X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Stroke Unit Care Benefits Patients With Intracerebral Hemorrhage : Systematic Review and Meta-analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 11 ( 2013-11), p. 3044-3049
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 11 ( 2013-11), p. 3044-3049
    Abstract: Patients with any type of stroke managed in organized inpatient (stroke unit) care are more likely to survive, return home, and regain independence. However, it is uncertain whether these benefits apply equally to patients with intracerebral hemorrhage and ischemic stroke. Methods— We conducted a secondary analysis of a systematic review of controlled clinical trials comparing stroke unit care with general ward care, including only trials published after 1990 that could separately report outcomes for patients with intracerebral hemorrhage and ischemic stroke. We performed random-effects meta-analyses and tested for subgroup interactions by stroke type. Results— We identified 13 trials (3570 patients) of modern stroke unit care that recruited patients with intracerebral hemorrhage and ischemic stroke, of which 8 trials provided data on 2657 patients. Stroke unit care reduced death or dependency (risk ratio [RR], 0.81; 95% confidence interval [CI] , 0.471–0.92; P =0.0009; I 2 =60%) with no difference in benefits for patients with intracerebral hemorrhage (RR, 0.79; 95% CI, 0.61–1.00) than patients with ischemic stroke (RR, 0.82; 95% CI, 0.70–0.97; P interaction =0.77). Stroke unit care reduced death (RR, 0.79; 95% CI, 0.64–0.97; P =0.02; I 2 =49%) to a greater extent for patients with intracerebral hemorrhage (RR, 0.73; 95% CI, 0.54–0.97) than patients with ischemic stroke (RR, 0.82; 95%, CI 0.61–1.09), but this difference was not statistically significant ( P interaction =0.58). Conclusions— Patients with intracerebral hemorrhage seem to benefit at least as much as patients with ischemic stroke from organized inpatient (stroke unit) care.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.001564
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 2
    Online Resource
    Online Resource
    Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 5 ( 2003-05), p. 1252-1257
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 5 ( 2003-05), p. 1252-1257
    Abstract: Background and Purpose— Dysphagia is common after stroke and is a marker of poor prognosis. Early identification is important. This article reviews the merits and limitations of various assessment methods available to clinicians. Methods— An electronic database search was performed of MEDLINE, EMBASE, and the Cochrane database using such terms as stroke, aspiration, dysphagia, and assessment; extensive manual searching of articles was also conducted. Results— Bedside tests are safe, relatively straightforward, and easily repeated but have variable sensitivity (42% to 92%), specificity (59% to 91%), and interrater reliability (κ=0 to 1.0). They are also poor at detecting silent aspiration. Videofluoroscopy gives anatomic and functional information and allows testing of therapeutic techniques. However, swallowing is assessed under ideal conditions that are different from clinical settings, and reliability is often poor (κ=0 to 0.75) in the absence of assessor training. Fiberoptic endoscopy allows swallow assessment and sensory testing but requires specialized staff and equipment. Oxygen desaturation during swallowing may be predictive of aspiration (sensitivity, 73% to 87%; specificity, 39% to 87%) but is more useful in combination with bedside testing than in isolation. Other methods of swallow testing are invasive and require specialized staff and equipment. Conclusions— Although bedside tests remain an important early screening tool for dysphagia and aspiration risk, further refinements are needed to improve their accuracy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000066309.06490.B8
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 3
    Online Resource
    Online Resource
    Recent Advances in Stroke Rehabilitation 2006
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Stroke Vol. 38, No. 2 ( 2007-02), p. 235-237
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 2 ( 2007-02), p. 235-237
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000254944.91297.a3
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 4
    Online Resource
    Online Resource
    Alternative Strategies for Stroke Care : Cost-Effectiveness and Cost-Utility Analyses From a Prospective Randomized Controlled Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Stroke Vol. 35, No. 1 ( 2004-01), p. 196-203
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 1 ( 2004-01), p. 196-203
