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Stroke management

Jan Steffel, Peter Verhamme, Tatjana S Potpara, Pierre Albaladejo, Matthias Antz, Lien Desteghe, Karl Georg Haeusler, Jonas Oldgren, Holger Reinecke, Vanessa Roldan-Schilling, Nigel Rowell, Peter Sinnaeve, Ronan Collins, A John Camm, Hein Heidbüchel
The current manuscript is the Executive Summary of the second update to the original Practical Guide, published in 2013. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF), and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain...
March 19, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jan Steffel, Peter Verhamme, Tatjana S Potpara, Pierre Albaladejo, Matthias Antz, Lien Desteghe, Karl Georg Haeusler, Jonas Oldgren, Holger Reinecke, Vanessa Roldan-Schilling, Nigel Rowell, Peter Sinnaeve, Ronan Collins, A John Camm, Hein Heidbüchel
The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation...
March 17, 2018: European Heart Journal
Parminder Raina, Anne Gilsing, Heinz Freisling, Edwin van den Heuvel, Nazmul Sohel, Mazda Jenab, Pietro Ferrari, Anne Tjønneland, Vassiliki Benetou, Susan Picavet, Sture Eriksson, Ben Schöttker, Hermann Brenner, Kai-Uwe Saum, Laura Perna, Tom Wilsgaard, Antonia Trichopoulou, Paolo Boffetta, Lauren E Griffith
Background: The number of older people living with cancer and cardio-metabolic conditions is increasing but little is known about how specific combinations of these conditions impact mortality. Methods: A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, MI, stroke, and diabetes at baseline...
March 19, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Sang Beom Kim, Sook Joung Lee, Kyeong Woo Lee, Jong Hwa Lee, Dong Won Kim
Objective: To demonstrate the usefulness of early videofluoroscopic swallowing study (VFSS) and to investigate change patterns in dietary methods in stroke patients with dysphagia. Methods: The VFSS was performed within 7 days of stroke onset in neurologically stable patients. The patients were divided into three groups according to type of brain lesion: cortical lesion (CL), subcortical lesion (SCL), and brainstem/cerebellar lesion (BCL). Based on the VFSS results, this study investigated change patterns in feeding method and discrepancies in the aspiration risk predicted by the Water Swallowing Test (WST) and the VFSS...
February 2018: Annals of Rehabilitation Medicine
Susann J Jarhult, Melissa L Howell, Isabelle Barnaure-Nachbar, Yuchiao Chang, Benjamin A White, Mary Amatangelo, David F Brown, Aneesh B Singhal, Lee H Schwamm, Scott B Silverman, Joshua N Goldstein
Introduction: Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA). Methods: We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup...
March 2018: Western Journal of Emergency Medicine
Lei Liu, Yaqin Wang, Zhongyang Hu, Pinting Yang, Xia Cao, Ting Yuan, Guilian Wang, Zhiheng Chen
To explore the correlation between cerebrovascular hemodynamic index (CVHI)accumulative score and subclinical arteriosclerosis indicators.
 Methods: A total of 27 184 cases were collected from the Health Management Center, the Third Xiangya Hospital, Central South University. Linear regression analysis was carried out to confirm the correlations between CVHI accumulative score and the modified Framingham stroke profile (FSP), as well as between CVHI accumulative score and cerebrovascular diseases (ICVD) scale...
February 28, 2018: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
Jessica Heward, Lydia Stone, Stella-Maria Paddick, Sarah Mkenda, William K Gray, Catherine L Dotchin, John Kissima, Cecilia Collingwood, Bernadetha Swai, Richard W Walker
BACKGROUND: The number of people living with dementia in sub-Saharan Africa (SSA) is expected to increase rapidly in the coming decades. However, our understanding of how best to reduce dementia risk in the population is very limited. As a first step in developing intervention strategies to manage dementia risk in this setting, we investigated rates of cognitive decline in a rural population in Tanzania and attempted to identify associated factors. METHODS: The study was conducted in the rural Hai district of northern Tanzania...
March 21, 2018: International Psychogeriatrics
Hui Yin Lim, Harshal Nandurkar, Prahlad Ho
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs...
March 20, 2018: Seminars in Thrombosis and Hemostasis
Kristina Griffin, Michael O'Hearn, Carla C Franck, Carol A Courtney
STUDY DESIGN: Case Report. PURPOSE: Stroke is the most common cause of long-term disability. Dysesthesia, an unpleasant sensory disturbance, is common following thalamic stroke and evidence-based interventions for this impairment are limited. The purpose of this case report was to describe a decrease in dysesthesia following manual therapy intervention in a patient with history of right lacunar thalamic stroke. CASE DESCRIPTION: A 66-year-old female presented with tingling and dysesthesia in left hemisensory distribution including left trunk and upper/lower extremities, limiting function...
March 20, 2018: Disability and Rehabilitation
Kathryn F Kirchoff-Torres, Ekaterina Bakradze
PURPOSE OF REVIEW: Cerebral hyperperfusion syndrome (CHS) is a rare but significant complication after carotid revascularization and is increasingly recognized after acute stroke treatments. In this review, we discuss the epidemiology and pathophysiology of CHS, clinical presentation including ipsilateral headache, seizures, and focal neurological deficits, and radiographic presentation. We propose preventive therapies with emphasis on acute stroke post-thrombectomy hyperperfusion. RECENT FINDINGS: CHS was first described after carotid revascularization but is now also reported in patients with acute ischemic stroke...
