August stroke current awareness final by Musgrove Park Hospital Library

Library Service Musgrove Park Academy

Current Awareness Stroke This monthly Current Awareness Bulletin is produced by the Library, Musgrove Park Academy to provide staff with a range of stroke-related resources to support practice. It includes recently published guidelines and research articles, news and policy items.

This guide provides a selection of resources relevant to the subject area and is not intended to be a comprehensive list. All websites have been evaluated and details are correct at the time of publications. Details correct at time of going to print. Please note that resources are continuously updated. For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Jess Pawley Senior Library Assistant Musgrove Park Hospital Library Service jessica.pawley@tst.nhs.uk

Issue 1 August 2015

Contents Click on a section title to navigate contents Page Recent journal articles

Books

Cochrane Systematic Reviews 12 UpToDate & DynaMed

Stroke in the News

Reports, publications and resources

Twitter

Training & Networking Opportunities, Conferences, Events

Literature search service

Training and Athens

Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Tel: 01823 34 (2433) Fax: 01823 34 (2434) Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

RECENT JOURNAL ARTICLES BACK TO TOP This is a list of journal articles on the topic of stroke. Some articles are available in the library or online via an OpenAthens password by following the full-text link. If you would like an article which is not available as full-text then please contact library staff. Please note that abstracts are not always available for all articles.

Click on the image to access full-text-available from 1970 to current using your OpenAthens password

ARTICLES FROM OTHER JOURNALS ________________________________________________________________________________ Title: Baseline oxidative defense and survival after 5–7 years among elderly stroke patients at nutritional risk: Follow-up of a randomized, nutritional intervention trial. Citation: Clinical Nutrition, 01 August 2015, vol./is. 34/4(775-778), 02615614 Author(s): Iversen, Per O., Ha, Lisa, Blomhoff, Rune, Hauge, Truls, Veierød, Marit B. Abstract: Summary Background & aims Patients at nutritional risk are particularly vulnerable to adverse outcomes of acute stroke. We previously found that increased energy- and protein intervention improved short-term survival among stroke patients with the highest baseline antioxidant capacity. We now examined survival of these patients after 5–7 years. Methods We studied 165 patients >65 years admitted to hospital for acute stroke and enrolled in a randomized nutritional intervention study in 2005–2007. Cox regression analysis was used to estimate the associations between all-cause mortality (through 2011) and baseline plasma levels of antioxidant markers (glutathione reducing capacity, alpha-tocopherol, vitamin C and total carotenoids). Results We found no significant difference ( P = 0.86) in survival between the intervention and control group. Among the tested antioxidant markers, plasma levels above the median for total carotenoids were associated with reduced risk of death in the intervention group (adjusted hazard ratio, 0.29; 95% confidence interval, 0.12–0.71). Conclusions Hospitalized patients that received enhanced dietary energy- and protein after acute stroke and with baseline plasma total carotenoids above median level, had reduced risk of death after 5–7 years. Further trials testing intervention with diets rich in antioxidants are warranted. ________________________________________________________________________________ Title: Ward-based interventions for patients with hemispatial neglect in stroke rehabilitation: A systematic literature review. Citation: International Journal of Nursing Studies, 01 August 2015, vol./is. 52/8(1375-1403), 00207489 Author(s): Klinke, Marianne E., Hafsteinsdóttir, Thóra B., Hjaltason, Haukur, Jónsdóttir, Helga Abstract: Objectives: To identify rehabilitation interventions that can be integrated into ward-based nursing for patients with hemispatial neglect following stroke in the right brain hemisphere. Design: A systematic review of interdisciplinary literature. Data sources: A preliminary literature search without