    Abstract: Background and Purpose— Although stroke units reduce mortality and institutionalization, their comparative cost-effectiveness is unknown. Methods— Healthcare, social services, and informal care costs were compared for 447 acute stroke patients randomly assigned to stroke unit, stroke team, or domiciliary stroke care. Prospective and retrospective methods were used to identify resource use over 12 months after stroke onset. Cost-effectiveness and cost-utility analyses were undertaken. Results— Mean healthcare and social care costs over 12 months were £11 450 for stroke unit, £9527 for stroke team, and £6840 for domiciliary care. More than half the costs were for the initial episode of care. Institutionalization was a large proportion of follow-up costs. Inclusion of informal care increased costs considerably. When informal care was excluded, the incremental cost-effectiveness ratio per percentage point in deaths or institutionalizations avoided in the first year was £496 for the stroke unit over domiciliary care; incremental cost per quality-adjusted life year quality-adjusted life year gained was £64 097 between these 2 groups. The stroke team was dominated by domiciliary care. Conclusions— Cost perspectives, especially those related to long-term and informal care, are important when stroke services are evaluated. Improved health outcomes in the stroke unit come at a higher cost.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000105390.20430.9F
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 5
    Online Resource
    Online Resource
    Abstract 18: Association of Peri-Infarct N-Acetyl Aspartate with Recovery from Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Introduction: Recovery from stroke has been correlated with specific anatomical lesions in the brain, however much of the variability in recovery remains unexplained. Recent research has indicated that the peri-infarct tissue plays a crucial role in recovery. We hypothesised that N-acetyl aspartate (NAA) can serve as a marker of neural integrity in the structurally intact peri-infarct region following stroke, with the potential to predict recovery. The objective of our study was to measure NAA in a longitudinal MR spectroscopy study in stroke patients, and to correlate these findings with functional outcome. Methods: Six patients (age 53±10 y) with a non-lacunar ischemic stroke in the left middle cerebral artery territory underwent MR spectroscopy on a 3.0 T MRI scanner. Patients were scanned at 3 and 15 weeks after stroke onset. Proton spectra were acquired from the structurally intact peri-infarct thalamus, the contralesional thalamus, and the anterior cingulate cortex (ACC) using a point resolved spectroscopy sequence with an echo time of 30 ms. NAA concentrations were calculated with LCModel. Clinical assessment included the Fugl-Meyer (FM) scale for the motor performance of the right arm and the NIHSS. Seven healthy controls (age 53±7 y) were also recruited. Results: At baseline, NAA was significantly lower in the patients in the structurally intact ipsilesional thalamus (9.0±2.1 vs 11.3±1.2, p=0.030), but not in the other 2 voxels. Baseline NAA was also significantly lower in the ipsilesional thalamus than in the ACC (9.0±2.1 vs 12.7±1.2, p=0.016) in the patients, but not in the controls. NAA decreased significantly between the 2 visits (9.0±2.1 vs 7.2±1.7, p=0.021) in the patients in the ipsilesional thalamus, but not in the other 2 voxels. The patients demonstrated significant clinical improvement during the course of follow up (median 15-point gain on the FM scale, p=0.042; and a 7-point decline on the NIHSS, p=0.026). NAA in the ipsilateral thalamus at baseline significantly correlated with the final FM (r s =0.81, p=0.025) and NIHSS scores (r s =-0.84, p=0.018). Conclusions: Stroke disturbs neuronal integrity in the structurally intact peri-infarct tissue. Despite clinical improvement, neural damage in the peri-infarct area appears to progress during the first 3-4 months following a non-lacunar ischemic stroke. This decreased neuronal integrity is associated with impaired recovery and may therefore represent a therapeutic target. Peri-infarct NAA is a potential biomarker not only for the prediction of recovery, but also for the monitoring of therapeutic interventions.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A18
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 6
    Online Resource
    Online Resource
    Abstract 94: Patient Selection using CT Perfusion (CTP) Imaging Improves Effectiveness of Stroke Thrombolysis in the 0-4.5 Hour Time Window
