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Total 186 results found since Jan 2013.
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 Statins: new American guidelines for prevention of cardiovascular disease
Guidelines released on Nov 13, 2013, by the American Heart Association (AHA) and the American College of Cardiology (ACC) for the management of cholesterol are a major step in the right direction. These new guidelines emphasise prevention of stroke as well as heart disease, focus appropriately on statin therapy rather than alternative unproven therapeutic agents, and recognise that more intensive treatment is superior to less intensive treatment for many patients. Furthermore, the new ACC/AHA guidelines show that for individuals in whom statin therapy is clearly indicated (such as those with previous vascular disease or LD...
Source: LANCET - November 30, 2013 Category: Journals (General) Authors: Paul M Ridker, Nancy R Cook Tags: Comment Source Type: research
Editorial Statins: new US guideline sparks controversy
Statins reduce cholesterol and are prescribed to many millions of people in high-income countries—not only high-risk patients with familial hypercholesterolaemia, for example, but also for primary prevention of atherosclerotic cardiovascular disease. Adverse events such as statin-induced myopathy are rare, and statins are likely to have contributed to the substantial fall in cardiovascular events, including stroke, at population level in recent decades.
Source: LANCET - November 23, 2013 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research
Correspondence Intermittent pneumatic compression in patients with stroke
We read with great interest the Article by the CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration (Aug 10, p 516) that assessed intermittent pneumatic compression (IPC) in immobile patients with acute stroke. Patients were allocated to receive either IPC or no IPC. The authors conclude that IPC is an effective method of reducing the risk of deep vein thrombosis (DVT) and possibly improving survival in patients who are immobile after stroke.
Source: LANCET - November 2, 2013 Category: Journals (General) Authors: Johann Auer, Robert Berent, Franz Gurtner Tags: Correspondence Source Type: research
Correspondence Intermittent pneumatic compression in patients with stroke – Authors' reply
Johann Auer and colleagues question whether intermittent pneumatic compression (IPC) would be as effective if used with prophylactic anticoagulants. The CLOTS 3 trial was done in the UK, where the evidence-based national guidelines do not recommend routine use of anticoagulants for deep vein thrombosis (DVT) prophylaxis after stroke. David Barer highlights that although anticoagulants reduce (mainly asymptomatic) DVT, effects on pulmonary embolism are unclear and the increase in bleeds offsets any benefits, so there is no significant effect on survival or functional outcomes.
Source: LANCET - November 2, 2013 Category: Journals (General) Authors: Martin Dennis, Peter Sandercock, Gordon Murray, John Forbes Tags: Correspondence Source Type: research
Correspondence Surgery for cerebral haemorrhage—STICH II trial
In the STICH II trial, an absolute benefit of 3·7% in favourable outcome and 5·6% in mortality were reported for the early surgery group, but a significant difference between surgery and conservative treatment was not reached for the primary outcome. Glasgow coma scale was the only scoring clinical indicator. Other stroke scales assessing clinical severity—ie, the National Institutes of Health scale, could be considered. Neurological severity, also in a conscious patient, is an important prognostic indicator.
Source: LANCET - October 26, 2013 Category: Journals (General) Authors: Simone Vidale, Silvio Bellocchi, Angelo Taborelli Tags: Correspondence Source Type: research
Department of Error Department of Error
CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet 2013;382:516–24— In this Article, in Table 4 the corrected numbers for “Any death, DVT or PE” within 6 months of randomisation should have been: 526 (36·6%) events in the IPC group and 626 (43·5%) events in the no-IPC group, the absolute risk difference −7·0 (95% CI −10·5 to −3·4), the risk ratio 0·83 (95% CI 0·75 to 0·92), the odds ratio 0·74...
Source: LANCET - September 21, 2013 Category: Journals (General) Authors: The Lancet Tags: Department of Error Source Type: research
Comment Genetics of warfarin dosing—one polymorphism at a time
Few drugs define a narrow therapeutic index better than warfarin. With a typical therapeutic international normalised ratio (INR) of 2·0–3·0 for most indications (2·5–3·5 for mechanical heart valves), clinicians are challenged to define and implement dosing regimens that achieve therapeutic anticoagulation. The stakes could hardly be higher: too low a dose places the patient at an increased risk of a life-altering ischaemic event (ie, stroke or pulmonary embolism); and too high a dose can lead to a fatal cerebral or gastrointestinal haemorrhage.
Source: LANCET - August 30, 2013 Category: Journals (General) Authors: Mark J Alberts Tags: Comment 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
Comment Intermittent pneumatic compression in patients with stroke
A patient with acute stroke has just been admitted who is immobile, and cannot walk to the bathroom without help. Looking at the patient's unmoving legs the risk of thrombosis is clear, but a low molecular weight heparin (LMWH) might lead to bleeding, and elastic compression stockings cause skin problems. So you settle on intermittent pneumatic compression devices (IPCs)—but do they actually prevent blood clots?
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: Scott M Stevens, Scott C Woller Tags: Comment Source Type: research
Department of Error Department of Error
The SPS3 Study Group. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet 2013; 382: 507–15— In this Article, C S Coffey should have been listed as a member of the writing committee and, in the list of clinical sites, University of Washington at St Louis should have been Washington University in St Louis. These corrections have been made to the printed report and to the online version as of Aug 9, 2013.
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: The Lancet Tags: Department of Error 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
Articles Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial
IPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke.
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration Tags: Articles Source Type: research
