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Latest & greatest articles for stroke
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Anticoagulation for stroke prevention in chronic non-valvular atrial fibrillation Anticoagulation for stroke prevention in chronic non-valvular atrial fibrillation Anticoagulation for stroke prevention in chronic non-valvular atrial fibrillation Green C J, Hadorn D, Kazanjian A Authors' objectives To assess the evidence concerning the outcomes associated with efforts to prevent the occurrence of stroke in patients with chronic non-valvular atrial fibrillation using warfarin sodium. Searching (...) MEDLINE was searched from 1987 to 1994 using the keywords: 'atrial fibrillation', 'anticoagulants', 'aspirin'). Reference lists of retrieved articles were sought. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) on the efficacy of warfarin sodium in the primary prevention of stroke in chronic non-valvular atrial fibrillation were included. Specific interventions included in the review The specific intervention was anticoagulation, i.e. warfarin
Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation Gage B, Cardinalli A, Albers G, Owens D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion (...) on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Warfarin sodium, for the prevention of stroke in patients who have nonvalvular atrial fibrillation (NVAF), with or without additional stroke risk factors. Type of intervention Primary prevention and secondary prevention. Economic study type Cost-effectiveness analysis. Study population
Acute and subacute rehabilitation for stroke: a comparison Acute and subacute rehabilitation for stroke: a comparison Acute and subacute rehabilitation for stroke: a comparison Keith R A, Wilson D B, Gutierrez P Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study (...) and the conclusions drawn. Health technology The comparative merits of acute and subacute rehabilitation for stroke. Type of intervention Rehabilitation. Economic study type Cost-effectiveness analysis. Study population Patients with left or right hemiplegia, discharged from the acute and subacute facilities and who had admission and discharge Functional Impairment Measures (FIM) ratings. Setting Hospital and skilled nursing unit. The economic study was carried out in the USA. Dates to which data relate
in the evaluation of patients with recent stroke. Chest 1995; 107(4): 916-918 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Aged; Arrhythmias, Cardiac /complications /diagnosis; Cerebrovascular Disorders /complications /therapy; Cost-Benefit Analysis; Electrocardiography, Ambulatory /economics; Female; Humans; Male; Middle Aged; Prospective Studies AccessionNumber 21995000533 Date bibliographic record published 21/02/1997 Date abstract record published 21/02/1997 NHS Economic Evaluation (...) Is ambulatory electrocardiography useful in the evaluation of patients with recent stroke Is ambulatory electrocardiography useful in the evaluation of patients with recent stroke Is ambulatory electrocardiography useful in the evaluation of patients with recent stroke Kessler D K, Kessler K M Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions
and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Day hospital facility (geriatric team). Type of intervention Rehabilitation. Economic study type cost-effectiveness analysis Study population Patients, 65 years of age and over, with a clinical diagnosis of cerebrovascularaccident, without previous history of stroke or dementia and with a Barthel Index score less than 20. Setting District general hospital. The study (...) hundred and twenty elderly patients with the clinical diagnosis of cerebrovascularaccident were randomised to inpatient care on a stroke ward under the care of either a neurologist (conventional, n=61) or a geriatric team (GDH, n=59). At baseline, fifty patients in the conventional and 49 patients in the GDH groups had a functional improvement Barthel Index (BI) score of <= 15, whilst 11 and 10 patients had a BI score between 16 to 19. Study design Randomised controlled trial. The study was carried
Heart Foundation, the Ebba Celinders Foundation, and the Gangsted Foundation. Bibliographic details Jorgensen H S, Nakayama H, Raaschou H O, Larsen K, Hubbe P, Olsen T S. The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost - a community-based study. Stroke 1995; 26(7): 1178-1182 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Aged; Cerebrovascular Disorders /mortality /therapy; Cost Savings /statistics & Denmark (...) The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost - a community-based study The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost - a community-based study The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost - a community-based study Jorgensen H S, Nakayama H, Raaschou H O, Larsen K, Hubbe P