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: The role of CT perfusion (CTP) in thrombolysis decisions remains controversial and there are no studies that compare outcomes of thrombolysis in patients with or without mismatch on CT perfusion imaging. Methods: We analysed registry data between Jan 2009 and December 2010 for patients thrombolysed within 0-4.5 hours of stroke onset in whom CTP studies were performed prior to thrombolysis. The centre followed thrombolysis guidelines but patients 〉 80 years were included. CTP was not obligatory in the treatment protocol and failure to demonstrate a mismatch was not a contraindication to thrombolysis. We retrospectively analysed data for estimated CTP mismatch of ≥ 100% according to pre-defined criteria and compared outcomes of thrombolysed patients showing perfusion mismatch with those showing no mismatch. Findings: The sample included 160 patients aged between 32-95 years of whom 63 had no mismatch and 97 had a significant mismatch. The two groups were comparable for mean age (73 v 70 years, p=0.18), sex (49% v 54% male, p=0.75), premorbid Rankin Score (mRS) 0-2 (81% v 92%, p=0.77), vascular risk factors profile, mean baseline BP (148/87 v 148/79 mm Hg, p=0.92), mean blood glucose (6.6 v 6.6 mmols/L, p=0.98) and mean National Institute of Health Stroke Scale (NIHSS) score (14.0 v 12.6,p=0.12). Patients who had mismatch prior to thrombolysis showed lower mean 24 hour NIHSS score (7.6 v 11.8, p=0.002) and greater mean 24 hour improvement in NIHSS score (5.1 v 2.0, p=0.010). A higher proportion of patients with mismatch achieved mRS 0-1 and mRS 0-2 at 3 months (36% v 18%, p= 0.012 and 51% v 32%, p=0.015 respectively) but there were no differences in symptomatic sICH rates (1.1% v 0%). Mortality (29% v 18%) and any intracranial haemorrhages (19% v 13%) were lower in mismatch patients but did not achieve significance. Regression analyses showed that PCT mismatch prior to thrombolysis was an independent predictor of both early improvement and functional outcomes at 3 months. Conclusion: Stroke patients who have perfusion mismatch on CTP imaging prior to thrombolysis within the 4.5 hour time window show better early and 3 month outcomes compared with those in whom mismatch cannot be demonstrated. Patient selection using multimodal CT may improve the effectiveness of thrombolysis.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A94
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 7
    Online Resource
    Online Resource
    Monitoring Brain Repair in Stroke Using Advanced Magnetic Resonance Imaging
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 11 ( 2012-11), p. 3124-3131
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 11 ( 2012-11), p. 3124-3131
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.649244
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 8
    Online Resource
    Online Resource
    Diagnosis of Stroke-Associated Pneumonia : Recommendations From the Pneumonia in Stroke Consensus Group
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. 8 ( 2015-08), p. 2335-2340
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 8 ( 2015-08), p. 2335-2340
    Abstract: Lower respiratory tract infections frequently complicate stroke and adversely affect outcome. There is currently no agreed terminology or gold-standard diagnostic criteria for the spectrum of lower respiratory tract infections complicating stroke, which has implications for clinical practice and research. The aim of this consensus was to propose standardized terminology and operational diagnostic criteria for lower respiratory tract infections complicating acute stroke. Methods— Systematic literature searches of multiple electronic databases were undertaken. An evidence review and 2 rounds of consensus consultation were completed before a final consensus meeting in September 2014, held in Manchester, United Kingdom. Consensus was defined a priori as ≥75% agreement between the consensus group members. Results— Consensus was reached for the following: (1) stroke-associated pneumonia (SAP) is the recommended terminology for the spectrum of lower respiratory tract infections within the first 7 days after stroke onset; (2) modified Centers for Disease Control and Prevention (CDC) criteria are proposed for SAP as follows—probable SAP: CDC criteria met, but typical chest x-ray changes absent even after repeat or serial chest x-ray; definite SAP: CDC criteria met, including typical chest x-ray changes; (3) there is limited evidence for a diagnostic role of white blood cell count or C-reactive protein in SAP; and (4) there is insufficient evidence for the use of other biomarkers (eg, procalcitonin). Conclusions— Consensus operational criteria for the terminology and diagnosis of SAP are proposed based on the CDC criteria. These require prospective evaluation in patients with stroke to determine their reliability, validity, impact on clinician behaviors (including antibiotic prescribing), and clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.009617
