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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The supportive education of stroke survivors and their carers has been identified as a key area of interest to rehabilitation nurses. The Audit Commission recommends the widespread use of stroke units within the NHS (Audit Commission, 2000). The aim of this review is to determine the authority of available evidence and to discuss how such evidence might influence practice. The literature tended to assume that education had a positive effect on the outcome of rehabilitation. Various education interventions were attempted, including information-giving through the use of written material as well as more supportive and facilitative approaches. Factors that may affect the ability to learn or absorb information were identified and attempts have been made to evaluate the effect of educational interventions.
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PMID:Stroke rehabilitation: benefits of educational initiatives. 1227 Nov 84

This article describes a nursing protocol for patients treated with thrombolysis for acute ischaemic stroke developed during the Stroke Association phase of the Third International Stroke Trial (IST-3), a randomized controlled trail of recombinant tissue plasminogen activator for acute ischaemic stroke. The IST-3 nurse collaborative group met three times over 3 years. The meetings consisted of educational updates on stroke thrombolysis, training on trial procedures, presentations by participating nurses and discussions of good practice, local initiatives and sharing common problems. Lack of knowledge, fear of bleeding complications and lack of appropriate NHS beds were common barriers. Core nursing requirements suggested by this research included: fast tracking of patients; access to trained stroke physicians; acute physiological monitoring and nursing intervention; effective communication and support of patients and carers; knowledge of complication and actions to be taken; transfer to an appropriately skilled stroke unit environment and successful discharge planning to home or rehabilitation.
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PMID:Thrombolysis for acute ischaemic stroke: core nursing requirements. 1274 88

Studies on stroke subjects that aim to improve their well-being or community support have not been shown to be effective when measures of disability and handicap have been employed. This paper illustrates the usefulness of the Subjective Index of Physical and Social Outcome (SIPSO) with young adults following a stroke. The study comprised a cross-sectional survey of people (57% male; 39% female; median age 55.7) with a stroke (1-10 years ago), aged 18-65, recruited via NHS stroke registers and young stroke groups (response rate 53%). The SIPSO was incorporated into a postal needs-assessment questionnaire. Median SIPSO score: 24.5 (IQR 17-32). The SIPSO internal reliability: ICC 0.91 (95% CI, 0.90-0.92), item to total SIPSO correlations ranged from 0.52-0.83. The SIPSO construct validity was good: those with poorer employment, mobility and sex-life outcomes had lower SIPSO scores than those with better outcomes; there was no association between age and SIPSO scores, SIPSO scores were not significantly different for men and women. Test-retest reliability was good. The SIPSO had excellent reliability and validity properties in his population. Further work on its responsiveness needs to be carried out. The measurement of personal experience of integration can be a vital basis for effective clinical care.
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PMID:The Subjective Index of Physical and Social Outcome: its usefulness in a younger stroke population. 1509 71

Incontinence is common following stroke, but there is little stroke-specific evidence to guide treatment and interventions for this condition. National clinical guidelines for stroke specify that all wards should have management protocols for urinary incontinence and yet, according to the recent Sentinel Stroke Audit result, many wards do not have this information available. This article describes the implementation of guidelines on a stroke unit within an NHS associate teaching hospital and describes the impact on patient care using clinical audit. The results indicate that patient care and outcome is improved following implementation. Recommendations are being made for information sharing and further research.
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PMID:The use of practice guidelines for urinary incontinence following stroke. 1558 84

