardial infarction on current secondary prevention management. Methods- In a population-based cohort (Oxford Vascular Study) of consecutive TIA or ischemic stroke patients recruited from 2002 to 2014, 10-year actuarial risks of myocardial infarction and of recurrent ischemic stroke were determined by face-to-face follow-up in patients with and without prior CAD

2019 EvidenceUpdates

4. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke

Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences (...) are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant

2019 EvidenceUpdates

5. Training for Walking Efficiency With a Wearable Hip-Assist Robot in Patients With Stroke: A Pilot Randomized Controlled Trial

Training for Walking Efficiency With a Wearable Hip-Assist Robot in Patients With Stroke: A Pilot Randomized Controlled Trial Background and Purpose- The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods- Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 (...) parameters (P<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (P<0.01). Conclusions- Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration

2019 EvidenceUpdates

6. A support programme for secondary prevention in patients with transient ischaemic attack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial

A support programme for secondary prevention in patients with transient ischaemic attack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial Patients with recent stroke or transient ischaemic attack are at high risk for a further vascular event, possibly leading to permanent disability or death. Although evidence-based treatments for secondary prevention are available, many patients do not achieve recommended behavioural modifications and pharmaceutical prevention targets (...) in the long-term. We aimed to investigate whether a support programme for enhanced secondary prevention can reduce the frequency of recurrent vascular events.INSPiRE-TMS was an open-label, multicentre, international randomised controlled trial done at seven German hospitals with acute stroke units and a Danish stroke centre. Patients with non-disabling stroke or transient ischaemic attack within 2 weeks from study enrolment and at least one modifiable risk factor (ie, arterial hypertension, diabetes

2019 EvidenceUpdates

7. Cilostazol Mono and Combination Treatments in Ischemic Stroke: An Updated Systematic Review and Meta-Analysis

Cilostazol Mono and Combination Treatments in Ischemic Stroke: An Updated Systematic Review and Meta-Analysis Background and Purpose- We performed a systematic review and meta-analysis to explore the efficacy and safety of cilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelet therapy (SAPT, mainly aspirin) for secondary stroke prevention. Methods- Randomized controlled trial studies were searched across multiple comprehensive (...) databases (MEDLINE, EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagic stroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and composite outcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recently published randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effects of mono versus combination

2019 EvidenceUpdates

8. Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis

Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis To meta-analyze and systematically review the effectiveness of aquatic therapy in improving mobility, balance, and functional independence after stroke.Articles published in Medline, Embase, CINAHL, PsycINFO, and Scopus up to 20 August 2019.Studies met the following inclusion criteria: (1) English, (2) adult stroke population

2019 EvidenceUpdates

9. A tool to identify patients with embolic stroke of undetermined source at high recurrence risk

A tool to identify patients with embolic stroke of undetermined source at high recurrence risk A tool to stratify the risk of stroke recurrence in patients with embolic stroke of undetermined source (ESUS) could be useful in research and clinical practice. We aimed to determine whether a score can be developed and externally validated for the identification of patients with ESUS at high risk for stroke recurrence.We pooled the data of all consecutive patients with ESUS from 11 prospective (...) stroke registries. We performed multivariable Cox regression analysis to identify predictors of stroke recurrence. Based on the coefficient of each covariate of the fitted multivariable model, we generated an integer-based point scoring system. We validated the score externally assessing its discrimination and calibration.In 3 registries (884 patients) that were used as the derivation cohort, age, leukoaraiosis, and multiterritorial infarct were identified as independent predictors of stroke

2019 EvidenceUpdates

10. Association Between Intravenous Thrombolysis and Anaphylaxis Among Medicare Beneficiaries With Acute Ischemic Stroke

Association Between Intravenous Thrombolysis and Anaphylaxis Among Medicare Beneficiaries With Acute Ischemic Stroke Background and Purpose- Allergic reactions, including anaphylaxis, can sometimes occur after intravenous thrombolysis in patients with acute ischemic stroke. However, it remains unclear whether patients with stroke who receive thrombolytic agents face a higher risk of anaphylaxis than those who do not receive thrombolytics. Methods- We performed a retrospective cohort study using (...) inpatient and outpatient claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included patients who were ≥65 years old and hospitalized with acute ischemic stroke, defined by validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Our exposure was treated with an intravenous thrombolytic agent during the index hospitalization (International Classification of Diseases, Ninth Revision, Clinical Modification

