Latest & greatest articles for stroke

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Top results for stroke

21. Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding

Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Signal - Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Dissemination Centre Discover Portal NIHR DC Discover Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Published on 14 (...) February 2018 People with peripheral arterial disease who took rivaroxaban plus aspirin daily over an average of 21 months reduced their risk of cardiovascular death, heart attack or stroke from seven to five in every 100 people treated compared with those given aspirin alone. The rivaroxaban plus aspirin group also reduced their risk of major limb problems or amputation but increased their risk of bleeding from one to two for every hundred people treated. Peripheral arterial disease is a condition

NIHR Dissemination Centre2018

22. Carers of stroke survivors voice an unmet need for practical and emotional support

Carers of stroke survivors voice an unmet need for practical and emotional support Signal - Carers of stroke survivors voice an unmet need for practical and emotional support Dissemination Centre Discover Portal NIHR DC Discover Carers of stroke survivors voice an unmet need for practical and emotional support Published on 22 August 2017 The carers of stroke survivors express a need to be recognised by hospital rehabilitation teams as partners in care. Carers emphasised that their deep (...) knowledge can contribute to joint decision making about the care of their spouse or family member. This research suggests that considering carers’ needs for support, information and training into care planning could ease the distress currently reported. This review describes how family, friends and spouses often felt emotionally overwhelmed, excluded from important discussions about the stroke survivor’s rehabilitation or unsupported in adapting to their caring role. The review included studies from ten

NIHR Dissemination Centre2018

23. Group rehabilitation activities improve walking after stroke

Group rehabilitation activities improve walking after stroke Signal - Group rehabilitation activities improve walking after stroke Dissemination Centre Discover Portal NIHR DC Discover Group rehabilitation activities improve walking after stroke Published on 12 September 2017 Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving (...) comparison interventions. CCT involves stroke survivors practising different activities at workstations in sight of each other. This Cochrane review identified 17 trials of group-based CCT, given at least weekly for four weeks, compared with other physical therapies or no intervention. Those receiving CCT showed clinically meaningful improvements in walking distance and speed, as well as independence and balance. Regular multidisciplinary team rehabilitation is a central component of post-stroke care

NIHR Dissemination Centre2018

24. Head position after acute stroke does not affect disability outcomes

Head position after acute stroke does not affect disability outcomes Signal - Head position after acute stroke does not affect disability outcomes Dissemination Centre Discover Portal NIHR DC Discover Head position after acute stroke does not affect disability outcomes Published on 3 October 2017 Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival (...) to 90 days, which was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position. The results of this large international randomised controlled trial are likely to be applicable to adults with different types of stroke in varied settings. As lying position did not affect outcomes, this suggests that clinicians can be guided by patients’ clinical condition

NIHR Dissemination Centre2018

25. Repetitive task training can help recovery after stroke

Repetitive task training can help recovery after stroke Signal - Repetitive task training can help recovery after stroke Dissemination Centre Discover Portal NIHR DC Discover Repetitive task training can help recovery after stroke Published on 25 April 2017 Following a stroke, people who received repetitive task training showed greater improvements in performing functional tasks, such as picking up a cup, standing up and walking. These improvements were sustained for up to six months (...) . Disability following stroke is common, affecting around half of all stroke survivors. This NIHR-funded review of over thirty trials found that repetitive task training provided small gains in arm and leg function, balance and walking distance (about 35 metres). We do not yet know the optimum number of sessions, or the ideal duration or intensity. However, it is a versatile and relatively easy intervention which can be delivered by physiotherapists/occupational therapists in groups, individually

NIHR Dissemination Centre2018

26. Better prescribing might prevent thousands of strokes in the UK

Better prescribing might prevent thousands of strokes in the UK Signal - Better prescribing might prevent thousands of strokes in the UK Dissemination Centre Discover Portal NIHR DC Discover Better prescribing might prevent thousands of strokes in the UK Published on 3 May 2017 One third of people who had a first stroke in the UK between 2009 and 2013 had known risk factors and were not taking the drugs that might have prevented their stroke. Electronic general practice records from almost (...) 30,000 people who had a stroke showed that about 60% had risk factors that meant they might have been eligible to take cholesterol-lowering, anti-clotting or blood pressure medication. But 54% of these people had no recent prescription for the appropriate drug(s). The researchers estimate that almost 12,000 strokes a year in the UK could be prevented if everyone eligible for preventive drugs took them. We don’t know the reasons why people weren’t prescribed these drugs. They might have had valid

NIHR Dissemination Centre2018

27. Intensive speech therapy helps stroke survivors with persistent communication difficulties

Intensive speech therapy helps stroke survivors with persistent communication difficulties Signal - Intensive speech therapy helps stroke survivors with persistent communication difficulties Dissemination Centre Discover Portal NIHR DC Discover Intensive speech therapy helps stroke survivors with persistent communication difficulties Published on 18 July 2017 Intensive speech and language therapy begun six months or more after a stroke improved verbal communication, language comprehension (...) and self-reported quality of life for those with persistent communication difficulties (chronic aphasia). The therapy in this trial consisted of around 30 hours over three weeks. Participants who received low-intensity therapy (around one hour per week) whilst on a waiting list did not improve during that time. NICE guidelines recommend speech and language therapy immediately after a stroke and if the person still experiences communication difficulties six months after their stroke, but do not specify

