Stroke Horizon Scanning Bulletin Volume 10 Issue 10

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Transforming the stroke care pathway

Source: NHS Improvement

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Date of publication: 19^th October 2018

Publication type: Case Study

In a nutshell:

The Greater Manchester Stroke Delivery Network was set up in 2015 and is a partnership between NHS providers of stroke care in Greater Manchester and eastern Cheshire. It works closely with ambulance trusts, commissioners and the local strategic clinical network to improve services.

Governed by a board, it is run by a small team that includes a manager, coordinator, administrator and two clinical leads. This case study shows how the Greater Manchester Stroke Delivery Network became the best-rated in the country.

Prevention of stroke: a global perspective

Source: The Lancet

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Date of publication: 6^th October 2018

Publication type: Journal Article

In a nutshell:

In this Series paper, the authors discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). The focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. The findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke.

Some important notes: Please contact your local NHS library for the full text of this article. Follow this link to find your local NHS library.

Does mirror therapy improve motor function after a stroke?

Source: The Cochrane Library

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Date of publication: 10^th October 2018

Publication type: Cochrane Clinical Answer

In a nutshell:

Mirror therapy is a technique that is used in the rehabilitation of people with unilateral limb problems. Through this approach, the non‐paretic limb is reflected during use, so the individual is given visual feedback of movement on the weaker side. Randomized controlled trial evidence would suggest that upper limb mirror therapy is an effective co‐intervention for stroke rehabilitation.

Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke

Source: The Lancet

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Date of publication: 6^th October 2018

Publication type: Journal Article

In a nutshell:

Even though stroke presents as a variety of clinical syndromes, neuroimaging is the most important biomarker to help differentiate between stroke subtypes and assess treatment eligibility.

Therapeutic advances have led to intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation being standard care for acute ischaemic stroke. Providing access to this care has implications for existing systems of care for stroke and their organisation and has reintroduced the possibility of adjuvant and neuroprotective treatment strategies in acute ischaemic stroke. The use of neuroimaging for patient selection and speed of diagnosis and delivery of treatment are the dominant themes of modern ischaemic stroke care.

Some important notes: Please contact your local NHS library for the full text of this article. Follow this link to find your local NHS library.

Two antiplatelet drugs may prevent further strokes but increase major bleeds

Source: The National Institute for Health Research

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Date of publication: 2^nd October 2018

Publication type: NIHR Signal

In a nutshell:

People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone. However, taking both drugs doubles the risk of bleeding over the same period.

Current UK guidelines recommend using clopidogrel alone.

In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the first 30 days of treatment. Major bleeding risk was fairly constant on combined treatment throughout 90 days, occurring in 0.9% compared with 0.4% on aspirin.

This study provides more evidence on the balance of benefits and risks. Further research into the timing and duration of dual antiplatelet therapy is needed.

For people who have had a stroke, does repetitive task training help to improve functional ability?

Source: The Cochrane Library

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Date of publication: 15^th October 2018

Publication type: Cochrane Clinical Answer

In a nutshell:

Repetitive task training (RTT) appears to provide some benefit in improving upper and lower limb function, global motor function, and quality of life for patients who have had a stroke. However, patient populations, characteristics of strokes, and control interventions were extremely heterogeneous, limiting overall conclusions.