March 19, 2018: Current Pain and Headache Reports
Amir Abukaresh, Rami Al-Abadlah, Bettina Böttcher, Khamis El-Essi
BACKGROUND: In the 2014 Palestinian annual health report, cerebrovascular accident was ranked as the third leading cause of death in the occupied Palestinian territory. Cerebrovascular accident is also one the most common causes of disability worldwide. Good management decreases mortality and morbidity. The aim of this study was to assess the current management of patients with ischaemic stroke at the Al-Shifa Hospital and to compare this with international guidelines. METHODS: For this clinical audit, we used simple random sampling to select files of patients admitted with the diagnosis of ischaemic stroke to the Al-Shifa Hospital...
February 21, 2018: Lancet
Mohammed N Alkhatib, Tamer Abd-Alghafoor, AlaaEldeen Elmassry, Loai Albarqouni, Bettina Böttcher, Maha Alfaqawi
BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. METHODS: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines...
February 21, 2018: Lancet
Natasha A Lannin, Louise Ada, Coralie English, Julie Ratcliffe, Maria Crotty
Rationale Although clinical practice guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin-A in conjunction with therapy, there is currently no evidence to support the addition of therapy. Aims To determine the effect and cost-benefit of adding evidence-based movement training to botulinum toxin-A. Sample size estimate A total of 136 participants will be recruited in order to be able to detect a between-group difference of seven points on the Goal Attainment Scale T-score with 80% power at a two-tailed significance level of 0...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Minjung Park, Jennifer Hunter, Soonman Kwon
High demand for traditional Korean medicine led to a policy change in 2010 allowing hospitals to provide Integrative medicine care that combines Western medicine and Korean medicine. This study evaluated the effects of Integrative medicine compared to Western medicine-only for managing acute stroke in South Korean hospitals. A retrospective matched case-control observational study was conducted for acute stroke patients admitted nationwide in 2012 and 2013. Propensity score matching was used to adjust for the likelihood of selecting Integrative medicine...
March 6, 2018: Health Policy
Jenq-Lin Yang, Sujira Mukda, Shang-Der Chen
Stroke is the leading cause of adult disability and mortality in most developing and developed countries. The current best practices for patients with acute ischemic stroke include intravenous tissue plasminogen activator and endovascular thrombectomy for large-vessel occlusion to improve clinical outcomes. However, only a limited portion of patients receive thrombolytic therapy or endovascular treatment because the therapeutic time window after ischemic stroke is narrow. To address the current shortage of stroke management approaches, it is critical to identify new potential therapeutic targets...
March 9, 2018: Redox Biology
Jaclyn Hirschey, Sunetra Bane, Moussa Mansour, Jodi Sperber, Stephen Agboola, Joseph Kvedar, Kamal Jethwani
BACKGROUND: Atrial fibrillation (AFib) is the most common form of heart arrhythmia and a potent risk factor for stroke. Nonvitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk; however, nonadherence to treatment is a concern. Additional tools that support self-care and medication adherence may benefit patients with AFib. OBJECTIVE: The aim of this study was to evaluate the perceived usability and usefulness of a mobile app designed to support self-care and treatment adherence for AFib patients who are prescribed NOACs...
March 15, 2018: JMIR Human Factors
Dan Rusinaru, Yohann Bohbot, Anne Ringle, Sylvestre Maréchaux, Momar Diouf, Christophe Tribouilloy
Aims: In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)<35 mL/m2. However, the relationship between LF and outcome remains unclear as data on normal reference values defining LF are scarce, and previous studies did not explore the risk associated with other SVi cut-points. We analysed the relationship between LF and mortality in severe AS to establish prognostic LF values associated with mortality risk...
March 13, 2018: European Heart Journal
William F McIntyre, David Conen, Brian Olshansky, Jonathan L Halperin, Emil Hayek, Menno V Huisman, Gregory Y H Lip, Shihai Lu, Jeff S Healey
BACKGROUND: Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF). HYPOTHESIS: Analysis of data in GLORIA-AF, an international, observational registry of patients with newly-diagnosed AF, can identify factors associated with treatment decisions and outcomes. METHODS: Multivariable regression identified patient, physician, and temporal factors associated with OAC prescription, versus management with antiplatelet drugs or no antithrombotic drugs in North American patients enrolled between November 2011 and February 2014...
March 15, 2018: Clinical Cardiology
Lenette M Jones, Kathy D Wright, McKenzie K Wallace, Tiffany Veinot
Nearly half of African-American women have hypertension, which increases their risk for cardiovascular disease and stroke. A plethora of consumer health information products and services exist to inform people with hypertension and to promote self-management among them. Promotion of information sharing by African-American women represents a promising, culturally-applicable strategy for consumer health information services focused on hypertension self-management. Yet, how African-American women share hypertension information with others is unclear...
January 2018: Journal of the Association for Information Science and Technology
Jorge C Kattah
Background: Previous series of bilateral vestibular loss (BVL) identified numerous etiologies, but surprisingly, a cause in a significant number of cases remains unknown. In an effort to understand possible etiology and management strategies, a global effort is currently in progress. Here, I contribute my 10-year experience with both acute and chronic BVL during the 2007-2017 decade. Methods: This is a retrospective review of the charts and EMR of patients diagnosed with BVL in the last 10 years...
2018: Frontiers in Neurology
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