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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

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

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

Using primary care data to assess comparative effectiveness and safety of apixaban and rivaroxaban in patients with nonvalvular atrial fibrillation in the UK: an observational cohort study
Conclusions Among patients with nonvalvular AFib, apixaban was as effective as rivaroxaban in reducing rate of stroke and safer in terms of major bleeding episodes. This head-to-head comparison supports conclusions drawn from indirect comparisons of DOAC trials against warfarin and demonstrates the potential for real-world evidence to fill evidence gaps and reduce uncertainty in both health technology assessment decision-making and clinical guideline development.
Source: BMJ Open - October 17, 2022 Category: General Medicine Authors: Jaksa, A., Gibbs, L., Kent, S., Rowark, S., Duffield, S., Sharma, M., Kincaid, L., Ali, A. K., Patrick, A. R., Govil, P., Jonsson, P., Gatto, N. Tags: Open access, Cardiovascular medicine Source Type: research

Primary Care Atrial Fibrillation Service: outcomes from consultant-led anticoagulation assessment clinics in the primary care setting in the UK
Conclusions Systematic identification of patients with AF with high stroke-risk and consultation in PCAF consultant-led clinics effectively delivers oral anticoagulation to high-risk patients with AF in the community.
Source: BMJ Open - December 9, 2015 Category: Journals (General) Authors: Das, M., Panter, L., Wynn, G. J., Taylor, R. M., Connor, N., Mills, J. D., Kirchhof, P., Gupta, D. Tags: Open access, Cardiovascular medicine, General practice / Family practice, Pharmacology and therapeutics Research Source Type: research

A retrospective cohort study to investigate fatigue, psychological or cognitive impairment after TIA: protocol paper
Introduction Transient ischaemic attack (TIA) is defined by short-lasting, stroke-like symptoms, and is recognised as a medical emergency. Symptoms are assumed to completely resolve, and treatment is focused on secondary stroke/TIA prevention. However, evidence suggests that patients with TIA may experience ongoing residual impairments, which they do not receive therapy for as standard practice. TIA-induced sequelae could impact on patients’ quality of life and ability to return to work or social activities. We aim to investigate whether TIA is associated with subsequent consultation for fatigue, psychological or cog...
Source: BMJ Open - May 3, 2015 Category: Journals (General) Authors: Moran, G. M., Calvert, M., Feltham, M. G., Ryan, R., Marshall, T. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice Protocol Source Type: research

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