time limits was conducted in the Cochrane Controlled Trials Register. We then searched the PubMed, CINAHL and PsychINFO databases for relevant articles published between January 2006 and June 2014. Selected journals were searched manually. Additional resources were explored by scrutinizing reference lists and tracking citations of the selected articles. Review methods: Titles and abstracts were matched with the inclusion criteria. Articles were read in their entirety if the abstracts adhered to inclusion criteria or if there was any uncertainty. Two reviewers evaluated the risk of methodological bias independently by using quantitative appraisal forms from the Johanna Briggs Institute (JBI). Any disagreements were resolved by consensus. Authors of nine studies were contacted to acquire additional information. The JBI Reviewers' Manual was used to guide the overall procedure of the review. We used the PRISMA statement to ensure precise reporting of the results. The selected studies were graded according to the strength of their evidence (Levels 1-5); the proposed interventions were given recommendation grades (Grades A-D). Results: Using 41 original studies, 11 interventions were identified. These comprise: (1) contralesional neck vibration (Grade C); (2) emotionally salient stimuli and reward (Grade D); (3) family participation and intensity of training (Grade C); (4) limb activation training (Grade C); (5) mental imagery training, (Grade D); (6) mirror therapy (Grade C); (7) music therapy (Grade D); (8) right half-field eye patching (Grade D); (9) smooth pursuit eye-movement training (Grade B); (10) virtual reality and computer-based training (Grade C); and (11) visual scanning training (Grade D). Conclusion: A total of 11 promising rehabilitation interventions were found. Encouraging results were, in particular, seen with smooth pursuit eyemovement training. It should be noted that the general low level of evidence and the diversity of interventions makes it difficult to endorse specific priorities and combinations for implementation. Instead, interventions should be applied after careful evaluation of each patient's unique capacities and problems. We include suggestions for operationalization into ward-based care in ''Discussion'' section. We also emphasize the need to integrate evidence-based interventions into nursing care to further stimulate rehabilitation outcomes and future research. ________________________________________________________________________________ Title: Ipsilesional and contralesional regions participate in the improvement of poststroke aphasia: a transcranial direct current stimulation study. Citation: Neurocase (Psychology Press), 01 August 2015, vol./is. 21/4(479-488), 13554794 Author(s): Costa, Vanessa, Giglia, Giuseppe, Brighina, Filippo, Indovino, Serena, Fierro, Brigida Language: English Abstract: In the past few years, noninvasive cerebral stimulations have been used to modulate language task performance in healthy and aphasic patients. In this study, a dual transcranial direct current stimulation (tDCS) on anterior and posterior language areas was applied for 2 weeks to a patient with a possible crossed aphasia following a right hemisphere stroke. Inhibitory cathodal stimulation of the right Brodmann areas (BA) 44/45 and simultaneous anodal stimulation of the left BA 44/45 improved the patient's performance in picture naming. Conversely, the same bilateral montage on BA 39/40 did not produce any significant improvement; finally, electrode polarity inversion over BA 39/40 yielded a further improvement compared with the first anterior stimulation. Our findings suggest that ipsilesional and contralesional areas could be useful in poststroke functional reorganization and provide new evidences for the therapeutic value of tDCS in aphasia. ________________________________________________________________________________ Title: Burden in caregivers of long-term stroke survivors: Prevalence and determinants at 6 months and 5 years after stroke. Citation: Patient Education & Counseling, 01 August 2015, vol./is. 98/8(1011-1016), 07383991 Author(s): Jaracz, Krystyna, Grabowska-Fudala, Barbara, Górna, Krystyna, Jaracz, Jan, Moczko, Jerzy, Kozubski, Wojciech Abstract: OBJECTIVES: To assess the prevalence of considerable burden among caregivers of stroke survivors at 6 months (Time 1) and 5 years after stroke (Time 2), to analyse changes in burden severity over time and to identify factors associated with the burden. METHODS: Eighty eight patient/caregiver pairs were assessed. Caregiver burden was measured with the Caregiver Burden Scale. Socio-demographic, stroke-related and psychological characteristics were analysed as potential determinants of the burden. Exact multiple logistic regression was used to identify the predictive factors. RESULTS: Considerable burden was reported by 44% of the caregivers at Time 1 and 30% at Time 2. The burden was independently associated with caregivers' sense of coherence and amount of time spent caregiving at Time 1, and with caregivers' anxiety at Time 2. CONCLUSIONS: A significant proportion of the caregivers experienced considerable burden in the