(D1) and district two (D2), respectively. Stroke was defined as 'rapidly developing clinical symptoms and/or signs of focal, and at times global (...) loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no cause apparent other than that of a vascular origin'. It was not stated whether power calculations determined sample size. The study also consisted of 103 carers. Study design A multi-centre (4 sites) prospective observational study, in which patients (...) . Bibliographic details Gompertz P, Pound P, Briffa J, Ebrahim S. How useful are non-random comparisons of outcomes and quality of care in purchasing hospital stroke services. Age and Ageing 1995; 24(2): 137-141 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Activities of Daily Living /classification; Aged; Aged, 80 and over; Cerebrovascular Disorders /economics /mortality /rehabilitation; Contract Services /economics; Cost-Benefit Analysis; England; Female; Geriatric Assessment; Humans; Male
Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Warfarin is an established treatment for prevention of ischaemicstroke in patients with atrial fibrillation, but the value of this agent relative to aspirin in unclear. In the first Stroke Prevention in Atrial Fibrillation (SPAF-I) study, direct comparison of warfarin with aspirin was limited by the small number of thromboembolic events. SPAF-II aims to address (...) this issue and also to assess the differential effects of the two treatments according to age. We compared warfarin (prothrombin time ratio 1.3-1.8, international normalised ratio 2.0-4.5) with aspirin 325 mg daily for prevention of ischaemicstroke and systemic embolism (primary events) in two parallel randomised trials involving 715 patients aged 75 years or less and 385 patients older than 75; we sought reductions in the absolute rate of primary events by warfarin compared with aspirin of 2% per year
of aspirin on risk of stroke or death in women who have suffered cerebralischemia. Cerebrovascular Diseases 1994; 4: 157-162 Indexing Status Subject indexing assigned by CRD MeSH Aspirin; Brain Ischemia; IschemicAttack, Transient; Women AccessionNumber 11997008094 Date bibliographic record published 30/11/1997 Date abstract record published 30/11/1997 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief (...) Effect of aspirin on risk of stroke or death in women who have suffered cerebralischemia Effect of aspirin on risk of stroke or death in women who have suffered cerebralischemia Effect of aspirin on risk of stroke or death in women who have suffered cerebralischemia Jonas S Authors' objectives To investigate the effect of aspirin on occurrence of stroke or death in women who have previously suffered cerebralischaemia. Searching Studies were identified by searching MEDLINE, and English
stenosis or bruit, transientischemicattack, previous stroke, nonvalvular atrial fibrillation or other vascular diseases). Outcomes assessed in the review Stroke, death from other causes other than stroke and complications after medical treatment for stroke (events were assigned to treatment and control groups using the intention to treat principle). How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for review, or how many of the authors (...) ) and death from other causes 0.57 (0.31, 1.1) but may result in more complications 1.1 (0.62, 2.1). Aspirin appears to be less effective at reducing stroke (relative risk 0.67, CI: 0.45 to 0.99) and death (relative risk 0.78, CI: 0.54, 1.13). In patients with transientischemicattack or minor stroke both aspirin (relative risk 0.84, CI: 0.72 to 0.99) and ticlopidine (relative risk 0.82, CI: 0.67, 1.0) reduce the risk for stroke. In patients who have had myocardial infarction warfarin is effective
following stroke: a research overview and meta-analysis Moreland J, Thomson M A Authors' objectives To examine the efficacy of electromyographic (EMG) biofeedback compared to conventional physical therapy, for improving upper-extremity function in patients following a stroke. Searching MEDLINE was searched with the keywords 'electromyography', biofeedback' and 'cerebrovascular disorders'; CINAHL with the keywords 'biofeedback' and 'cerebrovascularaccident'; and Dissertation Abstracts International (...) Efficacy of electromyographic biofeedback compared with conventional physical therapy for upper-extremity function in patients following stroke: a research overview and meta-analysis Efficacy of electromyographic biofeedback compared with conventional physical therapy for upper-extremity function in patients following stroke: a research overview and meta-analysis Efficacy of electromyographic biofeedback compared with conventional physical therapy for upper-extremity function in patients
