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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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Telerehabilitation services for stroke. Telerehabilitation offers an alternate way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative (...) to rehabilitation delivered face-to-face or when added to usual care.To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation or usual care. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence
Pharmacological, psychological, and non-invasive brain stimulation interventions for treating depression after stroke. Depression is an important morbidity associated with stroke that impacts on recovery yet often undetected or inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and updated in 2008.Primary objective • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations (...) of these interventions reduce the prevalence of diagnosable depression after stroke Secondary objectives • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations of these interventions reduce levels of depressive symptoms, improve physical and neurological function and health-related quality of life, and reduce dependency after stroke • To assess the safety of and adherence to such treatments SEARCH METHODS: We searched the Specialised Registers
Motor neuroprosthesis for promoting recovery of function after stroke. Motor neuroprosthesis (MN) involves electrical stimulation of neural structures by miniaturized devices to allow the performance of tasks in the natural environment in which people live (home and community context), as an orthosis. In this way, daily use of these devices could act as an environmental facilitator for increasing the activities and participation of people with stroke.To assess the effects of MN for improving (...) independence in activities of daily living (ADL), activities involving limbs, participation scales of health-related quality of life (HRQoL), exercise capacity, balance, and adverse events in people after stroke.We searched the Cochrane Stroke Group Trials Register (searched 19 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (August 2019), MEDLINE (1946 to 16 August 2019), Embase (1980 to 19 August 2019), and five additional databases. We also searched trial registries, databases
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
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
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
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
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.
stroke registries. We performed multivariable Cox regression analysis to identify predictors of stroke recurrence. Based on the coefficient of each covariate of the fitted multivariable model, we generated an integer-based point scoring system. We validated the score externally assessing its discrimination and calibration.In 3 registries (884 patients) that were used as the derivation cohort, age, leukoaraiosis, and multiterritorial infarct were identified as independent predictors of stroke (...) recurrence and were included in the final score, which assigns 1 point per every decade after 35 years of age, 2 points for leukoaraiosis, and 3 points for multiterritorial infarcts (acute or old nonlacunar). The rate of stroke recurrence was 2.1 per 100 patient-years (95% confidence interval [CI] 1.44-3.06) in patients with a score of 0-4 (low risk), 3.74 (95% CI 2.77-5.04) in patients with a score of 5-6 (intermediate risk), and 8.23 (95% CI 5.99-11.3) in patients with a score of 7-12 (high risk
A support programme for secondary prevention in patients with transientischaemicattack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial Patients with recent stroke or transientischaemicattack are at high risk for a further vascular event, possibly leading to permanent disability or death. Although evidence-based treatments for secondary prevention are available, many patients do not achieve recommended behavioural modifications and pharmaceutical prevention targets (...) in the long-term. We aimed to investigate whether a support programme for enhanced secondary prevention can reduce the frequency of recurrent vascular events.INSPiRE-TMS was an open-label, multicentre, international randomised controlled trial done at seven German hospitals with acute stroke units and a Danish stroke centre. Patients with non-disabling stroke or transientischaemicattack within 2 weeks from study enrolment and at least one modifiable risk factor (ie, arterial hypertension, diabetes
Guidelines for the Early Management of Patients With Acute IschemicStroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute IschemicStroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemicstroke. The intended audiences (...) are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute IschemicStroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant
Essen Risk Score in Prediction of Myocardial Infarction After TransientIschemicAttack or IschemicStroke Without Prior Coronary Artery Disease Background and Purpose- More intensive secondary prevention with newer drugs may be cost-effective in patients with coronary artery disease (CAD). Whether some subgroups of patients who had a transientischemicattack (TIA) or ischemicstroke, but no prior CAD are at similar high risk of myocardial infarction as those with prior CAD remains unclear. We (...) determined whether the Essen score identified a subset of TIA/stroke patients without known prior CAD who, nevertheless, had a high risk of myocardial infarction on current secondary prevention management. Methods- In a population-based cohort (Oxford Vascular Study) of consecutive TIA or ischemicstroke patients recruited from 2002 to 2014, 10-year actuarial risks of myocardial infarction and of recurrent ischemicstroke were determined by face-to-face follow-up in patients with and without prior CAD
Training for Walking Efficiency With a Wearable Hip-Assist Robot in Patients With Stroke: A Pilot Randomized Controlled Trial Background and Purpose- The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods- Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 (...) parameters (P<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (P<0.01). Conclusions- Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration
in Patients with Stroke and TransientIschemicAttack  Abbreviations: AHA: American Heart Association; ASA: American Stroke Association Sidebar 2: Assessment of Impairments and Disabilities ? Assessment of impairments • Auditory/hearing • Bowel and bladder function • Cognition • Communication • Emotion and behavior • Inattention/neglect • Motor/mobility • Swallowing and nutrition • Tactile/touch • Vision function and formal visual field ? Assessment of barriers to participation in therapy • Cognitive (...) in the form of medical, surgical, or rehabilitation interventions is essential to help reduce disability severity, decrease the risk of further complications, and lessen potentially life-long deficits.[5,6] Unfortunately, in approximately 30% of ischemicstroke cases, the cause of the stroke remains unknown. Ischemicstrokes with no obvious cause are labelled as “cryptogenic” strokes and are more common in younger patients than in the elderly. This is largely due to the lack of comorbidities