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Interventions for post-stroke fatigue.
CONCLUSIONS: There was insufficient evidence on the efficacy of any intervention to treat or prevent fatigue after stroke. Trials to date have been small and heterogeneous, and some have had a high risk of bias. Some of the interventions described were feasible in people with stroke, but their efficacy should be investigated in RCTs with a more robust study design and adequate sample sizes. PMID: 26133313 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 2, 2015 Category: Journals (General) Authors: Wu S, Kutlubaev MA, Chun HY, Cowey E, Pollock A, Macleod MR, Dennis M, Keane E, Sharpe M, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Antifibrinolytic drugs for acute traumatic injury.
CONCLUSIONS: TXA safely reduces mortality in trauma patients with bleeding without increasing the risk of adverse events.  TXA should be given as early as possible and within three hours of injury, as further analysis of the CRASH-2 trial showed that treatment later than this is unlikely to be effective and may be harmful. Although there is some promising evidence for the effect of TXA in patients with TBI, substantial uncertainty remains.Two ongoing trials being conducted in patients with isolated TBI should resolve these remaining uncertainties. PMID: 25956410 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 9, 2015 Category: Journals (General) Authors: Ker K, Roberts I, Shakur H, Coats TJ Tags: Cochrane Database Syst Rev Source Type: research

Transcranial direct current stimulation (tDCS) for improving aphasia in patients with aphasia after stroke.
CONCLUSIONS: Currently there is no evidence of the effectiveness of tDCS (anodal tDCS, cathodal tDCS and bihemispheric tDCS) versus control (sham tDCS) for improving functional communication, language impairment and cognition in people with aphasia after stroke. Further RCTs are needed in this area to determine the effectiveness of this intervention. Authors of future research should adhere to the CONSORT Statement. PMID: 25929694 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 1, 2015 Category: Journals (General) Authors: Elsner B, Kugler J, Pohl M, Mehrholz J Tags: Cochrane Database Syst Rev Source Type: research

Cooling for cerebral protection during brain surgery.
CONCLUSIONS: We found no evidence that the use of induced hypothermia was associated with a significant reduction in mortality or severe neurological disability, or an increase in harm in patients undergoing neurosurgery. PMID: 25626888 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - February 3, 2015 Category: Journals (General) Authors: Galvin IM, Levy R, Boyd JG, Day AG, Wallace MC Tags: Cochrane Database Syst Rev Source Type: research

Hyperbaric oxygen therapy for acute ischaemic stroke.
CONCLUSIONS: We found no good evidence to show that HBOT improves clinical outcomes when applied during acute presentation of ischaemic stroke. Although evidence from the 11 RCTs is insufficient to provide clear guidelines for practice, the possibility of clinical benefit has not been excluded. Further research is required to better define the role of HBOT in this condition. PMID: 25387992 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 12, 2014 Category: Journals (General) Authors: Bennett MH, Weibel S, Wasiak J, Schnabel A, French C, Kranke P Tags: Cochrane Database Syst Rev Source Type: research

Interventions for improving upper limb function after stroke.
CONCLUSIONS: Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effective...
Source: Cochrane Database of Systematic Reviews - November 12, 2014 Category: Journals (General) Authors: Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F Tags: Cochrane Database Syst Rev Source Type: research

Interventions for deliberately altering blood pressure in acute stroke.
CONCLUSIONS: There is insufficient evidence that lowering blood pressure during the acute phase of stroke improves functional outcome. It is reasonable to withhold blood pressure-lowering drugs until patients are medically and neurologically stable, and have suitable oral or enteral access, after which drugs can than be reintroduced. In people with acute stroke, CCBs, ACEI, ARA, beta blockers and NO donors each lower blood pressure while phenylephrine probably increases blood pressure. Further trials are needed to identify which people are most likely to benefit from early treatment, in particular whether treatment started...
Source: Cochrane Database of Systematic Reviews - October 28, 2014 Category: Journals (General) Authors: Bath PM, Krishnan K Tags: Cochrane Database Syst Rev Source Type: research

Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke.
CONCLUSIONS: The available trial evidence showed that, for individuals with acute ischaemic stroke, GP IIb-IIIa inhibitors are associated with a significant risk of intracranial haemorrhage with no evidence of any reduction in death or disability in survivors. These data do not support their routine use in clinical practice. The conclusion is driven by trials of Abciximab, which contributed 89% of the total number of study participants considered. PMID: 24609741 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 8, 2014 Category: Journals (General) Authors: Ciccone A, Motto C, Abraha I, Cozzolino F, Santilli I Tags: Cochrane Database Syst Rev Source Type: research

