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Latest & greatest articles for stroke
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on stroke or other clinical topics then use Trip today.
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The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation-a randomized controlled trial Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a "Patient-Directed Activity Program" on functional outcomes in people post stroke during (...) inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge.Randomized control trial.Inpatient rehabilitation facility.Patients admitted to inpatient rehabilitation post stroke.Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day.Outcomes (Stroke Rehabilitation Assessment of Movement Measure
random code with an interactive web response system with stratification by site. Participants, investigators, the trial leadership, and all other personnel were masked to treatment allocation until the trial was completed and the database was locked. During the treatment period, participants in both groups were instructed to inject study drug on the same day at around the same time, each week. Strokes were categorised as fatal or non-fatal, and as either ischaemic, haemorrhagic, or undetermined (...) . Stroke severity was assessed using the modified Rankin scale. Participants were seen at 2 weeks, 3 months, 6 months, and then every 3 months for drug dispensing and every 6 months for detailed assessments, until 1200 confirmed primary outcomes accrued. The primary endpoint was the first occurrence of any component of the composite outcome, which comprised non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular or unknown causes. All analyses were done according to an intention
Effect of Intravenous Tenecteplase Dose on Cerebral Reperfusion Before Thrombectomy in Patients With Large Vessel OcclusionIschemicStroke: The EXTEND-IA TNK Part 2 Randomized Clinical Trial. Intravenous thrombolysis with tenecteplase improves reperfusion prior to endovascular thrombectomy for ischemicstroke compared with alteplase.To determine whether 0.40 mg/kg of tenecteplase safely improves reperfusion before endovascular thrombectomy vs 0.25 mg/kg of tenecteplase in patients with large (...) vessel occlusionischemic stroke.Randomized clinical trial at 27 hospitals in Australia and 1 in New Zealand using open-label treatment and blinded assessment of radiological and clinical outcomes. Patients were enrolled from December 2017 to July 2019 with follow-up until October 2019. Adult patients (N = 300) with ischemicstroke due to occlusion of the intracranial internal carotid, \basilar, or middle cerebral artery were included less than 4.5 hours after symptom onset using standard intravenous
the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemicstroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular (...) Management of acute ischemicstroke. Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemicstroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review
compared with women: odds ratio (OR) 1.50, 95% confidence interval (CI) 1.08 to 2.08, p=0.015 7 . SHTG Advice | 10 In a large population-based cohort study in Oxfordshire (OXVASC), consecutive patients with a first transientischaemicattack (TIA) or ischaemicstroke were followed up for a period of 10 years 14 . Of 2,555 patients with a first ischaemic event, 32% were classed as cryptogenic. Incidence of cryptogenic ischaemicstroke in the OXVASC cohort was 0.36 per 1,000 population per year (95% CI (...) stroke or TIA has been indicated on clinical assessment and brain imaging. ? There is no significant atrial fibrillation requiring oral anticoagulant therapy. ? A full investigation has failed to identify known risk factors/explanations for the ischaemicstroke or TIA, such as vascular disease or hypertension. ? The presence of a PFO with a clinically significant right-to-left shunt or atrial septal aneurysm has been confirmed using bubble contrast transthoracic echocardiography, including
Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke.A single-blind, randomized controlled trial.Four hospitals.Outpatients with chronic stroke and mild to moderate motor impairment (N=44).UHT combined unilateral RT (URT) and modified constraint-induced (...) therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks.Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after
A Comparison of Two LDL Cholesterol Targets after IschemicStroke. The use of intensive lipid-lowering therapy by means of statin medications is recommended after transientischemicattack (TIA) and ischemicstroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied.In this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemicstroke (...) in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemicstroke, myocardial infarction
