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Study protocol for development and validation of a single tool to assess risks of stroke, diabetes mellitus, myocardial infarction and dementia: DemNCD-Risk
Introduction Current efforts to reduce dementia focus on prevention and risk reduction by targeting modifiable risk factors. As dementia and cardiometabolic non-communicable diseases (NCDs) share risk factors, a single risk-estimating tool for dementia and multiple NCDs could be cost-effective and facilitate concurrent assessments as compared with a conventional single approach. The aim of this study is to develop and validate a new risk tool that estimates an individual’s risk of developing dementia and other NCDs including diabetes mellitus, stroke and myocardial infarction. Once validated, it could be used by the ...
Source: BMJ Open - September 22, 2023 Category: General Medicine Authors: Kootar, S., Huque, M. H., Kiely, K. M., Anderson, C. S., Jorm, L., Kivipelto, M., Lautenschlager, N. T., Matthews, F., Shaw, J. E., Whitmer, R. A., Peters, R., Anstey, K. J. Tags: Open access, Public health Source Type: research

Improving sleep and learning in rehabilitation after stroke, part 2 (INSPIRES2): study protocol for a home-based randomised control trial of digital cognitive behavioural therapy (dCBT) for insomnia
Introduction Consolidation of motor skill learning, a key component of rehabilitation post-stroke, is known to be sleep dependent. However, disrupted sleep is highly prevalent after stroke and is often associated with poor motor recovery and quality of life. Previous research has shown that digital cognitive behavioural therapy (dCBT) for insomnia can be effective at improving sleep quality after stroke. Therefore, the aim of this trial is to evaluate the potential for sleep improvement using a dCBT programme, to improve rehabilitation outcomes after stroke. Methods and analysis We will conduct a parallel-arm randomised c...
Source: BMJ Open - April 6, 2023 Category: General Medicine Authors: Weightman, M., Robinson, B., Fallows, R., Henry, A. L., Kyle, S. D., Garratt, E., Pick, A., Teal, R., Ajina, S., Demeyere, N., Espie, C. A., Seymour, B., Johansen-Berg, H., Fleming, M. K. Tags: Open access, Rehabilitation medicine Source Type: research

Factors associated with discharge from hospital to residential aged care for younger people with neuropsychiatric disorders: an exploratory case-control study in New South Wales, Australia
Conclusions There are multiple intersecting and interacting pathways culminating in discharge from hospital to RAC among younger people with neuropsychiatric disorders. Improved capacity for interdisciplinary home care and alternative housing and support options for people with high support needs are required.
Source: BMJ Open - December 1, 2022 Category: General Medicine Authors: Cvejic, R. C., Watkins, T. R., Walker, A. R., Reppermund, S., Srasuebkul, P., Draper, B., Withall, A., Winkler, D., Honan, I., Mackechnie, D., Trollor, J. Tags: Open access, Epidemiology Source Type: research

Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomised-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2)
Conclusion We completed a large prehospital stroke trial involving a simple-to-administer intervention across multiple ambulance services. The time from onset to randomisation and modest distances travelled support the applicability of future large-scale paramedic-delivered ambulance-based stroke trials in urban and rural locations. Trial registration number ISRCTN26986053.
Source: BMJ Open - November 21, 2022 Category: General Medicine Authors: Dixon, M., Appleton, J. P., Scutt, P., Woodhouse, L. J., Haywood, L. J., Havard, D., Williams, J., Siriwardena, A. N., Bath, P. M., on behalf of the RIGHT-2 Investigators Tags: Open access, Neurology 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

Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study
Conclusion MM and CMM were common in older Australian adults; and MM was a better predictor of all-cause mortality risk than CMM. Higher mortality risk in those aged 45–59 years indicates tailored, person-centred integrated care interventions and better access to holistic healthcare are needed for this age group.
Source: BMJ Open - July 26, 2022 Category: General Medicine Authors: Kabir, A., Tran, A., Ansari, S., Conway, D. P., Barr, M. Tags: Open access, Geriatric medicine Source Type: research