Stroke is a major cause of death and disability. About 5.3 million people die every year from stroke worldwide with over 9 million people surviving at any one time after suffering a stroke. About 1 in 4 men and 1 in 5 women aged 45 years will suffer a stroke if they live to their 85th year. It is estimated that by 2023 there will be an absolute increase in the number of people experiencing a first ever stroke of about 30% compared with 1983. In the UK, stroke is the third commonest cause of death and the most common cause of adult physical disability and consumes 5% of the health and social services budget. Stroke is assuming strategic public health importance because of increased awareness in society, an ageing population and emerging new treatments. It is an NHS health service and research priority, being identified as a target in Our Healthier Nation and the NSF for Older People for prevention and risk factor control and in the NHS Plan as a disease requiring intermediate care planning and reduction in inequalities of care. Whilst a number of risk factors for stroke are well known (e.g. increasing age, ethnicity, socioeconomic deprivation, hypertension), the potential importance of outdoor air pollution as a modifiable risk factor is much less well recognised. This is because studies to date are inconclusive or have methodological limitations. In Sheffield, we estimated that 11% of stroke deaths may be linked to current levels of outdoor air pollution and this high figure is explained by the fact that so many people are exposed to air pollution.We plan to study the effects of outdoor air pollution on stroke using a series of epidemiological (i.e. population based) studies. The purpose of this project is: to examine if short term increases in pollution can trigger a stroke in susceptible individuals, to investigate if the occurrence of stroke is higher amongst people living in more polluted areas (which would be explained by a combination of exposure to short term increases and longer term exposure to higher pollution levels), and to see if people living in more polluted areas have reduced survival following their stroke. We will use geographical information systems, robust statistical methods and powerful grid computing facilities to link and analyse the data. The datasets we will use are the South London Stroke Register database, daily monitored pollution data from national monitoring networks and modelled pollution data for London from the Greater London Authority. The South London Stroke Register records information on all patients who suffer a stroke ("incident" cases) living within a defined area. This stroke incidence dataset offers major advantages over previous studies examining the effects of pollution on hospital admissions and mortality, as not all patients with stroke are admitted or die and there may be a delay between the onset of stroke and admission or death. In addition, it contains other useful information, particularly the type of stroke people have suffered. Air pollution is a potentially modifiable risk factor for stroke. This study will provide robust population level evidence regarding the effects of outdoor air pollution on stroke. If it confirms the link, it will suggest to policy-makers at national and international levels that targeting policy interventions at high pollution areas may be a feasible option for stroke prevention.
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PMID:A protocol for investigation of the effects of outdoor air pollution on stroke incidence, phenotypes and survival using the South London Stroke Register. 1654 33

The National Audit Office (NAO, 2005) has reported that the priority afforded to stroke care should be increased, given its impact on health and cost to the NHS. It recommends improvements in preventing, treating and managing stroke patients in line with recent evidence. Thrombolysis for acute ischaemic stroke is a proven treatment that produces good results in significant numbers of patients (Mar et al, 2005). However, owing to various barriers, many hospitals in the UK have failed to implement effective systems to facilitate the delivery of this treatment to acute stroke patients. These barriers include a lack of skill, nursing knowledge, and 'fast-track' organization relating to thrombolysis as a treatment for acute stroke. Fears of intracranial bleeding and lack of appropriate stroke unit beds and issues of consent have also been identified as further problems (Innes and International Stroke Trial (IST-3), 2003). Taking these concerns into consideration, Scarborough District General Hospital has developed a multidisciplinary model with the Coronary Care Unit (CCU), integral to the delivery of treatment. Between 2003 and 2005, 24 stroke patients have received thrombolysis treatment and have been cared for in CCU. Outcome results have been positive, with 51% of patients demonstrating a significant benefit at 7 days post-stroke. This model has broken traditional professional and speciality boundaries to allow patients to receive treatments they otherwise would not have received. Moreover, it provides the potential for further exploration into the wider implementation of thrombolysis for acute stroke patients in the UK.
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PMID:Evolution of a model for the thrombolysis of acute stroke patients. 1672 52

