Latest & greatest articles for stroke

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Top results for stroke

121. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke.

Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. BACKGROUND: Intravenous infusion of alteplase is used for thrombolysis before endovascular thrombectomy for ischemic stroke. Tenecteplase, which is more fibrin-specific and has longer activity than alteplase, is given as a bolus and may increase the incidence of vascular reperfusion. METHODS: We randomly assigned patients with ischemic stroke who had occlusion of the internal carotid, basilar, or middle cerebral artery (...) patients with ischemic stroke treated within 4.5 hours after symptom onset. (Funded by the National Health and Medical Research Council of Australia and others; EXTEND-IA TNK ClinicalTrials.gov number, NCT02388061 .).

NEJM2018

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

Surgical clot removal within seven hours of stroke improves function NIHR DC | Signal - Surgical clot removal within seven hours of stroke improves function Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

123. 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 NIHR DC | Signal - Exercise therapy may still improve balance when started a long time after a stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

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

Supported self-management improves quality of life and self-belief after stroke NIHR DC | Signal - Supported self-management improves quality of life and self-belief after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

125. Repetitive task training can help recovery after stroke

Repetitive task training can help recovery after stroke NIHR DC | Signal - Repetitive task training can help recovery after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

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

Better prescribing might prevent thousands of strokes in the UK NIHR DC | Signal - Better prescribing might prevent thousands of strokes in the UK Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

127. Early aspirin reduces stroke recurrence following warning symptoms

Early aspirin reduces stroke recurrence following warning symptoms NIHR DC | Signal - Early aspirin reduces stroke recurrence following warning symptoms Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

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

Mechanical clot removal may offer better outcomes for people with stroke NIHR DC | Signal - Mechanical clot removal may offer better outcomes for people with stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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 (...) . Mechanical clot removal 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. 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 costs

NIHR Dissemination Centre2018

129. Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical importance is uncertain

Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical importance is uncertain NIHR DC | Signal - Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical importance is uncertain Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical (...) importance is uncertain Published on 5 November 2015 This systematic review and meta-analysis found that electrical stimulation produced a small, but statistically significant improvement, in tight muscles (spasticity) for people recovering from stroke. The clinical importance of the improvement is uncertain. For example, electrical stimulation improved joint flexibility by an average of 2.87 degrees and spasticity improved by 0.3 on a 5 point scale. Stimulation was only found to work when used alongside

NIHR Dissemination Centre2018

130. Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke

Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke NIHR DC | Signal - Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke Published on 1 December 2015 This NIHR-funded trial found that using intermittent pneumatic compression sleeves around the legs was effective (...) in preventing deep vein thrombosis in immobile people after a stroke. When used on people admitted within three days of an acute stroke, this technique was inexpensive and also appeared to improve survival at six months. The results of this study were used in the 2015 update to the 2010 NICE guideline about the care and treatment of people who are at risk of developing deep vein thrombosis while in hospital. Healthcare staff working in UK stroke units may require training in the use of intermittent

NIHR Dissemination Centre2018

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

Lowering blood pressure reduces the risk of heart disease, stroke and death NIHR DC | Signal - Lowering blood pressure reduces the risk of heart disease, stroke and death Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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. Why was this study needed? High blood pressure is one of the biggest risk factors for premature death

NIHR Dissemination Centre2018

132. 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 NIHR DC | 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 NIHR Signal 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

NIHR Dissemination Centre2018

133. Very early mobilisation following a stroke is no better than usual care

Very early mobilisation following a stroke is no better than usual care NIHR DC | Signal - Very early mobilisation following a stroke is no better than usual care Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Very early mobilisation following a stroke is no better than usual care Published on 22 April 2015 The AVERT trial found very early mobilisation - such as out-of-bed sitting, standing and walking - within 24 hours of stroke onset and at increased intensity, led to 4 (...) day after a stroke. Why was this study needed? Stroke is the fourth largest cause of death in the UK and the largest cause of complex disability. Each year in England, approximately 110,000 people have a first or recurrent stroke. More than 900,000 people in England are living with the effects of stroke, with half of these being dependent on other people for help with everyday activities. Early mobilisation – including sitting out-of-bed, standing and walking – is thought to improve outcomes after

NIHR Dissemination Centre2018

134. Self-management support for stroke survivors may improve independence

Self-management support for stroke survivors may improve independence NIHR DC | Signal - Self-management support for stroke survivors may improve independence Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Self-management support for stroke survivors may improve independence Published on 19 October 2015 This NIHR-funded summary of systematic reviews looked at the evidence on self-management support for stroke survivors. It found that the term self-management was rarely used (...) in the literature. There was high quality evidence that therapy-based rehabilitation, some of it including components supporting self-management, had a beneficial effect on the basic activities of daily living, such as feeding, bathing and dressing and extended activities, such as shopping. Self-management support is a less well established aspect of care for people after stroke, in contrast to its established role for other long-term conditions like diabetes. These researchers looked in detail

NIHR Dissemination Centre2018

135. Occupational therapy several years after stroke does not improve function in severely ill care home residents

Occupational therapy several years after stroke does not improve function in severely ill care home residents NIHR DC | Signal - Occupational therapy several years after stroke does not improve function in severely ill care home residents Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Occupational therapy several years after stroke does not improve function in severely ill care home residents Published on 21 August 2015 This trial found that a three-month individualised (...) occupational therapy programme did not significantly improve the daily functioning (dressing, using the toilet and overall mobility) of severely physically and cognitively impaired people living in residential care who had a stroke on average three years before. About a quarter of stroke survivors in the UK cannot return home and need residential care. Occupational therapy is recommended immediately after a stroke for those likely to benefit. As occupational therapy did not help this severely disabled

NIHR Dissemination Centre2018

136. Centralising stroke services improves chances of patients getting the right care

Centralising stroke services improves chances of patients getting the right care NIHR DC | Signal - Centralising stroke services improves chances of patients getting the right care Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Centralising stroke services improves chances of patients getting the right care Published on 2 September 2015 This study of two models of organising stroke care showed that fully centralised services were more likely to deliver clinically effective (...) treatments. This NIHR-funded study looked at stroke care audit data before and after introducing two different models of centralised stroke services in London and Manchester. The audit recorded the proportion of stroke patients in each location who received each of seven effective care interventions, such as brain scans or clot-busting drugs within the recommended time. This study is one output from a large NIHR programme of research on the effects of stroke reconfiguration in London and Manchester

NIHR Dissemination Centre2018

137. 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 NIHR DC | 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

NIHR Dissemination Centre2018

138. Giving oxygen routinely after a stroke does not improve outcomes

Giving oxygen routinely after a stroke does not improve outcomes NIHR DC | Signal - Giving oxygen routinely after a stroke does not improve outcomes Dissemination Centre Discover Portal NIHR DC Discover Giving oxygen routinely after a stroke does not improve outcomes Published on 3 January 2018 There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability (...) to do everyday tasks or live independently. There were no oxygen-related adverse events reported. Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Therefore, giving oxygen to reduce the potential damage may appear to make sense. Guidelines from NICE and the British Thoracic Society recommend that people are not routinely given oxygen after a stroke unless

NIHR Dissemination Centre2018

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

Head position after acute stroke does not affect disability outcomes NIHR DC | Signal - Head position after acute stroke does not affect disability outcomes Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

140. Group rehabilitation activities improve walking after stroke

Group rehabilitation activities improve walking after stroke NIHR DC | Signal - Group rehabilitation activities improve walking after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018