NIHR Dissemination Centre2018

28. Mechanical clot removal for stroke reduces disability at two years

Mechanical clot removal for stroke reduces disability at two years Signal - Mechanical clot removal for stroke reduces disability at two years Dissemination Centre Discover Portal NIHR DC Discover Mechanical clot removal for stroke reduces disability at two years Published on 1 August 2017 Timely mechanical removal of the blood clots from inside vessels in the brain after a stroke reduces disability and improves quality of life at two years compared with usual care. Over a third of those (...) awareness of early signs of stroke enables early medical attention. The procedure is currently planned for 24 specialist centres in England and will be available around the clock to facilitate urgent diagnosis and effective treatment. Share your views on the research. Why was this study needed? Stroke is the fourth leading cause of death in the UK and the leading cause of disability. There are over 100,000 strokes in the UK each year, costing the NHS in England around £1.7 billion. Eighty five per cent

NIHR Dissemination Centre2018

29. Surgical clot removal within seven hours of stroke improves function

Surgical clot removal within seven hours of stroke improves function Signal - Surgical clot removal within seven hours of stroke improves function Dissemination Centre Discover Portal NIHR DC Discover Surgical clot removal within seven hours of stroke improves function Published on 13 December 2016 For ischaemic stroke caused by a blood clot, early surgical clot removal alongside medical treatment improves functional outcomes at three months compared with medical treatment alone. Urgent stroke (...) treatment is known to improve outcomes. Endovascular thrombectomy is a relatively new technique to mechanically remove the clot, where this is possible. Uncertainty over the optimal timing of the procedure led to this review. This analysis of 1,287 patients in five trials found that endovascular thrombectomy improves outcomes only if performed within seven hours of initial stroke symptoms. The earlier that the clot was removed the better; the minimum “time to treatment” in the trials was 3 hours

NIHR Dissemination Centre2018

30. Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke

Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke Dissemination Centre Discover Portal NIHR DC Discover Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke Published on 27 March 2018 A combination of aspirin, clopidogrel and dipyridamole does not reduce the incidence or severity of recurrent stroke in people who have had a stroke (...) or transient ischaemic attack (TIA). This NIHR-funded trial compared the triple treatment to current guideline-based antiplatelet therapy for preventing further stroke or TIA (brief loss of blood supply to the brain). UK guidance recommends aspirin initially followed by clopidogrel alone as for most people this gives the best balance of effectiveness and bleeding risk. Dual therapy with aspirin and clopidogrel may be used for the first three months following ischaemic stroke or TIA in certain

NIHR Dissemination Centre2018

31. Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke

Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke Signal - Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke Dissemination Centre Discover Portal NIHR DC Discover Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke Published on 17 December 2015 Restoring blood flow to the brain within (...) a few hours of having a stroke improves a person’s chances of recovery. Early use of drugs to dissolve clots (thrombolysis) has been the mainstay of management in recent years and there has also been rapid development of devices to remove clots. Using evidence from trials published in the last five years, this review found mechanical removal of clots was more effective than thrombolysis alone whereas earlier research of older techniques had suggested that mechanical removal was no more effective

NIHR Dissemination Centre2018

32. Supported self-management improves quality of life and self-belief after stroke

Supported self-management improves quality of life and self-belief after stroke Signal - Supported self-management improves quality of life and self-belief after stroke Dissemination Centre Discover Portal NIHR DC Discover Supported self-management improves quality of life and self-belief after stroke Published on 1 November 2016 Training people to take an active role in managing the consequences of their stroke improves their quality of life. These self-management programmes are usually led (...) by health professionals. They cover a range of skills including problem solving, goal setting, and decision-making and provide advice about stroke. The improvement appears to act through “self-belief”. For example, promoting independence in people appeared to foster a greater belief in their own abilities. This Cochrane review pooled data from 14 trials comparing supported self-management with control interventions in people who had experienced a stroke one month to a year previously and lived

NIHR Dissemination Centre2018

33. Exercise therapy may still improve balance when started a long time after a stroke

Exercise therapy may still improve balance when started a long time after a stroke Signal - Exercise therapy may still improve balance when started a long time after a stroke Dissemination Centre Discover Portal NIHR DC Discover Exercise therapy may still improve balance when started a long time after a stroke Published on 15 November 2016 Exercise therapy may improve balance for people in the chronic phase of recovery six or more months after stroke. The most effective training regimens seem (...) to be those that focus on balance, weight shifting and gait training. Though significant, the improvements in function may still be small. Often little recovery can be expected beyond six months of stroke, and available treatments may be limited. This review found that exercise therapy in this population gave small improvements, generally in the scale of a few points on a scale of about 50, depending on the balance test used. This review included a large number of small trials, but most were high quality

