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Barriers and facilitators to staying in work after stroke: insight from an online forum
Conclusions Despite having been able to return to work after a stroke, people may still experience difficulties in staying in work and risking losing their job. There is a need to improve awareness, in particular of invisible stroke-related impairments, among stroke survivors, work personnel and clinicians. This might be achieved through improved assessments of residual impairments in the workplace and in general practice. Future studies should investigate the effect of unrecognised fatigue and invisible impairments on staying in work following stroke, and explore the potential role for primary care in supporting stroke su...
Source: BMJ Open - April 5, 2016 Category: Journals (General) Authors: Balasooriya-Smeekens, C., Bateman, A., Mant, J., De Simoni, A. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Occupational and environmental medicine, Qualitative research, Rehabilitation medicine, Research methods Source Type: research

Systematic review of rehabilitation programmes initiated within 90 days of a transient ischaemic attack or 'minor' stroke: a protocol
Discussion This review will be of value to clinicians and healthcare professionals working in TIA and stroke services as well as to general practitioners/family physicians who care for these patients in the community and to researchers involved in designing and evaluating rehabilitation interventions. Trial registration number CRD42015016450.
Source: BMJ Open - June 18, 2015 Category: Journals (General) Authors: Heron, N., Kee, F., Donnelly, M., Cupples, M. E. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Neurology, Rehabilitation medicine, Sports and exercise medicine Protocol Source Type: research

Patients experience of and participation in a stroke self-management programme, My Life After Stroke (MLAS): a multimethod study
Conclusions MLAS was a positive experience for participants but many stroke survivors did not feel it was appropriate for them. Participation in self-management programmes after stroke might be improved by offering them sooner after the stroke and providing a range of delivery options beyond group-based, face-to-face learning. Trial registration number NCT03353519, NIH.
Source: BMJ Open - November 15, 2022 Category: General Medicine Authors: Blatchford, E. G., Aquino, M. R. J., Grant, J., Johnson, V., Mullis, R., Lim, L., Mant, J. Tags: Open access, Public health Source Type: research

Retrospective case review of missed opportunities for primary prevention of stroke and TIA in primary care: protocol paper
This study will investigate: (1) the proportion of strokes/TIAs with prior missed opportunities for prevention in primary care; (2) the influence of patient characteristics on missed prevention opportunities and (3) how the proportion of missed prevention opportunities has changed over time. Methods and analysis A retrospective case review will identify first-ever stroke and patients with TIA between 2000 and 2013 using anonymised electronic medical records extracted from the health improvement network (THIN) database. Four categories of missed opportunities for stroke/TIA prevention will be sought: untreated high blood p...
Source: BMJ Open - November 11, 2014 Category: Journals (General) Authors: Moran, G. M., Calvert, M., Feltham, M. G., Marshall, T. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice, Global health Protocol Source Type: research

Understanding stroke survivors and informal carers experiences of and need for primary care and community health services--a systematic review of the qualitative literature: protocol
Introduction Despite the rising prevalence of stroke, no comprehensive model of postacute stroke care exists. Research on stroke has focused on acute care and early supported discharge, with less attention dedicated to longer term support in the community. Likewise, relatively little research has focused on long-term support for informal carers. This review aims to synthesise and appraise extant qualitative evidence on: (1) long-term healthcare needs of stroke survivors and informal carers, and (2) their experiences of primary care and community health services. The review will inform the development of a primary care mode...
Source: BMJ Open - January 6, 2016 Category: Journals (General) Authors: Aziz, N. A., Pindus, D. M., Mullis, R., Walter, F. M., Mant, J., Lim, Rundell, Hobbs Tags: Open access, General practice / Family practice, Qualitative research, Research methods Protocol Source Type: research

The NAILED stroke risk factor trial (Nurse based Age independent Intervention to Limit Evolution of Disease after stroke): study protocol for a randomized controlled trial
This study started in January 2010 and the first results are expected at the end of 2013.DiscussionThis study will test the hypothesis that a nurse-led, long-term follow-up after stroke with a focus on reaching set treatment goals as soon as possible, is an effective secondary preventive method. If proven effective, this method could be implemented in general practice at a low cost.Trial registration: Current Controlled Trials ISRCTN23868518
Source: Trials - January 5, 2013 Category: Journals (General) Authors: Thomas MooeLisa BergströmAnna-Lotta IrewallJoachim Ögren Source Type: research

A cluster-randomized controlled trial of a computerized antithrombotic risk assessment tool to optimize stroke prevention in general practice: a study protocol
This study (a prospective, cluster-randomized controlled clinical trial) will be conducted across selected regions in the state of New South Wales, Australia. Fifty GPs will be randomized to either the 'intervention' or 'control' arm, with each GP recruiting 10 patients (aged>=65 with AF); target sample size is 500 patients. GPs in the intervention arm will use CARAT during routine patient consultations to: assess risk factors for stroke, bleeding and medication misadventure; quantify the risk/benefit ratio of antithrombotic treatment, identify the recommended therapy, and decide on the treatment course, for an individual ...
Source: BMC Health Services Research - February 7, 2014 Category: Journals (General) Authors: Beata BajorekParker MaginSarah HilmerInes Krass Source Type: research

Antiepileptic drugs and the risk of ischaemic stroke and myocardial infarction: a population-based cohort study
Conclusions The use of enzyme-inducing AEDs was not associated with an increased risk of ischaemic stroke; a small increase of MI with prolonged use was observed. In contrast, use of inhibiting AEDs was associated with a decreased risk of MI.
Source: BMJ Open - August 12, 2015 Category: Journals (General) Authors: Renoux, C., Dell'Aniello, S., Saarela, O., Filion, K. B., Boivin, J.-F. Tags: Open access, Cardiovascular medicine, Epidemiology, Neurology, Public health Research Source Type: research