to hospital for patients with a stroke mimic or transientischaemicattack (TIA) – this may include the rapid introduction of pre- hospital tele medicine, eg via apps such as GoodSam/Facetime. Work on the direct to CT pathway for patients with clear stroke symptoms and an onset time that makes them amenable to recanalisation therapy. Maintaining high standards of stroke care across the pathway Many facets of the stroke pathway are deemed important, but during this time of considerable pressure some (...) that should hold precedence: • early senior assessment on admission (<1 hour) – this may be face-to-face with PPE, but only one stroke specialist to consider, with secondary reviews done via video or telephone • early appropriate cerebral imaging (<1 hour) • rapid thrombolysis and referral for thrombectomy • early reversal of anticoagulation and management of raised BP in patients with intracerebral haemorrhage (<1 hour) • direct admission to stroke unit early swallow screen 3 | Clinical guide
Long term exposure to ambient fine particulate matter and incidence of stroke: prospective cohort study from the China-PAR project. To study the effect of long term exposure to ambient fine particulate matter of diameter ≤2.5 μm (PM2.5) on the incidence of total, ischemic, and hemorrhagic stroke among Chinese adults.Population based prospective cohort study.Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project carried out in 15 provinces across China.117 575 (...) Chinese men and women without stroke at baseline in the China-PAR project.Incidence of total, ischemic, and hemorrhagic stroke.The long term average PM2.5 level from 2000 to 2015 at participants' residential addresses was 64.9 μg/m3, ranging from 31.2 μg/m3 to 97.0 μg/m3. During 900 214 person years of follow-up, 3540 cases of incident stroke were identified, of which 63.0% (n=2230) were ischemic and 27.5% (n=973) were hemorrhagic. Compared with the first quarter of exposure to PM2.5 (<54.5 μg/m3
The Management of Stroke Rehabilitation: A Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. In June 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update of the joint clinical practice guideline for rehabilitation after stroke. This synopsis summarizes the key recommendations from this guideline.In February 2018, the VA/DoD Evidence-Based Practice Work Group convened a joint (...) VA/DoD guideline development effort that included clinical stakeholders and stroke survivors and conformed to the National Academy of Medicine (formerly the Institute of Medicine) tenets for trustworthy clinical practice guidelines. The guideline panel identified key questions, systematically searched and evaluated the literature, and developed 2 algorithms and 42 key recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Stroke survivors
artery revascularization and transfemoral carotid artery stenting for carotid artery stenosis, from September 2016 to April 2019. The final date for follow-up was May 29, 2019.Transcarotid artery revascularization vs transfemoral carotid artery stenting.Outcomes included a composite end point of in-hospital stroke or death, stroke, death, myocardial infarction, as well as ipsilateral stroke or death at 1 year. In-hospital stroke was defined as ipsilateral or contralateral, cortical or vertebrobasilar (...) , and ischemic or hemorrhagic stroke. Death was all-cause mortality.During the study period, 5251 patients underwent transcarotid artery revascularization and 6640 patients underwent transfemoral carotid artery stenting. After matching, 3286 pairs of patients who underwent transcarotid artery revascularization or transfemoral carotid artery stenting were identified (transcarotid approach: mean [SD] age, 71.7 [9.8] years; 35.7% women; transfemoral approach: mean [SD] age, 71.6 [9.3] years; 35.1% women
Brussel (control) with standard emergency care complemented with in-ambulance teleconsultation service by stroke experts (PreSSUB).The primary efficacy endpoint is the call-to-brain imaging time. Secondary endpoints for the efficacy analysis include the prevalence of medical events diagnosed and corrected during in-ambulance teleconsultation, the proportion of patients with ischemicstroke receiving recanalization therapy, the assessment of disability, functional status, quality of life and overall (...) 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
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
Cases in Precision Medicine: A Personalized Approach to Stroke and Cardiovascular Risk Assessment in Women. Cardiovascular disease is the leading cause of death among women in the United States, and stroke is third. This article uses a case scenario to examine female sex-specific cardiovascular risk factors across the lifespan and describes a precision medicine-based approach to risk factor modification and primary prevention. It also presents recent updates to the role of genetic testing (...) and polygenic risk scores for the prediction of stroke and cardiovascular disease.