NIHR Dissemination Centre2018

34. Mechanical clot removal may offer better outcomes for people with stroke

Mechanical clot removal may offer better outcomes for people with stroke Signal - Mechanical clot removal may offer better outcomes for people with stroke Dissemination Centre Discover Portal NIHR DC Discover Mechanical clot removal may offer better outcomes for people with stroke Published on 28 June 2016 Mechanical clot removal alongside standard clot-busting drug treatment may offer better functional outcomes for people who have suffered a stroke caused by a blood clot than drug treatment (...) is a highly skilled operation that should be performed within six to eight hours after the stroke. Patients would need early access to stroke units with the necessary diagnostics, technology and specialist expertise. Therefore a pragmatic NHS trial and cost-effectiveness analysis would be informative. Share your views on the research. Why was this study needed? Stroke is the UK’s third largest cause of death, after heart disease and cancer, and a major cause of adult disability. The health and social care

NIHR Dissemination Centre2018

35. Early aspirin reduces stroke recurrence following warning symptoms

Early aspirin reduces stroke recurrence following warning symptoms Signal - Early aspirin reduces stroke recurrence following warning symptoms Dissemination Centre Discover Portal NIHR DC Discover Early aspirin reduces stroke recurrence following warning symptoms Published on 7 July 2016 Aspirin taken as soon as possible after a stroke or symptoms of a stroke reduces the risk of further stroke within the next six weeks by about 60%. This is much better than the 13% reduction previously (...) estimated. People with warning strokes, where symptoms resolve within 24 hours, stand to benefit by self-administering aspirin even before a scan can be organised. This analysis of 12 large randomised controlled trials compared outcomes for adults taking aspirin, other drugs that prevent blood clots and no treatment. Aspirin importantly and significantly reduced the risk of early recurrent stroke in people with warning strokes and strokes perceived as less severe. The results support current

NIHR Dissemination Centre2018

36. Lowering blood pressure reduces the risk of heart disease, stroke and death

Lowering blood pressure reduces the risk of heart disease, stroke and death Signal - Lowering blood pressure reduces the risk of heart disease, stroke and death Dissemination Centre Discover Portal NIHR DC Discover Lowering blood pressure reduces the risk of heart disease, stroke and death Published on 23 February 2016 This meta-analysis showed that a 10 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular disease events by 20%, coronary heart disease by 17 (...) %, stroke by 27%, heart failure by 28%, and death from all causes by 13%. This study strongly supports offering drug treatments to reduce systolic blood pressure levels to less than 130 mm Hg to all people regardless of whether or not they have a history of cardiovascular disease, diabetes or chronic kidney disease. This evidence is likely to be considered by guideline developers. Share your views on the research. Why was this study needed? High blood pressure is one of the biggest risk factors

NIHR Dissemination Centre2018

37. Two antiplatelet drugs may prevent further strokes but increase major bleeds

Two antiplatelet drugs may prevent further strokes but increase major bleeds Two antiplatelet drugs may prevent further strokes but increase major bleeds Dissemination Centre Discover Portal NIHR DC Discover Two antiplatelet drugs may prevent further strokes but increase major bleeds Published on 2 October 2018 doi: People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone (...) . However, taking both drugs doubles the risk of bleeding over the same period. Current UK guidelines recommend using clopidogrel alone. In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the first 30 days of treatment. Major bleeding risk was fairly constant on combined treatment throughout 90 days, occurring in 0.9% compared with 0.4% on aspirin. This study provides more

NIHR Dissemination Centre2018

39. Ischaemic stroke

Ischaemic stroke Ischaemic stroke - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Ischaemic stroke Last reviewed: September 2018 Last updated: October 2018 Summary A leading cause of morbidity and mortality. Approximately 85% of strokes are ischaemic, caused by vascular occlusion. A clinical emergency: timely diagnosis, triage, and intervention can improve outcome. Care of patients in dedicated stroke units improves (...) survival and function. Intravenous recombinant tissue plasminogen activator is given within 4.5 hours of stroke onset. Endovascular interventions, such as clot retrieval devices or intra-arterial thrombolysis, can be used in carefully selected patients within 6 hours of ischaemic stroke onset. Definition Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology. It is further subdivided into ischaemic stroke (caused by vascular occlusion

BMJ Best Practice2018

40. Very early versus delayed mobilisation after stroke.

Very early versus delayed mobilisation after stroke. BACKGROUND: Very early mobilisation (VEM) is performed in some stroke units and recommended in some acute stroke clinical guidelines. However, it is unclear whether very early mobilisation independently improves outcome after stroke. OBJECTIVES: To determine whether very early mobilisation (started as soon as possible, and no later than 48 hours after onset of symptoms) in people with acute stroke improves recovery (primarily the proportion (...) of independent survivors) compared with usual care. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched 31 July 2017). We also systematically searched 19 electronic databases including; CENTRAL; 2017, Issue 7 in the Cochrane Library (searched July 2017), MEDLINE Ovid (1950 to August 2017), Embase Ovid (1980 to August 2017), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to August 2017) , PsycINFO Ovid (1806 to August 2017), AMED Ovid (Allied

Cochrane2018