AUtomated Risk Assessment for Stroke in Atrial Fibrillation (AURAS-AF) - an automated software system to promote anticoagulation and reduce stroke risk: study protocol for a cluster randomised controlled trial
DiscussionAURAS-AF will investigate whether a simple intervention, using electronic primary care records, can improve OAC uptake in a high risk group for stroke. Given previous concerns about safety, especially surrounding inappropriate prescribing, we will also examine whether electronic reminders safely impact care in this clinical area.Trial registration: ISRCTN 55722437
Source: Trials - November 13, 2013 Category: Journals (General) Authors: Tim HoltDavid FitzmauriceTom MarshallMatthew FayNadeem QureshiAndrew DaltonF HobbsDaniel LassersonKaren KearleyJenny HislopJing Jin Source Type: research

Service factors causing delay in specialist assessment for TIA and minor stroke: a qualitative study of GP and patient perspectives
Conclusions Primary and emergency care providers need to review how they can best handle patients presenting with symptoms that could be due to stroke or TIA. In general practice, this may include receptionist training and/or triage by a nurse or doctor. Mechanisms need to be established to enable direct referral to the TIA clinic when patients whose symptoms have resolved present to other agencies. Further work is needed to improve diagnostic accuracy by non-specialists.
Source: BMJ Open - May 16, 2016 Category: Journals (General) Authors: Wilson, A., Coleby, D., Regen, E., Phelps, K., Windridge, K., Willars, J., Robinson, T. Tags: Open access, Cardiovascular medicine, Emergency medicine, Health services research, Qualitative research Source Type: research

Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care
Conclusions Observed differential prescribing of OACs can result in channelling bias in comparative effectiveness research. Persistence patterns changed over follow-up time, but there are indications of improved persistence rates with apixaban over other OACs in the UK. A larger study with longer follow-up is needed to corroborate findings. This study is registered on ClinicalTrials.gov (NCT02488421).
Source: BMJ Open - September 25, 2016 Category: Journals (General) Authors: Johnson, M. E., Lefevre, C., Collings, S.-L., Evans, D., Kloss, S., Ridha, E., Maguire, A. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice Research Source Type: research

Cluster randomised controlled trial of screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the pilot study for the SAFER trial
Introduction Atrial fibrillation (AF) is a common arrhythmia associated with 30% of strokes, as well as other cardiovascular disease, dementia and death. AF meets many criteria for screening, but there is limited evidence that AF screening reduces stroke. Consequently, no countries recommend national screening programmes for AF. The Screening for Atrial Fibrillation with ECG to Reduce stroke (SAFER) trial aims to determine whether screening for AF is effective at reducing risk of stroke. The aim of the pilot study is to assess feasibility of the main trial and inform implementation of screening and trial procedures. Metho...
Source: BMJ Open - September 9, 2022 Category: General Medicine Authors: Williams, K., Modi, R. N., Dymond, A., Hoare, S., Powell, A., Burt, J., Edwards, D., Lund, J., Johnson, R., Lobban, T., Lown, M., Sweeting, M. J., Thom, H., Kaptoge, S., Fusco, F., Morris, S., Lip, G., Armstrong, N., Cowie, M. R., Fitzmaurice, D. A., Free Tags: Open access, Public health Source Type: research

Myocardial infarction and stroke subsequent to urinary tract infection (MISSOURI): protocol for a self-controlled case series using linked electronic health records
Introduction There is increasing interest in the relationship between acute infections and acute cardiovascular events. Most previous research has focused on understanding whether the risk of acute cardiovascular events increases following a respiratory tract infection. The relationship between urinary tract infections (UTIs) and acute cardiovascular events is less well studied. Therefore, the aim of this study is to determine whether there is a causal relationship between UTI and acute myocardial infarction (MI) or stroke. Methods and analysis We will undertake a self-controlled case series study using linked anonymised ...
Source: BMJ Open - September 22, 2022 Category: General Medicine Authors: Reeve, N. F., Best, V., Gillespie, D., Hughes, K., Lugg-Widger, F. V., Cannings-John, R., Torabi, F., Wootton, M., Akbari, A., Ahmed, H. Tags: Open access, Infectious diseases Source Type: research

Accounts of preventative coping: an interview study of stroke survivors on general practice registers
Conclusions We highlight that coping was characterised by survivors as something enacted by the individual self, and consider how constructions of self may impact preventative coping efforts.
Source: BMJ Open - September 5, 2022 Category: General Medicine Authors: Scott Reid, P., Neville, E., Cater, F., Mullis, R., Mant, J., Duschinsky, R. Tags: Open access, Cardiovascular medicine Source Type: research

Evaluating quality and its determinants in lipid control for secondary prevention of heart disease and stroke in primary care: a study in an inner London Borough
Conclusions In this study, the key factor that explained poor lipid control in people with CVD was having no current prescription record of a statin. Women were more likely to have poorly controlled cholesterol (independent of comorbid risk factors and after adjusting for age, ethnicity, deprivation index and practice-level variation). Women with CVD should be offered statin prescription and may require higher statin dosage for improved control.
Source: BMJ Open - December 9, 2015 Category: Journals (General) Authors: Dodhia, H., Kun, L., Logan Ellis, H., Crompton, J., Wierzbicki, A. S., Williams, H., Hodgkinson, A., Balazs, J. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Health services research Source Type: research

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