attack (TIA), reversible ischemic neurological deficit, amaurosis fugax, or minor stroke. Setting Primary care/hospital setting. The economic study was carried out in the USA. Dates to which data relate Effectiveness data related to studies published in 1988 and 1991. Cost data was reported from a variety of sources and mainly related to 1981-1991 period. All costs were adjusted to 1991. Source of effectiveness data Synthesis of previous published studies. Modelling A decision tree was used (...) critical assessment on the reliability of the study and the conclusions drawn. Health technology Antiplatelet agents to reduce the risk of stroke in high-risk patients. In particular the use of ticlopidinevs aspirin was considered. Type of intervention Secondary prevention Economic study type Cost-effectiveness and cost-utility analyses. Study population A hypothetical cohort of 100 patients aged 65 when the therapy was initiated, who could be defined as high risk, i.e. with a recent transientischemic
Secondary prevention in non-rheumatic atrial fibrillation after transientischaemicattack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Several studies have established the value of anticoagulation for primary prevention of thromboembolic events in patients with non-rheumatic atrial fibrillation (NRAF). However, in patients with a recent transientischaemicattack (TIA) or minor ischaemicstroke the preventive benefit of anticoagulation or aspirin remains unclear (...) . Physicians in 108 centres from 13 countries collaborated to study this question. 1007 NRAF patients with a recent TIA or minor ischaemicstroke were randomised to open anticoagulation or double-blind treatment with either 300 mg aspirin per day or placebo (group 1, 669). Patients with contraindications to anticoagulation were randomised to receive aspirin or placebo (group 2,338). The measure of outcome was death from vascular disease, any stroke, myocardial infarction, or systemic embolism. During mean
1993LancetControlled trial quality: predicted high
decreased by at least 50% in all cases during citalopram treatment vs 2 patients during placebo treatment (p < 0.005, McNemar's test), the effect being rapid (1-3 days) and pronounced in 11 (73%). There was a concomitant significant decrease in depression rating from HDS 8.9 to 5.3 (p < 0.005, Wilcoxon's test). Citalopram was well tolerated, the few side-effects being mild and transient. We conclude that serotoninergic neurotransmission plays an important part in post-stroke pathological crying (...) Citalopram for post-stroke pathological crying. Post-stroke pathological crying is a distressing condition in which episodes occur in response to minor stimuli without associated mood changes. There is preliminary evidence of disturbed serotoninergic neurotransmission in such cases. We investigated the effect of the selective serotonin reuptake inhibitor citalopram on uncontrolled crying in stroke patients in a double-blind placebo-controlled crossover study. 16 consecutive patients (median age
Antiphospholipid antibodies after myocardial infarction and their relation to mortality, reinfarction, and non-haemorrhagic stroke. Antiphospholipid antibodies have been suggested as markers for a high risk of recurrent cardiovascular events in young survivors of an acute myocardial infarction. However, there are few data to confirm or refute this hypothesis. In a cohort study, we have measured anticephalin (aCEPHA) and anticardiolipin (aCL) antibodies in a group of patients surviving an acute (...) infarct. Of 597 patients studied, 13.2% were IgG or IgM aCEPHA positive compared with 4.4% of a reference population (n = 158; p = 0.002). In a multivariate analysis, adjusted for major cardiovascular risk factors, neither aCEPHA (IgG or IgM) nor a CL (IgG or IgM) was an independent risk factor for mortality, reinfarction, or non-haemorrhagic stroke. Although an increased proportion of survivors of a myocardial infarction have antiphospholipid antibodies, the presence of such antibodies is not a risk
