Latest & greatest articles for stroke

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Top results for stroke

141. 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

142. 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

143. 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

144. 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

145. 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

146. 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

147. 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

148. 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

149. 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

150. 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 NIHR DC | Signal - Carers of stroke survivors voice an unmet need for practical and emotional support Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

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

Mechanical clot removal for stroke reduces disability at two years NIHR DC | Signal - Mechanical clot removal for stroke reduces disability at two years Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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 (...) be delivered promptly. Public 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. 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

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

Intensive speech therapy helps stroke survivors with persistent communication difficulties NIHR DC | Signal - Intensive speech therapy helps stroke survivors with persistent communication difficulties Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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

NIHR Dissemination Centre2018

153. Adding a third antiplatelet drug after a stroke increases harms but not benefits

Adding a third antiplatelet drug after a stroke increases harms but not benefits NIHR DC | Signal - Adding a third antiplatelet drug after a stroke increases harms but not benefits Dissemination Centre Discover Portal NIHR DC Discover Adding a third antiplatelet drug after a stroke increases harms but not benefits Published on 27 March 2018 A combination of aspirin, clopidogrel and dipyridamole increases the risk of major bleeding. Taking all three drugs at the same time 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

NIHR Dissemination Centre2018

154. Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Stroke Search for this keyword Search Search (...) for this keyword Search Header Publisher Menu AHA/ASA Systematic Review Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Eric E. Smith , David M. Kent , Ketan R. Bulsara , Lester Y. Leung , Judith H. Lichtman , Mathew J. Reeves , Amytis Towfighi , William N. Whiteley , Darin B. Zahuranec and on behalf of the American Heart Association Stroke

American Heart Association2018

155. Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke | Stroke Search for this keyword Search Search for this keyword Search Header Publisher Menu AHA/ASA Systematic Review Effect (...) of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Eric E. Smith , David M. Kent , Ketan R. Bulsara , Lester Y. Leung , Judith H. Lichtman , Mathew J. Reeves , Amytis Towfighi , William N. Whiteley , Darin B. Zahuranec and on behalf of the American Heart Association Stroke Council https://doi.org/10.1161/STR.0000000000000159 Stroke. 2018; 49: e123-e128 Originally published January

American Heart Association2018

156. Effect on Risk of Stroke and Acute Myocardial Infarction of Nonselective Nonsteroidal Anti-Inflammatory Drugs in Patients With Rheumatoid Arthritis

Effect on Risk of Stroke and Acute Myocardial Infarction of Nonselective Nonsteroidal Anti-Inflammatory Drugs in Patients With Rheumatoid Arthritis 29548675 2018 03 17 1879-1913 2018 Feb 12 The American journal of cardiology Am. J. Cardiol. Effect on Risk of Stroke and Acute Myocardial Infarction of Nonselective Nonsteroidal Anti-Inflammatory Drugs in Patients With Rheumatoid Arthritis. S0002-9149(18)30189-9 10.1016/j.amjcard.2018.01.044 There are still debates on the association of increased (...) cardiovascular risk with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA) because of inconsistent results. Therefore, our study aims to evaluate the transient effects of selective and nonselective NSAIDs on the risk of stroke and acute myocardial infarction (AMI) in patients with RA. We conducted a case-crossover study of 5,921 stroke or AMI patients with co-morbidity of RA. All cases were identified from the Taiwan National Health Insurance Database between

EvidenceUpdates2018

157. Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation

Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation 29579168 2018 03 26 1522-9645 2018 Mar 20 European heart journal Eur. Heart J. Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation. 10.1093/eurheartj/ehy176 It is recommended to perform atrial fibrillation ablation with continuous anticoagulation. Continuous apixaban has not been tested. We compared continuous apixaban (5 mg b.i.d.) to vitamin K antagonists (VKA (...) , international normalized ratio 2-3) in atrial fibrillation patients at risk of stroke a prospective, open, multi-centre study with blinded outcome assessment. Primary outcome was a composite of death, stroke, or bleeding (Bleeding Academic Research Consortium 2-5). A high-resolution brain magnetic resonance imaging (MRI) sub-study quantified acute brain lesions. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at baseline and at end of follow-up. Overall, 674 patients (median age 64 years, 33% female

EvidenceUpdates2018

158. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials

Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials 29590333 2018 03 28 1522-9645 2018 Mar 24 European heart journal Eur. Heart J. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials. 10.1093/eurheartj/ehy121 The efficacy of patent foramen ovale (PFO) closure for cryptogenic stroke has been controversial. We undertook a meta-analysis of randomized controlled (...) trials (RCTs) comparing device closure with medical therapy to prevent recurrent stroke for patients with PFO. We systematically identified all RCTs comparing device closure to medical therapy for cryptogenic stroke in patients with PFO. The primary efficacy endpoint was recurrent stroke, analysed on an intention-to-treat basis. The primary safety endpoint was new onset atrial fibrillation (AF). Five studies (3440 patients) were included. In all, 1829 patients were randomized to device closure

EvidenceUpdates2018

159. CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials

CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials 29523641 2018 04 03 1526-632X 90 14 2018 Apr 03 Neurology Neurology CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials. e1222-e1230 10.1212/WNL.0000000000005262 To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effectiveness of continuous positive airway pressure (CPAP) in stroke patients with sleep disordered breathing (SDB (...) ). In a systematic literature search of electronic databases (MEDLINE, Embase, and the Cochrane Library) from 1980 to November 2016, we identified RCTs that assessed CPAP compared to standard care or sham CPAP in adult patients with stroke or TIA with SDB. Mean CPAP use, odds ratios (ORs), and standardized mean differences (SMDs) were calculated. The prespecified outcomes were adherence to CPAP, neurologic improvement, adverse events, new vascular events, and death. Ten RCTs (564 participants) with CPAP as

EvidenceUpdates2018

160. Validating the TeleStroke Mimic Score: A Prediction Rule for Identifying Stroke Mimics Evaluated Over Telestroke Networks

Validating the TeleStroke Mimic Score: A Prediction Rule for Identifying Stroke Mimics Evaluated Over Telestroke Networks 29374105 2018 03 15 2018 03 15 1524-4628 49 3 2018 03 Stroke Stroke Validating the TeleStroke Mimic Score: A Prediction Rule for Identifying Stroke Mimics Evaluated Over Telestroke Networks. 688-692 10.1161/STROKEAHA.117.018758 Up to 30% of acute stroke evaluations are deemed stroke mimics, and these are common in telestroke as well. We recently published a risk prediction (...) score for use during telestroke encounters to differentiate stroke mimics from ischemic cerebrovascular disease derived and validated in the Partners TeleStroke Network. Using data from 3 distinct US and European telestroke networks, we sought to externally validate the TeleStroke Mimic (TM) score in a broader population. We evaluated the TM score in 1930 telestroke consults from the University of Utah, Georgia Regents University, and the German TeleMedical Project for Integrative Stroke Care

EvidenceUpdates2018