Insulin for glycaemic control in acute ischaemic stroke.
CONCLUSIONS: After updating the results of our previous review, we found that the administration of intravenous insulin with the objective of maintaining serum glucose within a specific range in the first hours of acute ischaemic stroke does not provide benefit in terms of functional outcome, death, or improvement in final neurological deficit and significantly increased the number of hypoglycaemic episodes. Specifically, those people whose glucose levels were maintained within a tighter range with intravenous insulin experienced a greater risk of symptomatic and asymptomatic hypoglycaemia than those people in the control ...
Source: Cochrane Database of Systematic Reviews - January 23, 2014 Category: Journals (General) Authors: Bellolio MF, Gilmore RM, Ganti L Tags: Cochrane Database Syst Rev Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in patients with stroke or transient ischaemic attack.
CONCLUSIONS: PPAR-γ agonists were demonstrated to reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and improve insulin sensitivity and the stabilisation of carotid plaques. There is evidence of limited quality that they are well-tolerated. However, the conclusions should be interpreted with caution considering the small number and the quality of the included studies. In future, well-designed, double-blind RCTs with large samples are required to test the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular ev...
Source: Cochrane Database of Systematic Reviews - January 8, 2014 Category: Journals (General) Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Transcranial direct current stimulation (tDCS) for improving function and activities of daily living in patients after stroke.
CONCLUSIONS: At the moment, evidence of very low to low quality is available on the effectiveness of tDCS (anodal/cathodal/dual) versus control (sham/any other intervention) for improving ADL performance and function after stroke. Future research should investigate the effects of tDCS on lower limb function and should address methodological issues by routinely reporting data on adverse events and dropouts and allocation concealment, and by performing intention-to-treat analyses. PMID: 24234980 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 15, 2013 Category: Journals (General) Authors: Elsner B, Kugler J, Pohl M, Mehrholz J Tags: Cochrane Database Syst Rev Source Type: research

Physical fitness training for stroke patients.
CONCLUSIONS: The effects of training on death and dependence after stroke are unclear. Cardiorespiratory training reduces disability after stroke and this may be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programs to improve the speed and tolerance of walking; improvement in balance may also occur. There is insufficient evidence to support the use of resistance training. Further well-designed trials are needed to determine the optimal content of the exercise prescription and identify long-t...
Source: Cochrane Database of Systematic Reviews - October 21, 2013 Category: Journals (General) Authors: Saunders DH, Sanderson M, Brazzelli M, Greig CA, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Organised inpatient (stroke unit) care for stroke.
CONCLUSIONS: Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. We observed no systematic increase in the length of inpatient stay. PMID: 24026639 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 11, 2013 Category: Journals (General) Authors: Stroke Unit Trialists' Collaboration Tags: Cochrane Database Syst Rev Source Type: research

Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage.
CONCLUSIONS: The current evidence does not support the use of antifibrinolytic drugs in the treatment of people with aneurysmal subarachnoid haemorrhage, even in those who have concomitant treatment strategies to prevent cerebral ischaemia. Results on short-term treatment are promising, but not conclusive. Further randomised trials evaluating short-term antifibrinolytic treatment are needed to evaluate its effectiveness. PMID: 23990381 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 30, 2013 Category: Journals (General) Authors: Baharoglu MI, Germans MR, Rinkel GJ, Algra A, Vermeulen M, van Gijn J, Roos YB Tags: Cochrane Database Syst Rev Source Type: research

Cognitive rehabilitation for spatial neglect following stroke.
CONCLUSIONS: The effectiveness of cognitive rehabilitation interventions for reducing the disabling effects of neglect and increasing independence remains unproven. As a consequence, no rehabilitation approach can be supported or refuted based on current evidence from RCTs. However, there is some very limited evidence that cognitive rehabilitation may have an immediate beneficial effect on tests of neglect. This emerging evidence justifies further clinical trials of cognitive rehabilitation for neglect. However, future studies need to have appropriate high quality methodological design and reporting, to examine persisting ...
Source: Cochrane Database of Systematic Reviews - July 1, 2013 Category: Journals (General) Authors: Bowen A, Hazelton C, Pollock A, Lincoln NB Tags: Cochrane Database Syst Rev Source Type: research

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