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Total 186 results found since Jan 2013.
Editorial Postacute stroke care: same standards as acute care?
The Sentinel Stroke National Audit Programme (SSNAP), led by the Royal College of Physicians, has released the first comprehensive audit into 604 of 756 postacute stroke care services throughout the UK. Although vast improvements have been achieved in acute stroke care in recent years, progress in postacute care for long-term rehabilitation has been left behind in comparison.
Source: LANCET - December 11, 2015 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research
Comment Age of PISCES: stem-cell clinical trials in stroke
Laboratory studies and limited clinical trials over the past two decades have shown feasibility and safety, and have revealed potential mechanisms of action of stem-cell therapy in ischaemic stroke. Despite consistent efficacy in animal studies, functional benefits after transplantation of stem cells remain to be shown unequivocally in stroke patients.1 Translation of stem-cell therapy from the laboratory to the clinic has been approached with ample caution, in part due to the largely negative outcomes for several stroke therapeutics in human beings compared with those in animals.
Source: LANCET - August 2, 2016 Category: Journals (General) Authors: Cesar V Borlongan Tags: Comment Source Type: research
Correspondence Risk of mortality and stroke after atrial fibrillation – Authors' reply
On behalf our colleagues, we would like to thank Zitian Huo and Constantinos Mihas and colleagues for their interest in our Article and for their questions. We agree with Mihas and colleagues that it would be informative to examine regional differences in haemorrhagic stroke. However, given the large size of our study,1 we needed to minimise the burden of data collection to keep costs affordable. As a result, we did not collect any data on stroke subtypes. The decision not to collect these data was also influenced by the fact that not all participating regions in this study had equal access to advanced neurological imaging...
Source: LANCET - March 3, 2017 Category: Journals (General) Authors: Jeff S Healey, Jonas Oldgren, RE-LY Atrial Fibrillation and Cohort Study Investigators Tags: Correspondence Source Type: research
Comment An optimum blood pressure target after lacunar stroke?
Sustained lowering of blood pressure by 10 mm Hg systolic and 5 mm Hg diastolic lessens the risk of recurrent stroke by about one-third (relative risk 0·66, 95% CI 0·56–0·79). The blood-pressure range within which the association with stroke risk remains linear, however, is uncertain.
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: Graeme J Hankey Tags: Comment Source Type: research
Articles Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial
Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial.
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: The SPS3 Study Group Tags: Articles Source Type: research
Correspondence Intermittent pneumatic compression in patients with stroke
It is surprising that the CLOTS Trials Collaboration, previously prominent advocates of patient-centred outcomes in stroke studies, publish large trials of mechanical methods of preventing deep venous thrombosis (DVT) after stroke, without providing information about functional recovery. in view of the potential effect of IPC on rehabilitation, not to mention the costs and commercial implications of a positive result.
Source: LANCET - November 2, 2013 Category: Journals (General) Authors: David Barer Tags: Correspondence Source Type: research
Comment Training caregivers of disabled patients after stroke
At least a third of stroke survivors remain disabled, making stroke the third leading cause of disability-adjusted life-years (DALYs) worldwide. Assistance is often provided informally by family and friends who might be ill-informed or ill-prepared physically and emotionally. Informal caregiving imposes a persistent burden on 25–50% of caregivers, dependent on the mental health, mood, and requirements of the caregiver as well as on the age, mental health, and function of the patient. Caregiver burden can compromise caregivers' health and patients' rehabilitation and recovery.
Source: LANCET - December 20, 2013 Category: Journals (General) Authors: Graeme J Hankey Tags: Comment Source Type: research
Comment Improved medical treatment in secondary prevention of stroke
Atherosclerotic intracranial arterial stenosis is a cause of transient ischaemic attack and ischaemic stroke, and is associated with a high risk of recurrence. Patients with recently symptomatic severe (70–99%) stenosis are at particularly high risk. In the SAMMPRIS trial, investigators compared two alternative treatment strategies in patients with a recent (<30 days) transient ischaemic attack or non-disabling stroke attributed to angiographically verified 70–99% intracranial stenosis: aggressive medical treatment (combination antiplatelet therapy and intensive management of risk factors) versus aggressive medical ...
Source: LANCET - January 24, 2014 Category: Journals (General) Authors: Peter M Rothwell, Hugh S Markus Tags: Comment Source Type: research
Correspondence Questions about authorisation of alteplase for ischaemic stroke
Stroke thrombolysis can cause potentially fatal intracerebral haemorrhage, but advocates claim the potential reduction in disability justifies this risk. Alteplase was authorised following the National Institute of Neurological Disorders and Stroke (NINDS) trial. A 2004 review raised concerns over the trial data. Outcomes across the centres differed considerably. Bias could explain the observation that the plot of outcome (modified Rankin score 0–1) against number of patients recruited does not resemble the expected symmetrical funnel ().