Physiotherapy intervention late after stroke and mobility. To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke.Randomised crossover trial comparing two groups offered intervention by a physiotherapist, one immediately after entry into the trial and the other after a delay of three months. The intervention consisted of identifying problems and offering advice and help to solve the problems.Patients' homes (...) in Oxfordshire.Patients who had reduced mobility due to a stroke more than one year before entry; 60 were recruited from a community stroke register and 34 in other ways.Standard measures of mobility including gait speed, functional ambulation categories, the Nottingham extended activities of daily living index, and individual items from the Barthel activities of daily living index and the Frenchay activities index. Measures of manual dexterity, depression, and anxiety were used as controls.94 patients entered
Risk of cardiac events in atypical transientischaemicattack or minor stroke. The Dutch TIA Study Group. Proposed guidelines for the diagnosis of transientischaemicattack (TIA) involve interpretation of symptoms, so it can be very difficult to distinguish a TIA from other disorders, such as migraine, epilepsy, syncope, or neurosis. Atypical cerebral and visual events may be classified as TIA. To see whether TIA or stroke patients with atypical cerebral or visual symptoms are at high or low (...) risk of cardiac complications, we prospectively followed 572 patients (entered into the Dutch multicentre TIA trial) with a diagnosis of TIA or minor ischaemicstroke, but whose symptoms did not fully accord with internationally accepted criteria. We compared their outcome with that of 2555 other TIA or stroke patients in the trial, who had unequivocal symptoms; all patients were treated with aspirin. During mean follow-up of 2.6 years the risk of a major vascular event did not differ between
The Bradford community stroke trial: results at six months. Comparison of day hospital attendance and home physiotherapy for stroke patients leaving hospital to determine which service produces greater functional and social improvement for the patient, reduces emotional stress for the care giver, and lessens the need for community support.Stratified, randomised trial of stroke patients attending day hospital two days a week or receiving home treatment from a community physiotherapist. The six (...) month assessment results are reported in this paper.Patients over 60 years old resident within the Bradford metropolitan district discharged home after a new stroke with residual disability.Four day hospitals in two health authorities and domiciliary work undertaken by experienced community physiotherapists.Barthel index, functional ambulatory categories, Motor Club assessment, Frenchay activities index, and Nottingham health profile were used. Carers' stress was indicated by the general health
The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and The International Study Group. Many trials in patients with acute myocardial infarction have demonstrated that thrombolytic therapy is not associated with an excessive risk of stroke, as compared with conventional treatment. However, the incidence of various forms of stroke in patients treated (...) with different thrombolytic and antithrombotic regimens and the associated effect of risk factors for stroke are largely unknown.Strokes occurring in patients hospitalized with acute myocardial infarction who were enrolled in either of two large trials were analyzed. The patients were randomly assigned to receive streptokinase (1.5 million units) or recombinant tissue plasminogen activator (t-PA) (100 mg) and also randomly assigned to receive subcutaneous heparin or no heparin. Ninety-one percent
-time ratio, 1.2 to 1.5) in 571 men with chronic nonrheumatic atrial fibrillation; 525 patients had not previously had a cerebralinfarction, whereas 46 patients had previously had such an event. The primary end point was cerebralinfarction; secondary end points were cerebral hemorrhage and death.Among the patients with no history of stroke, cerebralinfarction occurred in 19 of the 265 patients in the placebo group during an average follow-up of 1.7 years (4.3 percent per year) and in 4 of the 260 (...) gastrointestinal, occurred in 10 patients: 4 in the placebo group, for a rate of 0.9 percent per year, and 6 in the warfarin group, for a rate of 1.3 percent per year. There were 37 deaths that were not preceded by a cerebral end point--22 in the placebo group and 15 in the warfarin group (risk reduction, 0.31; P = 0.19). Cerebralinfarction was more common among patients with a history of cerebralinfarction (9.3 percent per year in the placebo group and 6.1 percent per year in the warfarin group) than among