post-acute and chronic phases of stroke, although this proportion declined over time. Several characteristics were associated with the increased burden at different time points. All the independent predictors related to aspects of the carers. PRACTICE IMPLICATIONS: Programmes including education about coping strategies and time management, as well as respite care provision, could be beneficial and might help to reduce the burden of caregiving. ________________________________________________________________________________ Title: A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Citation: Disability & Rehabilitation, 15 July 2015, vol./is. 37/15(1316-1323), 09638288 Author(s): Meyer, Matthew J., Pereira, Shelialah, McClure, Andrew, Teasell, Robert, Thind, Amardeep, Koval, John, Richardson, Marina, Speechley, Mark Abstract: Purpose: This systematic review summarizes the utility of variables available at acute discharge after stroke for predicting functional independence at discharge from inpatient rehabilitation. Methods: A systematic review of four electronic databases (Medline, EMBASE, PsycINFO and CINAHL) was conducted to identify studies reporting multivariable models predicting postrehabilitation Barthel Index (BI) or Functional Independence Measure (FIM®) scores. In studies meeting inclusion criteria, the frequency with which candidate predictors were found statistically significant was calculated and summarized. Results: A total of 3260 articles were screened, of which 27 were included and 63 multivariable models of discharge BI or FIM® were reported. In all, 126 candidate predictors of BI or FIM® were explored. Variables found to be significant most frequently included admission functional level (BI or FIM®), National Institute of Health Stroke Scale (NIHSS), dysphasia, impulsivity, neglect, previous stroke, and age. Conclusions: Only a selected group of variables have repeatedly proven to be significant predictors of functional ability after post-stroke inpatient rehabilitation. ______________________________________________________________________________ Title: Aphasia therapy early after stroke: behavioural and neurophysiological changes in the acute and post-acute phases. Citation: Aphasiology, 01 July 2015, vol./is. 29/7(845-871), 02687038 Author(s): Aerts, Annelies, Batens, Katja, Santens, Patrick, Van Mierlo, Pieter, Huysman, Eline, Hartsuiker, Robert, Hemelsoet, Dimitri, Duyck, Wouter, Raedt, Robrecht, Van Roost, Dirk, De Letter, Miet Abstract: Background: There is reasonable evidence to suggest that speech and language therapy can be effective in the chronic stages of stroke recovery. However, the active ingredients remain unknown and several variables can influence therapy outcome, such as content, type, and amount of therapy. Neurophysiological measures, event-related brain potentials such as the N400 and P300, have shown to be sensitive markers of therapeutic effects. As a supplement to the usual behavioural evaluation methods, neurophysiological measures might help to further disentangle the effect of content, type, and/or amount of therapy. Aims: The present single case study aims to investigate the effect of language therapy by combining behavioural and neurophysiological outcome measures in a patient with aphasia during the acute and post-acute stage after stroke. By further subdividing the therapy period into different therapy blocks, possible influences of content, type, and/or amount of therapy are investigated. Methods & Procedures:RL is a 47-year-old man with a moderate non-fluent aphasia, who received three periods of therapy in the first four months after his stroke. The initial evaluation moment occurred 10 days post-stroke. First, he received an intensive language treatment of 30 hr in 3 weeks, which was followed by a conventional treatment of 30 hr in 7 weeks. Then, RL received a second, intensive language therapy of 30 hr in 3 weeks. This was followed by a period of 6 months without any form of language treatment. Behavioural and neurophysiological measures were collected after every therapy and therapy-free period. The effect of therapy was examined by comparing the whole therapy period with the therapy-free period, without differentiating between the intensive and conventional treatment. In a second analysis, a comparison was made between the intensive therapy periods and the conventional therapy programme. Outcomes & Results: RL showed a general improvement on both behavioural and neurophysiological measures after the whole therapy period, which was preserved throughout the therapy-free period. Intensive treatment yielded better language outcomes as indicated by a behavioural and neurophysiological improvement in contrast with the behavioural deterioration of auditory discrimination of pseudowords and decline of the N400 neurophysiological marker, after the conventional therapy. Conclusions: The present study