Structured follow-up pathway to support people after transient ischaemic attack and minor stroke (SUPPORT TIA): protocol for a feasibility study and process evaluation
Introduction People who experience transient ischaemic attack (TIA) and minor stroke have limited follow-up despite rapid specialist review in hospital. This means they often have unmet needs and feel abandoned following discharge. Care needs after TIA/minor stroke include information provision (diagnosis and stroke risk), stroke prevention (medication and lifestyle change) and holistic care (residual problems and return to work or usual activities). This protocol describes a feasibility study and process evaluation of an intervention to support people after TIA/minor stroke. The study aims to assess the feasibility and ac...
Source: BMJ Open - June 16, 2022 Category: General Medicine Authors: Turner, G. M., Jones, R., Collis, P., Patel, S., Jowett, S., Tearne, S., Foy, R., Atkins, L., Mant, J., Calvert, M. Tags: Open access, Cardiovascular medicine Source Type: research

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb post Stroke (RHOMBUS II): protocol of a feasibility randomised controlled trial
Introduction Upper limb (UL) rehabilitation is most effective early after stroke, with higher doses leading to improved outcomes. For the stroke survivor, the repetition may be monotonous. For clinicians, providing a clinically meaningful level of input can be challenging. As such, time spent engaged in UL activity among subacute stroke survivors remains inadequate. Opportunities for the stroke survivor to engage with UL rehabilitation in a safe, accessible and engaging way are essential to improving UL outcomes following stroke. The NeuroBall is a non-immersive virtual reality (VR) digital system designed for stroke rehab...
Source: BMJ Open - June 7, 2022 Category: General Medicine Authors: Kilbride, C., Warland, A., Stewart, V., Aweid, B., Samiyappan, A., Ryan, J., Butcher, T., Athanasiou, D. A., Baker, K., Singla-Buxarrais, G., Anokye, N., Pound, C., Gowing, F., Norris, M. Tags: Open access, Rehabilitation medicine Source Type: research

Exploring the experiences and challenges for patients undergoing cranioplasty: a mixed-methods study protocol
This study hopes to understand some of these issues and therefore help inform clinicians of some of the difficulties and perceptions that patients and their relatives may have. Methods and analysis A mixed-methods study. Data will be collected through focus groups with healthcare professionals (HCPs) and semi-structured interviews with patients and their relatives, field notes, a researcher diary and a patient questionnaire. Different perspectives will be brought together through method triangulation. Patient and relative data will be analysed using interpretive phenomenological analysis, and HCPs data will be analysed th...
Source: BMJ Open - April 22, 2022 Category: General Medicine Authors: Mee, H., Clement, C., Anwar, F., Whiting, G., Timofeev, I., Helmy, A., Hutchinson, P. J., Kolias, A. G. Tags: Open access, Rehabilitation medicine Source Type: research

Investigating the association between inpatient stroke therapy and disability, destination on discharge, length of stay and mortality: a prospective cohort study using the Sentinel Stroke National Audit Programme
Conclusions Our findings suggest for stroke inpatients requiring therapy, ‘More is better’ may be overly simplistic. Strong limitations associated with analysis of routine data restrict further robust investigation of the therapy–response relationship. Robust prospective work is urgently needed to further investigate the relationships observed here.
Source: BMJ Open - April 1, 2022 Category: General Medicine Authors: Gittins, M., Lugo-Palacios, D. G., Vail, A., Bowen, A., Paley, L., Bray, B., Gannon, B., Tyson, S. Tags: Open access, Rehabilitation medicine Source Type: research

How are adults with capacity-affecting conditions and associated communication difficulties included in ethically sound research? A documentary-based survey of ethical review and recruitment processes under the research provisions of the Mental Capacity Act (2005) for England and Wales
Conclusions People with capacity-affecting conditions and associated communication difficulties continue to be excluded from research, with recruitment efforts largely concentrated around participant-facing documentation. There is a need for a more nuanced approach if such individuals are to be included in ethically sound research.
Source: BMJ Open - March 31, 2022 Category: General Medicine Authors: Bunning, K., Jimoh, O. F., Heywood, R., Killett, A., Ryan, H., Shiggins, C., Langdon, P. E. Tags: Open access, Ethics Source Type: research