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 9
    Online Resource
    Online Resource
    Abstract 2394: A Systematic Review of Respiratory Muscle Training in Stroke and Neurological Diseases
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: Respiratory muscle weakness in stroke patients may contribute to increased risk of pneumonias. We undertook a meta-analysis of randomised controlled trials (RCT) of respiratory muscle training (RMT) to investigate their benefit in stroke patients. Method: A literature search for relevant articles was performed on Medline, EMBASE, ISI web of knowledge and the Cochrane Central Register for Controlled Trials. Key words searched were stroke, cerebrovascular accident, multiple sclerosis, Parkinson’s disease, motor neurone disease and neurolog* in combination with inspiratory, expiratory, respiratory or ventilatory and training, loading and muscle . Studies were assessed for quality and analyses were undertaken following Cochrane guidelines. The primary outcome measure of muscle strength was the maximum inspiratory mouth pressure (PImax). Results: The search identified 1140 articles of which 34 remained after screening aganist pre-defined criteria and removal of duplicates. Of these 25 were excluded because 17 were not RCTs, 1 did not assess PI max and 7 investigated children. A total of 103 patients were included in the 9 eligible studies (2 stroke, 7 other neurological diseases). PImax was greater in patients receiving respiratory muscle training compared with controls at the end of training (WMD 6.94 cmH 2 O, 95% CI 2.84 - 11.04, P = 0.0009). The 2 studies in stroke patients included only 24 patients but showed a definite benefit in improving respiratory muscle strength (WMD for PI max 6.93 cmH 2 O, 95% CI 1.76 12.09, P = 0.009). ( Fig 1 ) Conclusion: Large trials of RMT in stroke are lacking but there is a suggestion that stroke patients have a potential to benefit. Large well designed studies are needed to evaluate the effectiveness of RMT for improving respiratory muscle strength and clinical outcomes in stroke patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A2394
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 10
    Online Resource
    Online Resource
    A Case-Controlled Comparison of Thrombolysis Outcomes Between Wake-Up and Known Time of Onset Ischemic Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 8 ( 2013-08), p. 2226-2231
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 8 ( 2013-08), p. 2226-2231
    Abstract: Wake-up ischemic stroke (WUIS) patients are not thrombolysed even if they meet other criteria for treatment. We hypothesized that patients with WUIS showing no or early ischemic changes on brain imaging will have thrombolysis outcomes comparable with those with known time of symptom onset. Methods— Consecutive sampling of a prospective registry of patients with stroke between January 2009 and December 2010 identified 394 thrombolysed patients meeting predefined inclusion criteria, 326 presenting within 0 to 4.5 hours of symptom onset (Reference Group) and 68 WUIS patients. Inclusion criteria were last seen normal 〈 12 hours or 〉 4.5 hours (WUIS) or presented 〈 4.5 hours (Reference Group), had National Institutes of Health Stroke Scale score ≥5, and no or early ischemic changes on imaging at presentation. The primary outcome measure was the modified Rankin Scale of 0 to 2 at 90 days measured by trained assessors blinded to patient grouping. Other outcome measures were symptomatic intracerebral hemorrhage, modified Rankin Scale 0 to 1, and mortality at 90 days. Results— The groups were comparable for mean age (72.8 versus 73.9 years; P =0.58) and baseline median National Institutes of Health Stroke Scale score (median 13 versus 12; P =0.34). The proportions of patients with modified Rankin Scale 0 to 2 (38% versus 37%; P =0.89) and modified Rankin Scale 0 to 1 (24% versus 16%; P =0.18) at 90 days, any ICH (20% versus 22%; P =0.42) and symptomatic intracerebral hemorrhage (3.4% versus 2.9%; P =1.0) were comparable after adjusting for age, stroke severity, and imaging changes. Only 9/394 (2%) patients were lost to follow-up. Conclusions— Thrombolysis in selected patients with WUIS is feasible, and its outcomes are comparable with those thrombolysed with 0 to 4.5 hours.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.000757
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
Nothing or not found what you are looking for? Please check your search query or use the Interlibrary Loan Search.
Close ⊗
This website uses cookies and the analysis tool Matomo. Further information can be found on the KOBV privacy pages