demonstrates the outcome of early language treatment after stroke in which intensity can play an important role. In addition, the use of neurophysiological outcome measures provides added value to the behavioural evaluations in the context of therapeutic follow-up. _______________________________________________________________________________ Title: Effect of an Evidence-Based Mobility Intervention on the Level of Function in Acute Intracerebral and Subarachnoid Hemorrhagic Stroke Patients on a Neurointensive Care Unit. Citation: Archives of Physical Medicine & Rehabilitation, 01 July 2015, vol./is. 96/7(1191-1199), 00039993 Author(s): Rand, Maxine L., Darbinian, Jeanne A. Abstract: Objectives To explore the effect of an evidence-based mobility intervention on the level of function (LOF) achieved by patients with intracerebral hemorrhage (ICH) stroke and subarachnoid hemorrhage (SAH) stroke and to identify clinical characteristics and measures associated with walking distances >15.24m. Design Retrospective pre- and postintervention study. Setting Regional neurointensive care unit. Participants Adult patients with ICH and SAH (N=361). Intervention Daily mobility intervention based on patient's current LOF. Main Outcome Measure Walking >15.24m (LOF 5) by neurointensive care unit discharge. Results Electronic health records for 361 patients (52.6% women; mean age, 62.1y; ICH stroke, 63.2%; aphasia, 35%; hemiplegia, 33%) were included. There was a 2.3-fold increase in patients with hemorrhagic stroke achieving a LOF of 5 by neurointensive care unit discharge after introduction of a mobility intervention. In the multivariable logistic regression model including neurointensive care unit length of stay (LOS) as a covariate, the intervention, LOF of 5 at admission, SAH stroke type, third (vs lowest) quartile of neurointensive care unit LOS, and absence of aphasia and/or hemiplegia were associated with higher likelihood of achieving a LOF of 5 (odds ratio [OR]=5.28; 95% confidence interval [CI], 2.52–11.06; OR=6.02; 95% CI, 1.45–24.96; OR=3.78; 95% CI, 1.83–7.80; OR=2.94; 95% CI, 1.16–7.47; OR=17.77; 95% CI, 6.59–47.92, respectively). Conclusions A mobility intervention was strongly associated with increased distance walked by neurointensive care unit patients with acute hemorrhage at discharge and can be applied in any intensive care unit setting to promote stroke recovery. Future studies directed at building predictive models for walking achievement in patients with acute hemorrhagic stroke may provide insight into individualized treatment goal setting and discharge planning. ________________________________________________________________________________ Title: Geographic and Facility Variation in Inpatient Stroke Rehabilitation: Multilevel Analysis of Functional Status. Citation: Archives of Physical Medicine & Rehabilitation, 01 July 2015, vol./is. 96/7(1248-1254), 00039993 Author(s): Reistetter, Timothy A., Kuo, Yong-Fang, Karmarkar, Amol M., Eschbach, Karl, Teppala, Srinivas, Freeman, Jean L., Ottenbacher, Kenneth J. Abstract: Objective To examine geographic and facility variation in cognitive and motor functional outcomes after postacute inpatient rehabilitation in patients with stroke. Design Retrospective cohort design using Centers for Medicare and Medicaid Services (CMS) claims files. Records from 1209 rehabilitation facilities in 298 hospital referral regions (HRRs) were examined. Patient records were analyzed using linear mixed models. Multilevel models were used to calculate the variation in outcomes attributable to facilities and geographic regions. Setting Inpatient rehabilitation units and facilities. Participants Patients (N=145,460) with stroke discharged from inpatient rehabilitation from 2006 through 2009. Intervention Not applicable. Main Outcome Measures Cognitive and motor functional status at discharge measured by items in the CMS Inpatient Rehabilitation Facility–Patient Assessment Instrument. Results Variation profiles indicated that 19.1% of rehabilitation facilities were significantly below the mean functional status rating (mean ± SD, 81.58±22.30), with 221 facilities (18.3%) above the mean. Total discharge functional status ratings varied by 3.57 points across regions. Across facilities, functional status values varied by 29.2 points, with a 9.1-point difference between the top and bottom deciles. Variation in discharge motor function attributable to HRR was reduced by 82% after controlling for cluster effects at the facility level. Conclusions Our findings suggest that variation in motor and cognitive function at discharge after postacute rehabilitation in patients with stroke is accounted for more by facility than geographic location. ________________________________________________________________________________ Title: Effect of Anterior Cervical Osteophyte in Poststroke Dysphagia: A Case-Control Study. Citation: Archives of Physical Medicine & Rehabilitation, 01 July 2015, vol./is. 96/7(1269-1276), 00039993