2019 EvidenceUpdates

11. Botulinum toxin A for the management of focal spasticity of the upper limbs associated with stroke in adults

Botulinum toxin A for the management of focal spasticity of the upper limbs associated with stroke in adults '); } else { document.write(' '); } ACE | Botulinum toxin A for the management of focal spasticity of the upper limbs associated with stroke in adults Search > > Botulinum toxin A for the management of focal spasticity of the upper limbs associated with stroke in adults - Botulinum toxin A for the management of focal spasticity of the upper limbs associated with stroke in adults First (...) published on 16 October 2017 Guidance Recommendation The Ministry of Health's Drug Advisory Committee has recommended: Clostridium botulinum toxin type A neurotoxin complex (Botox) 50 U and 100 U injection vials for the management of focal spasticity of the upper limbs associated with stroke in adults who: have a score of 2 or more on the Modified Ashworth Scale at the target muscle intended for botulinum toxin A treatment, do not have the affected joint permanently fixed in position due to fibrotic

2019 Appropriate Care Guides, Agency for Care Effectiveness (Singapore)

12. Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke

Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke To prospectively investigate the relationships between serum tissue inhibitor metalloproteinase-1 (TIMP-1) and clinical outcomes in patients with acute ischemic stroke.We derived data from the China Antihypertensive Trial in Acute Ischemic Stroke. Baseline serum TIMP-1 concentrations were measured in 3,342 participants. The primary outcome was the combination of death and major disability (modified Rankin (...) Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.A total of 843 participants (25.2%) experienced major disability or died within 3 months. After adjustment for age, sex, admission NIH Stroke Scale score, and other important covariates, odds ratios or hazard ratios (95% confidence intervals) of 1-SD (0.17 ng/mL) higher log-TIMP-1 were 1.17 (1.06-1.29) for the primary outcome, 1.13 (1.02-1.25) for major disability, 1.49

2019 EvidenceUpdates

13. Therapeutic-induced hypertension in patients with noncardioembolic acute stroke

Therapeutic-induced hypertension in patients with noncardioembolic acute stroke To evaluate the safety and efficacy of induced hypertension in patients with acute ischemic stroke.In this multicenter randomized clinical trial, patients with acute noncardioembolic ischemic stroke within 24 hours of onset who were ineligible for revascularization therapy and those with progressive stroke during hospitalization were randomly assigned (1:1) to the control and intervention groups. In the intervention (...) group, phenylephrine was administered intravenously to increase systolic blood pressure (SBP) up to 200 mm Hg. The primary efficacy endpoint was early neurologic improvement (reduction in NIH Stroke Scale [NIHSS] score of ≥2 points during the first 7 days). The secondary efficacy endpoint was a modified Rankin Scale score of 0 to 2 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage/edema, myocardial infarction, and death.In the modified intention-to-treat analyses, 76 and 77

2019 EvidenceUpdates

14. Postoperative Atrial Fibrillation Following Noncardiac Surgery Increases Risk of Stroke

Postoperative Atrial Fibrillation Following Noncardiac Surgery Increases Risk of Stroke New-onset postoperative atrial fibrillation is well recognized to be an adverse prognostic marker in patients undergoing noncardiac surgery. Whether postoperative atrial fibrillation confers an increased risk of stroke remains unclear.A systematic review and meta-analysis was performed to assess the risk of stroke after postoperative atrial fibrillation in noncardiac surgery. MEDLINE, Cochrane, and EMBASE (...) databases were searched for articles published up to May 2019 for studies of patients undergoing noncardiac surgery that reported incidence of new atrial fibrillation and stroke. Event rates from individual studies were pooled and risk ratios (RR) were pooled using a random-effects model.Fourteen studies of 3,536,291 patients undergoing noncardiac surgery were included in the quantitative analysis (mean follow-up 1.4 ± 1 year). New atrial fibrillation occurred in 26,046 (0.74%), patients with a higher