Source: LANCET - August 23, 2014 Category: Journals (General) Authors: Roger Shinton Tags: Correspondence Source Type: research
Articles Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial
In patients with acute stroke and high blood pressure, transdermal glyceryl trinitrate lowered blood pressure and had acceptable safety but did not improve functional outcome. We show no evidence to support continuing prestroke antihypertensive drugs in patients in the first few days after acute stroke.
Source: LANCET - October 21, 2014 Category: Journals (General) Authors: The ENOS Trial Investigators Tags: Articles Source Type: research
Case Report Reversible right heart failure after medullary stroke
In May, 2013, a 73-year-old woman presented to our clinic with drowsiness. She had had a left medullary stroke due to atrial fibrillation 7 months earlier (figure) and was taking oral anticoagulants. Since her stroke she had had fragmented sleep and excessive daytime sleepiness, and during the previous 4 months had developed facial and generalised oedema, which had become much worse in the week before admission, and was associated with anuria and drowsiness. On examination she was afebrile, blood pressure was 141/121 mm Hg, pulse was 80 beats per min and irregular, and jugular venous pressure was raised.
Source: LANCET - April 3, 2015 Category: Journals (General) Authors: Han-Gil Jeong, Dae Lim Koo, Hyunwoo Nam, Hyung-Min Kwon Tags: Case Report Source Type: research
Correspondence Thrombolysis in acute stroke
In their meta-analysis of intravenous thrombolysis with alteplase for acute ischaemic stroke, Jonathan Emberson and colleagues (Nov 29, p 1929)1 concluded that the increased risk of early death from intracranial haemorrhage in patients taking alteplase was offset by an increase in disability-free survival. This interpretation gives the impression that the high level of mortality in the acute phase tends to diminish with time, but that is not the case. In the latest Cochrane analysis of thrombolysis for acute ischaemic stroke,2 thrombolysis gave no survival advantage between 7 days after thrombolysis and the end of follow-up.
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: Peter Appelros, Andreas Terént Tags: Correspondence Source Type: research
Articles The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial
Preventive ceftriaxone does not improve functional outcome at 3 months in adults with acute stroke. The results of our trial do not support the use of preventive antibiotics in adults with acute stroke.
Source: LANCET - January 20, 2015 Category: Journals (General) Authors: Willeke F Westendorp, Jan-Dirk Vermeij, Elles Zock, Imke J Hooijenga, Nyika D Kruyt, Hans J L W Bosboom, Vincent I H Kwa, Martijn Weisfelt, Michel J M Remmers, Robert ten Houten, A H C M (Tobien) Schreuder, Sarah E Vermeer, Ewout J van Dijk, Diederik W J Tags: Articles Source Type: research
Correspondence Could upright posture be harmful in the early stages of stroke? – Author's reply
The AVERT trial1 delivered a surprising result; higher dose of out-of-bed activity soon after stroke (very early mobilisation) led to a less favourable outcome than lower dose, but still early, out-of-bed activity. This finding will prompt revision of current guidelines,2 which have increasingly recommended early mobilisation. Precisely what should be recommended, however, is less clear at this point. Usual care did not consist of prolonged bed rest; 623 (59%) of 1050 patients in the usual care group started out-of-bed activity within 24 h of stroke onset, 525 (50%) patients had little or no disability (modified Rankin sca...
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Julie Bernhardt, AVERT investigators Tags: Correspondence Source Type: research
Correspondence Prophylactic antibiotics to reduce pneumonia after acute stroke
The STROKE-INF trial (Nov 7, p1835)1 reported outcomes that were different from those initially included in the ISRCTN registry (number ISRCTN37118456). There were two pre-specified primary outcomes, of which one was reported in the Article, and the other (“total hospital costs”) was not reported anywhere in the paper. In addition, the Article reported a new co-primary outcome (“physician diagnosed post-stroke pneumonia”) that was not pre-specified, without declaring it as such. Of the 14 pre-specified secondary outcomes, six were reported in the paper, and eight were unreported anywhere in the paper.
Source: LANCET - January 30, 2016 Category: Journals (General) Authors: Ioan Milosevic, Aaron Dale, Henry Drysdale, Kamal Mahtani, COMPare project team Tags: Correspondence Source Type: research