Author(s): Kim, Youngkook, Park, Geun-Young, Seo, Yu Jung, Im, Sun Abstract: Objective To investigate whether the concomitant presence of anterior cervical osteophytes can influence the severity and outcome of patients with poststroke dysphagia. Design Retrospective case-control study. Setting Hospital. Participants A total of 40 participants were identified (N=40). Patients with poststroke dysphagia with anterior cervical osteophytes (n=20) were identified and matched by age, sex, location, and laterality of the stroke lesion to a poststroke dysphagia control group with no anterior cervical osteophytes (n=20). Interventions Not applicable. Main Outcome Measures Videofluoroscopic swallowing study, Functional Oral Intake Scale (FOIS), and PenetrationAspiration Scale results assessed within the first month of stroke were analyzed. The FOIS at 6 months was recorded, and severity of dysphagia was compared between the 2 groups. Results The case group had larger degrees of postswallow residues in the valleculae and pyriform sinuses ( P =.020 and P <.001, respectively), with more patients showing postswallow aspiration (62.5%) than the control group (0%; P <.001), along with a higher risk of being on enteral nutrition feeding (odds ratio [OR]=13.933; 95% confidence interval [CI], 2.863-infinity) within the first month of stroke. At the 6month follow-up, the case group had significantly lower mean FOIS scores (3.8±1.7) than the control group (6.1±1.3; P <.001), with an increased risk of having persistent dysphagia (OR=15.375; 95% CI, 3.195-infinity). Conclusions The presence of anterior cervical osteophytes, which may cause mechanical obstruction and interfere with residue clearance at the valleculae and pyriform sinuses and result in more postswallow aspiration, may influence initial severity and outcome of poststroke dysphagia. The presence of anterior cervical osteophytes may be considered an important clinical condition that may affect poststroke dysphagia rehabilitation. ________________________________________________________________________________ Title: Restricted Participation in Stroke Caregivers: Who Is at Risk? Citation: Archives of Physical Medicine & Rehabilitation, 01 July 2015, vol./is. 96/7(1284-1290), 00039993 Author(s): Grigorovich, Alisa, Forde, Samantha, Levinson, Dahlia, Bastawrous, Marina, Cheung, Angela M., Cameron, Jill I. Abstract: Objective To identify caregiver-, stroke survivor–, and caregiving situation–related factors that are associated with caregivers' restriction from participation in their normative activities (ie, participation restriction) over the first 2 years poststroke. Design Longitudinal cohort study. Setting Acute care facilities and community. Participants A secondary data analysis of caregiver/survivor dyads (N=399). Interventions Not applicable. Main Outcome Measures Data were collected at 1, 3, 6, 12, 18, and 24 months poststroke. The primary outcome was caregivers' participation restriction and was assessed using the Caregiver Impact Scale. Caregivers also provided demographic information and completed standardized measures to capture assistance provided, mastery, and depression. From stroke survivors we collected demographic characteristics, stroke severity, and cognitive and physical functioning. Data were analyzed using individual growth curve modeling. Results Participation restriction level improved over time. Caregiver factors associated with restricted participation included younger age, being employed, higher depression, and lower mastery level. Stroke survivor factors associated with caregivers' restricted participation included hemorrhagic stroke, more severe stroke, more physical and memory impairments, and lower participation. Significant factors related to the caregiving situation included providing high levels of assistance and caring for a spouse. Conclusions Depressed younger caregivers, with low levels of mastery, who provide high-intensity support to spouses with cognitive difficulties may be at risk. Screening for these factors may help identify stroke families at risk for poor outcomes and may be used to more efficiently allocate health resources. ________________________________________________________________________________ Title: Resistance Training Improves Hyperglycemia and Dyslipidemia, Highly Prevalent Among Nonelderly, Nondiabetic, Chronically Disabled Stroke Patients. Citation: Archives of Physical Medicine & Rehabilitation, 01 July 2015, vol./is. 96/7(1291-1296), 00039993 Author(s): Zou, Jingjing, Wang, Zun, Qu, Qingming, Wang, Lei Abstract: Objective To test the effect of 8 weeks of lower body resistance training on hyperglycemia and dyslipidemia, which may be prevalent among nonelderly, nondiabetic, chronically disabled stroke patients. Design Randomized controlled study. Setting Outpatient clinics of rehabilitation centers. Participants Nonelderly, nondiabetic, chronically disabled stroke subjects (N=56) were enrolled and