2019 EvidenceUpdates

15. Management of Stroke Rehabilitation

Management of Stroke Rehabilitation VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF STROKE REHABILITATION Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one (...) and/or therapeutic interventions within these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 4.0 – 2019VA/DoD Clinical Practice Guideline for the Management of Stroke Rehabilitation July 2019 Page 2 of 170 Prepared by: The Management of Stroke Rehabilitation Work Group With support from: The Office of Quality, Safety and Value, VA

2019 VA/DoD Clinical Practice Guidelines

16. Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack. (PubMed)

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack. Peroxisome proliferator-activated receptor gamma (PPAR-γ) agonists are insulin-sensitising drugs used for the treatment of insulin resistance. In addition to lowering glucose in diabetes, these drugs may also protect against hyperlipidaemia and arteriosclerosis, which are risk factors for stroke. This is an update of a review (...) first published in January 2014 and subsequently updated in December 2017.To assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular events for people with stroke or transient ischaemic attack (TIA).We searched the Cochrane Stroke Group Trials Register (30 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 7), MEDLINE (1949 to 30 July 2019), Embase (1980 to 30 July 2019), CINAHL (1982 to 30 July 2019), AMED (1985

2019 Cochrane

17. Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults. (PubMed)

Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults. To estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH).Matched cohort study.Population based, electronic primary healthcare databases before 31 December 2015 from four European countries: Italy (n=1 542 672), Netherlands (n=2 (...)  225 925), Spain (n=5 488 397), and UK (n=12 695 046).120 795 adults with a recorded diagnosis of NAFLD or NASH and no other liver diseases, matched at time of NAFLD diagnosis (index date) by age, sex, practice site, and visit, recorded at six months before or after the date of diagnosis, with up to 100 patients without NAFLD or NASH in the same database.Primary outcome was incident fatal or non-fatal AMI and ischaemic or unspecified stroke. Hazard ratios were estimated using Cox models and pooled

2019 BMJ

18. Interventions for preventing falls in people after stroke. (PubMed)

Interventions for preventing falls in people after stroke. Falls are one of the most common complications after stroke, with a reported incidence ranging between 7% in the first week and 73% in the first year post stroke. This is an updated version of the original Cochrane Review published in 2013.To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Our primary objective was to determine the effect of interventions on the rate of falls (number (...) of falls per person-year) and the number of fallers. Our secondary objectives were to determine the effects of interventions aimed at preventing falls on 1) the number of fall-related fractures; 2) the number of fall-related hospital admissions; 3) near-fall events; 4) economic evaluation; 5) quality of life; and 6) adverse effects of the interventions.We searched the trials registers of the Cochrane Stroke Group (September 2018) and the Cochrane Bone, Joint and Muscle Trauma Group (October 2018

2019 Cochrane

19. Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: A Review of Diagnostic Accuracy and Cost-Effectiveness

Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: A Review of Diagnostic Accuracy and Cost-Effectiveness Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: A Review of Diagnostic Accuracy and Cost-Effectiveness | CADTH.ca Find the information you need Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: A Review of Diagnostic Accuracy and Cost-Effectiveness Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: A Review of Diagnostic (...) Accuracy and Cost-Effectiveness Last updated: July 2, 2019 Project Number: RC1151-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What is the diagnostic accuracy of portable stroke diagnostic devices for adults with stroke symptoms? What is the cost-effectiveness of portable stroke diagnostic devices for adults with stroke symptoms? Key Message One relevant non-randomized study was identified regarding diagnostic accuracy

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

20. Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: Diagnostic Accuracy and Cost-Effectiveness

Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: Diagnostic Accuracy and Cost-Effectiveness Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: Diagnostic Accuracy and Cost-Effectiveness | CADTH.ca Find the information you need Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: Diagnostic Accuracy and Cost-Effectiveness Portable Stroke Diagnosis Devices for Adults with Stroke Symptoms: Diagnostic Accuracy and Cost-Effectiveness Last updated: June (...) 17, 2019 Project Number: RA1042-000 Product Line: Research Type: Devices and Systems Report Type: Reference List Result type: Report Question What is the diagnostic accuracy of portable stroke diagnostic devices for adults with stroke symptoms? What is the cost-effectiveness of portable stroke diagnostic devices for adults with stroke symptoms? Key Message One non-randomized study was identified regarding the diagnostic accuracy of portable stroke diagnostic devices for adults with stroke

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review