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Total 186 results found since Jan 2013.
Correspondence Could upright posture be harmful in the early stages of stroke?
Findings from the AVERT trial (July 4, p 46)1 have effectively slain a long cherished theory of stroke unit enthusiasts, that the sooner mobilisation and active rehabilitation begin after stroke, the better. In fact, evidence of a small, but significant, harmful effect of early mobilisation was found. After adjusting for age and stroke severity, and applying the prespecified cutoff for favourable outcome on the modified Rankin scale, we estimate that one in 13 patients (95% CI 8–40) had worse outcome with early mobilisation than with standard treatment.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: David Barer, Caroline Watkins Tags: Correspondence 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
Articles Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial
Routine thrombus aspiration during PCI for STEMI did not reduce longer-term clinical outcomes and might be associated with an increase in stroke. As a result, thrombus aspiration can no longer be recommended as a routine strategy in STEMI.
Source: LANCET - October 13, 2015 Category: Journals (General) Authors: Sanjit S Jolly, John A Cairns, Salim Yusuf, Michael J Rokoss, Peggy Gao, Brandi Meeks, Sasko Kedev, Goran Stankovic, Raul Moreno, Anthony Gershlick, Saqib Chowdhary, Shahar Lavi, Kari Niemela, Ivo Bernat, Warren J Cantor, Asim N Cheema, Philippe Gabriel S Tags: Articles Source Type: research
Articles Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial
Antibiotic prophylaxis cannot be recommended for prevention of post-stroke pneumonia in patients with dysphagia after stroke managed in stroke units.
Source: LANCET - September 3, 2015 Category: Journals (General) Authors: Lalit Kalra, Saddif Irshad, John Hodsoll, Matthew Simpson, Martin Gulliford, David Smithard, Anita Patel, Irene Rebollo-Mesa, STROKE-INF Investigators Tags: Articles Source Type: research
Comment Prevention of stroke-associated pneumonia: where next?
Prevention and treatment of complications, such as infection, are a mainstay of post-stroke care.1,2 However, even with dedicated care in a stroke unit, disorders such as stroke-associated pneumonia are a major challenge;2,3 and since this disorder is a substantial contributor to mortality and morbidity after stroke, new therapeutic approaches are urgently needed.3,4 Experimental studies and phase 2b randomised controlled trials5,6 raised hope that preventive anti-infective treatment with antibiotics might not only control infections, but also improve outcomes after stroke.
Source: LANCET - September 3, 2015 Category: Journals (General) Authors: Andreas Meisel, Craig J Smith Tags: Comment Source Type: research
Correspondence The promise of personalised medicine
I read with great interest the Viewpoint by Victor Dzau and colleagues (May 23, p 2118)1 who suggested that personalised and precision medicine would result in identification of patients at highest risk of six high-prevalence diseases (cancer, diabetes, heart disease, hypertension, lung disease, and stroke) and lead to subsequent early prophylactic intervention. The authors also suggested that personalised medicine could lead to substantial cumulative gains (expressed using US$100 000 per quality-adjusted life-year, with a $33 billion gain at a reduced disease incidence of 10% and up to a $607 billion gain at a 50% incid...
Source: LANCET - August 21, 2015 Category: Journals (General) Authors: Claude Matuchansky Tags: Correspondence Source Type: research
Comment Long working hours: an avoidable cause of stroke?
William Osler, in an article about atherosclerosis published 100 years ago, wrote that the main cause of myocardial infarction was “wear and tear of life”.1 Although we now have more detailed theories regarding the causal mechanisms, there is still some kinship between modern studies of work-related determinants of cardiovascular diseases and Osler's broad approach to the cause of disease.2
Source: LANCET - August 19, 2015 Category: Journals (General) Authors: Urban Janlert Tags: Comment Source Type: research
Articles Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.
Source: LANCET - August 19, 2015 Category: Journals (General) Authors: Mika Kivimäki, Markus Jokela, Solja T Nyberg, Archana Singh-Manoux, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Raimund Erbel, Goedele A Geuskens, Mark H Tags: Articles Source Type: research
Correspondence Parenteral antibiotics are not enough to prevent pneumonia in stroke
The Preventive Antibiotics in Stroke Study (PASS; April 18, p 1519)1 reported that parenteral ceftriaxone did not significantly reduce pneumonia. We would like to comment on these results.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Luciano Silvestri, Hendrick K F van Saene, Marco Milanese, Silvia Ros, Durk F Zandstra Tags: Correspondence Source Type: research
Correspondence Parenteral antibiotics are not enough to prevent pneumonia in stroke – Authors' reply
The susceptibility of patients with stroke to pneumonia has been well recognised,1 and its cause is multifactorial.2 Luciano Silvestri and colleagues rightly point out pathophysiological differences between early pneumonia after stroke, defined as within the first week after stroke onset, and late pneumonia, defined as after the first week. The Pneumonia In Stroke ConsEnsuS (PISCES) group has recently recommended reserving the term stroke-associated pneumonia for the spectrum of lower respiratory tract infections within the first 7 days after stroke onset.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Diederik van de Beek, Matthijs Brouwer, Paul Nederkoorn Tags: Correspondence Source Type: research
Correspondence The future of stroke therapy must not be mired by past arguments
Stroke is the leading cause of disability and the fifth leading cause of death in the UK, costing the UK economy more than £7 billion per year.1 At present, the only therapeutic approved by the UK National Institute for Health and Care Excellence (NICE) for the treatment of ischaemic stroke is thrombolysis using recombinant tissue-type plasminogen activator (rtPA). However, rtPA is only effective in patients who present within 4·5 h of stroke onset, with a number needed to treat for benefit of 3·6 before 90 min, rising to 5·9 between 3 h and 4·5 h.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Alastair M Buchan, Hasneen G Karbalai, Brad A Sutherland Tags: Correspondence Source Type: research
Obituary Levi Watkins
Cardiac surgeon and US civil rights champion. Born in Parsons, KS, USA, on June 13, 1944, he died of complications from a stroke in Baltimore, MD, USA, on April 11, 2015, aged 70 years.
Source: LANCET - July 24, 2015 Category: Journals (General) Authors: Geoff Watts Tags: Obituary Source Type: research
Department of Error Department of Error
Verheugt FWA, Granger CB. Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs. Lancet 2015; 386: 303–10—In table 1 of this Series paper, the drug metabolism row for the RE-LY trial should have stated only P-glycoprotein. This correction has been made to the printed paper, and to the online version as of July 17, 2015.
Source: LANCET - July 17, 2015 Category: Journals (General) Tags: Department of Error Source Type: research
Comment AVERT: a major milestone in stroke research
Prevention of stroke is, of course, the ideal scenario, but with more than 10 million major strokes every year worldwide, acute treatment and rehabilitation should also be optimised. Organised acute stroke care within dedicated stroke units reduces death and dependency after stroke,1 but which elements of such care confer this benefit is uncertain. Systematic prevention of common complications and more expert nursing care undoubtedly contribute, but in the physiologically unstable setting of acute stroke, the benefits and harms of each specific element of care need to be reliably assessed.
Source: LANCET - May 10, 2015 Category: Journals (General) Authors: Peter M Rothwell Tags: Comment Source Type: research
Obituary John Arras
Leading US philosopher and bioethicist. Born on Aug 25, 1945, in San Mateo, CA, USA, he died from a stroke on March 9, 2015, in Galveston, TX, USA, aged 69 years.
Source: LANCET - May 8, 2015 Category: Journals (General) Authors: Alison Snyder Tags: Obituary Source Type: research