A retrospective cohort study was carried out of new referrals to transient ischaemic attack (TIA) clinics in Glasgow. The aims of the study were to describe the profile of referrals and to assess the odds ratios for TIA, minor stroke or amaurosis fugax of both cardiovascular risk factors and clinical features. In total, data were collected for 813 new referrals in a period of six months. Thirteen point eight percent of referrals were from other Health Boards. The overall referral rate among residents of Greater Glasgow NHS Board was 165.6 per 100,000 per year. About 20% of referrals were made by clinicians in secondary care. The specialties from which referrals were most commonly made were accident and emergency, general medicine, ophthalmology and geriatric assessment. The most common risk factors in patients referred were hypertension (52.9%), smoking (31.7%), ischaemic heart disease (22.7%) and former smokers (22.4%). The most common clinical features were hemiparesis (13.3%), weakness of an upper limb (8.7%), vertigo (7.9%) and dysphasia (7.3%). In 48.7% of cases, a non-cerebrovascular diagnosis was made. Separate multivariate models were established for risk factors and clinical features. In the model for risk factors, five factors were significant for risk of TIA, stroke or amaurosis fugax. These were hyperlipidaemia, age over 64 years, hypertension, smoking and ex-smoking. In the model for clinical features, five factors were also significant. These were visual field defect, speech defact, facial weakness and hemiparesis.
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PMID:Epidemiological aspects of referral to TIA clinics in Glasgow. 1737 16

Human protein C (PC) is a natural anticoagulant, antithrombotic, anti-inflammatory, and anti-apoptotic in the bloodstream. PC deficiency can lead to abnormal blood clot formation inside blood vessels, possibly causing heart attack, stroke, skin necrosis, or even death. PC can be, therefore, a valuable therapeutic with little side effect, unlike the currently used anti-coagulants. To reduce the cost involved in immuno purification of PC from blood plasma, single chain variable fragments (mini-Mab) are being produced by recombinant E. coli using phagemid technique. As an economic means of purifying the PC specific mini-Mab, metal affinity chromatography (IMAC) purification process was also investigated. Then using the purified mini-Mab, the feasibility of PC purification from the Cohn Fraction IV-1 was examined. Cohn Fraction IV-1 is usually a discarded side-stream from the blood plasma fractionation of human serum albumin. It holds 90% of PC in plasma, but is very cheap. Preliminary study of PC purification from the Cohn Fraction IV-1 showed 16% purification yield using mini-Mab immobilized NHS-activated Sepharose. The economic analysis for PC purification using mini-Mab showed that the overall process was found to be tens of times cheaper than that using Mab.
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PMID:Separation of protein C from Cohn Fraction IV-1 by mini-antibody. 1772 56

Atrial fibrillation (AF) is the most common sustained tachyarrhythmia and its prevalence is increasing. It is an independent risk factor for stroke and is associated with significant morbidity and mortality. AF currently accounts for 1% of NHS expenditure. The management of AF has a broad evidence base and both the American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) and the National Institute for Clinical Excellence (NICE) have recently published guidelines. Some controversy persists regarding stroke risk stratification and appropriate anticoagulation regimes although a general consensus is now emerging. Rate and rhythm control strategies have been shown to be comparable in terms of clinical outcomes. Current anti-arrhythmic drugs have limited efficacy and significant side-effect profiles. Electrophysiological and surgical interventions have a role in both strategies. This article broadly reviews the evidence for different management strategies in AF and presents a practical approach to treatment in light of the recently published national and international guidelines.
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PMID:Key issues in the management of atrial fibrillation--protecting the patient and controlling the arrhythmia. 1787 12

This article reports on the project management and Culture Change Programme adopted by the NHS Greater Glasgow Health Board to deliver an electronic patient record (EPR) to support cardiology and stroke clinical services. To achieve its vision for the EPR (;to "really make a difference" to patient care by providing to the right person, the right information, under the right safeguards') the Board recognized that attending to social and organizational issues is at least of equal importance to addressing strictly technical concerns. Consequently, an ICT Culture Change Programme (ICT CCP) was devised and implemented to assist in the management of change, and in particular to facilitate a visionary clinical and cultural environment operating in conjunction with the evolving technical environment. In this article we describe the key components of this approach, outline the benefits we believe have accrued, and describe the steps being taken to build upon lessons learned.
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PMID:Deploying a culture change programme management approach in support of information and communication technology developments in Greater Glasgow NHS Board. 1847 99


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