randomly assigned to an experimental group (n=28) and a control group (n=28). Interventions Lower body resistance training was performed by subjects in the experimental group 3 times a week for 8 weeks. The control group was given duration-matched stretch exercises. Main Outcome Measures Fasting glucose level, fasting insulin level, 2-hour blood glucose level during oral glucose tolerance test, homeostasis model assessment of insulin resistance (HOMA-IR), glycosylated hemoglobin (Hb A 1c ), total triglyceride level, total cholesterol level, high-density lipoprotein (HDL) cholesterol level, lowdensity lipoprotein (LDL) cholesterol level, body mass index, lower limb muscle strength, and FuglMeyer motor score. Results Before the intervention, 34 subjects (60.7%) had hyperglycemia and 38 (67.9%) had dyslipidemia. Fifty-one subjects finished the study. Subjects in the experimental group (n=26) showed significant improvements in fasting insulin and 2-hour blood glucose levels; HOMA-IR; total cholesterol, HDL cholesterol, and LDL cholesterol levels; and muscle strength compared with control subjects (n=25) after the intervention ( P <.05). Conclusions Resistance training may play a significant role in improving hyperglycemia and dyslipidemia, which are frequently present among nonelderly, nondiabetic, chronically disabled stroke patients. ________________________________________________________________________________ Title: Factors Associated With Discharge to Home Versus Discharge to Institutional Care After Inpatient Stroke Rehabilitation. Citation: Archives of Physical Medicine & Rehabilitation, 01 July 2015, vol./is. 96/7(1297-1303), 00039993 Author(s): Nguyen, Vu Q.C., PrvuBettger, Janet, Guerrier, Tami, Hirsch, Mark A., Thomas, J. George, Pugh, Terrence M., IIIRhoads, Charles F. Abstract: Objective To examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation. Design Retrospective cohort study. Setting Three tertiary accredited acute care rehabilitation facilities. Participants Adult patients with stroke (N=2085). Interventions Not applicable. Main Outcome Measures Not applicable. Results Of 2085 patients with stroke treated at 3 centers over a 4-year period, 78.2% (n=1631) were discharged home and 21.8% (n=454) discharged to an SNF. Findings from a multivariable logistic regression analysis indicated that patients were less likely to be discharged home if they were older (odds ratio [OR], .98; 95% confidence interval [CI], .96–.99), separated or divorced (compared with married; OR, .61; 95% CI, .48–.79), or with Medicare health insurance (compared with private insurance; OR, .69; 95% CI, .55–.88), or had dysphagia (OR, .83; 95% CI, .71–.98) or cognitive deficits (OR, .79; 95% CI, .77–.81). The odds of being discharged home were higher for those admitted with a higher motor FIM score (OR, 1.10; 95% CI, 1.09–1.11). The following were not associated with discharge disposition: sex, race, prestroke vocational status, availability of secondary health insurance, number of days from stroke onset to rehabilitation facility admission, stroke type, impairment group, cognitive FIM on admission, other stroke deficits (aphasia, ataxia, neglect, or speech disturbance), stroke complications of hyponatremia or urinary tract infection, or comorbid conditions. Conclusions One in 5 patients with stroke were discharged to an SNF after inpatient rehabilitation. On admission, several sociodemographic and clinical characteristics were identified that could be considered as important factors in early discussions for discharge planning. ________________________________________________________________________________ Title: Exercise Stress Testing After Stroke or Transient Ischemic Attack: A Scoping Review. Citation: Archives of Physical Medicine & Rehabilitation, 01 July 2015, vol./is. 96/7(1349-), 00039993 Author(s): Gäverth, Johan, Parker, Robin, MacKay-Lyons, Marilyn Abstract: Objective To provide insight into exercise stress testing after stroke or transient ischemic attack (TIA) in terms of feasibility, safety, and protocols used. Data Sources PubMed, Embase, CINAHL, and Web of Science were searched for relevant studies published from inception to March 2014, and reference lists were hand searched. Study Selection To be included in the review, the articles needed to include participants diagnosed with stroke or TIA and have any form of test to assess exercise capacity. Data Extraction The scoping review methodology does not include critical appraisal of the literature but was chosen to reflect all aspects of exercise stress testing after stroke or TIA. Two reviewers performed screening for eligible studies independently, and 1 reviewer extracted the data. Data Synthesis We found a total of 112 studies involving 5008 participants describing symptom-limited (n=103), submaximal (n=9), and field (n=6) exercise stress test protocols. Some of

the studies reported on data from >1 protocol. Metabolic analysis was included in 87% of the studies involving symptom-limited tests, 40% of submaximal studies, and 29% of field tests. Monitoring of blood pressure, perceived exertion, and electrocardiographic responses was done in 54%, 42%, and 95% of all studies, respectively. A mere 10% of all studies reported on electrocardiographic abnormalities detected during testing. No serious adverse events were reported. Conclusions Symptom-limited exercise stress testing appears to be safe in patients with stroke or TIA and provides a more valid measure of exercise capacity than submaximal and field tests. The level of disability may compromise feasibility, and test modality should be chosen carefully to optimize test results. ________________________________________________________________________________ Title: Multiple therapeutic effects of progranulin on experimental acute ischaemic stroke. Citation: Brain: A Journal of Neurology, 01 July 2015, vol./is. 138/Pt 7(1932-1948), 00068950 Author(s): Kanazawa, Masato, Kawamura, Kunio, Takahashi, Tetsuya, Miura, Minami, Tanaka, Yoshinori, Koyama, Misaki, Toriyabe, Masafumi, Igarashi, Hironaka, Nakada, Tsutomu, Nishihara, Masugi, Nishizawa, Masatoyo, Shimohata, Takayoshi Full text: Available Highwire Press at Brain ________________________________________________________________________________ Title: Prognostic factors for discharge destination after acute stroke: a comprehensive literature review. Citation: Disability & Rehabilitation, 01 July 2015, vol./is. 37/14(1214-1227), 09638288 Author(s): Van der Cruyssen, Kelly, Vereeck, Luc, Saeys, Wim, Remmen, Roy Abstract: Purpose: In the future, budget constraints will make efficient care for stroke patients more important. The cost of hospitalization for stroke is high. It is desirable to consider a patient's discharge destination soon after onset and thereby screen patients for further care. This study aims to review the evidence of factors that determine discharge destinations after acute phase of stroke in adult patients. Methods: The systematic literature search was performed in seven databases. This systematic review was conducted by the preferred reporting items for systematic reviews and metaanalyses (PRISMA statement). Full-text articles were included and assessed for methodological quality by two independent researchers. Results: Eighteen articles were selected that demonstrate factors defining discharge destination. Younger age, good post-stroke admission to a teaching hospital, and a number of medical factors are determinants to a favorable discharge destination. Determinants for unfavorable discharge destinations were a severe stroke, high body mass index, alcohol abuse, statin withdrawal during hospitalization, the presence of comorbidities like respiratory failure and dementia or having a Medicaid insurance. Conclusion: Patient initial medical care, age and sex, neurological and medical complications and environmental/socio-economic factors should be considered in the decision-making process for discharge destination. ________________________________________________________________________________ Title: Exploring the decision-making process in the delivery of physiotherapy in a stroke unit. Citation: Disability & Rehabilitation, 01 July 2015, vol./is. 37/14(1277-1284), 09638288 Author(s): McGlinchey, Mark P., Davenport, Sally Abstract: Purpose: The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit. Methods: A focused ethnographical approach involving semistructured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes. Results: Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process. Conclusions: The study has generated insight into the reality of decisionmaking in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. ________________________________________________________________________________

Title: Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey. Citation: Disability & Rehabilitation, 01 July 2015, vol./is. 37/14(1291-1298), 09638288 Author(s): Scobbie, Lesley, Duncan, Edward A., Brady, Marian C., Wyke, Sally Abstract: Purpose: We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. Methods: We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Results: Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services ( n = 358/395) reported setting goals with 'all' or 'most' stroke survivors. Seventeen percent ( n = 65/380) reported that no methods were used to guide goal setting practice; 47% ( n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services ( n = 362/369) reported routinely asking patients about goal priorities; 39% ( n = 141/360) reported routinely providing patients with a copy of their goals. Conclusions: Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. ________________________________________________________________________________ Title: A significant risk factor for poststroke depression: the depression-related subnetwork. Citation: Journal of Psychiatry & Neuroscience, 01 July 2015, vol./is. 40/4(259-268), 11804882 Author(s): Songran Yang, Ping Hua, Xinyuan Shang, Zaixu Cui, Suyu Zhong, Gaolang Gong, Humphreys, Glyn W. Abstract: Background: Despite being one of the direct causes of depression, whether stroke-induced neuroanatomical deterioration actually plays an important role in the onset of poststroke depression (PSD) is controversial. We assessed the structural basis of PSD, particularly with regard to white matter connectivity. Methods: We evaluated lesion index, fractional anisotropy (FA) reduction and brain structural networks and then analyzed whole brain voxel-based lesions and FA maps. To understand brain damage in the context of brain connectivity, we used a graph theoretical approach. We selected nodes whose degree correlated with the Hamilton Rating Scale for Depression score (p < 0.05, false discovery rate-corrected), after controlling for age, sex, years of education, lesion size, Mini Mental State Examination score and National Institutes of Health Stroke Scale score. We used Poisson regression with robust standard errors to assess the contribution of the identified network toward poststroke major depression. Results: We included 116 stroke patients in the study. Fourteen patients (12.1%) had diagnoses of major depression and 26 (22.4%) had mild depression. We found that lesions in the right insular cortex, left putamen and right superior longitudinal fasciculus as well as FA reductions in broader areas were all associated with major depression. Seventeen nodes were selected to build the depression-related subnetwork. Decreased local efficiency of the subnetwork was a significant risk factor for poststroke major depression (relative risk 0.84, 95% confidence interval 0.72-0.98, p = 0.027). Limitations: The inability of DTI tractography to process fibre crossings may have resulted in inaccurate construction of white matter networks and affected statistical findings. Conclusion: The present study provides, to our knowledge, the first graph theoretical analysis of white matter networks linked to poststroke major depression. These findings provide new insights into the neuroanatomical substrates of depression that develops after stroke. Full text: Available ProQuest at Journal of Psychiatry and Neuroscience : JPN Full text: Available ProQuest at Journal of Psychiatry and Neuroscience : JPN ________________________________________________________________________________

BOOKS BACK TO TOP If you are unable to find a book, or require a book that is not on this list, please ask library staff who will be able to locate the book for you using interlibrary loan. New book recently added to stock

Oxford Case Histories in TIA and stroke Sarah T Pendlebury et al 2012 Oxford University Press From the back of the book: Covering many aspects of TIA and stroke outlined in the training curriculum for this sub-specialty including differential diagnosis, management, and secondary prevention, Oxford Case Histories in TIA and Stroke features 51 well-structured, peer-reviewed cases from the Oxford Hospitals giving detailed coverage of the specialty, including diagnostic and management dilemmas.

Other books of interest Evidence-based nursing care for stroke and neurovascular conditions Sheila A Alexander 2013 Chichester: Wiley-Blackwell

Evidence-based management of stroke Jose Biller et al 2011 Harley, Shropshire: TFM

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Full-text evidence-based systematic reviews prepared by the Cochrane collection Reviews from July 2015 Amitriptyline for neuropathic pain in adults Interventions for post-stroke fatigue

GUIDELINES

National Clinical Guideline for Stroke, 4 edition 2012 NICE Guidelines Stroke rehabilitation: Long-term rehabilitation after stroke (June 2013, to be reviewed December 2015) Atrial fibrillation: the management of atrial fibrillation- assessing your risk of stroke (June 2014) Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (February 2013)

UPTODATE & DYNAMED BACK TO TOP What’s new from our clinical decision-making tools on the topic of stroke. UpToDate DynaMed Please contact library staff for details on how to access these resources; you will need an Athens password if accessing from home.

STROKE IN THE NEWS BACK TO TOP Behind the Headlines Heart attack, stroke and diabetes ‘can shorten life by 23 years’ GP receptionists ‘could help prevent stroke deaths’ Elderly living near noisy roads have ‘increased stroke risk’ BBC News Stroke drug is safe, says review

REPORTS, PUBLICATIONS AND RESOURCES

UK Stroke Forum- hosted by Stroke Association Highlights from the European Stroke Conference 2015 Stroke Association website- contains information about support groups, conferences, fundraising, research and professional advice including toolkits and posters. NICE Pathway on Stroke

TOPIC ALERTS AND UPDATES

ABSTRACTS AVAILABLE VIA LINKS BELOW - FOR FULL-TEXT PLEASE ASK LIBRARY STAFF Medscape Topic Alerts Trajectory of cognitive decline after incident stroke- JAMA. 2015;314(1):41-51 Temporal relationship between infective endocarditis and stroke- Neurology. Published online July 10, 2015 Impact of general anesthesia on safety and outcomes in the endovascular arm of interventional management of stroke (IMS) III Trial- Stroke. Published online before print July 2, 2015

Elsevier Practice Updates Sex Disparities in Stroke: Women Have More Severe Strokes but Better Survival Than Men- J Am Heart Assoc. 2015 Jul 6;4(7). pii: e001967

TWITTER BACK TO TOP The latest from popular Twitter pages dedicated to stroke: Stroke Association @TheStrokeAssoc World Stroke Campaign @WStrokeCampaign Sign Against Stroke in Atrial Fibrillation @signagnststroke Different Strokes- Support for Younger Stroke Survivors @diffstrokes

TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP

LITERATURE SEARCH SERVICE BACK TO TOP Looking for the latest evidence-based research but haven’t got time to trawl the databases? Do you need a literature search carried out? Do you need to find evidence to support an improvement? Do you want to know how something has been done elsewhere and whether it worked?

Library staff provide a literature search service for busy clinicians who are pressed for time.

To request a search please complete and return the attached form ,providing as much information as possible. Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library.

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at www.swice.nhs.uk and following the link for Athens selfregistration. Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement. The library offers training on how to access and use Athens resources, as well as an introductory course on critical appraisal. You can book a course through the Learning and Development intranet page, or by contacting the library directly.