June stroke current awareness by Musgrove Park Hospital Library

Library Services Musgrove Park and Somerset Partnership

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 10 June 2016

Contents Click on a section title to navigate contents Page Results of Library Current Awareness Survey

Colleague App

Recent journal articles

Cochrane Systematic Reviews

Guidelines

UpToDate & DynaMed Plus

Stroke in the News

Reports, publications and resources

Topic Alerts and Updates

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)

Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

RESULTS OF LIBRARY CURRENT AWARENESS SURVEY BACK TO TOP

During 2015-6 the library team introduced a number of new current awareness bulletins as a result of feedback from staff. Along with the fortnightly Library Alert monthly updates were produced for: Dementia Stroke End of life Sign up to safety

Mentorship Cancer ITU

While we had some feedback that these bulletins were useful, we felt due to the cost in library staff time, it would be better to have more detailed evidence. We circulated the survey via email to the various email lists, added a link on the Library webpage and also put reminders in the Library Alert and Staff Bulletin. During the month when we received 211 replies on all bulletins covering both Taunton and Somerset and Somerset Partnership staff. The final report can be found here

COLLEAGUE APP BACK TO TOP The MPH Staff App has specifically been produced and designed to offer both current and future employees relevant information related to their work. Whether seeking information about policies and procedures, following us on Twitter or even taking advantage of special offers, all can be found here.

Library monthly current awareness bulletins are also available. To download, please follow this link Please note- The app has not been created by the library. If you have any problems downloading or accessing the app then you will need to contact the IT department.

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.

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

Title: Cardiovascular diseases in patients 65 years and younger with non-cardiogenic stroke. Citation: Archives of medical science : AMS, Jun 2016, vol. 12, no. 3, p. 556-562, 1734-1922 (June 1, 2016) Author(s): Lasek-Bal, Anetta, Gąsior, Zbigniew Abstract: Approximately 10-15% of patients with stroke are under 65 years of age. The aim of the study was to determine types of stroke In people below 65. We analysed the incidence and types of associated cardiovascular diseases in patients with non-cardiogenic stroke. In this prospective study patients (aged ≤ 65) with stroke underwent physical examination, computed tomography of the head, blood tests, electrocardiogram, echocardiography, and transcranial and carotid artery ultrasound. Classification of stroke was performed according to the ASCOD scale. Analysis considered the incidence of heart diseases in patients with non-cardiogenic stroke and the incidence of heart diseases recognised as a cause of cerebral embolism in patients with cardiogenic stroke. The study included 611 patients with stroke at the age of 27-65 (mean: 57.2 ±6.7; M/F 380/231). Stroke of heterogeneous aetiology was observed in 321 patients, cardiogenic stroke in 78, and stroke caused by small vessel and carotid artery disease in 73 and 72 patients, respectively. The most common heart diseases in non-cardiogenic stroke patients included persistent foramen ovale, coronary heart disease and past myocardial infarction. The most common causes of cardiogenic embolism were cardiomyopathy, atrial fibrillation and interatrial septal defect. Aetiologically heterogeneous stroke and cardiogenic stroke are the most commonly observed among young stroke patients. Cardiomyopathy and atrial fibrillation are the most common sources of cerebral embolism in young patients with cardiogenic stroke. Nearly 1/5 of patients with a non-cardiogenic stroke have congenital or acquired structural changes in the heart. Full Text: Available from ProQuest in Archives of Medical Science Available from National Library of Medicine in Archives of Medical Science : AMS

Title: Obstructive sleep apnea as an independent stroke risk factor: a review of the evidence, stroke prevention guidelines, and implications for neuroscience nursing practice Citation: Journal of Neuroscience Nursing, Jun 2016, vol. 48, no. 3, p. 133-142, 0888-0395 (June

2016) Author(s): King, Sharon, Cuellar, Norma Abstract: Background: Stroke is a leading cause of death and disability affecting nearly 800,000 people in the United States every year. Obstructive sleep apnea (OSA) is found in over 60% of patients with stroke/transient ischemic attack (TIA) and identified as an independent stroke risk factor in large epidemiology studies and Canadian Stroke Prevention Guidelines (SPG) but not in the United States. The 2014 Secondary SPG recommend OSA screening and treatment as a consideration only, not a requirement. The twofold purpose of this article is, first, to present the evidence supporting OSA as an independent stroke risk factor in national SPG with mandatory recommendations and, second, to engage neuroscience nurses to incorporate OSA assessment and interventions into the nursing process and thereby promote excellence in stroke/TIA patient care. Methods: A systematic literature search was conducted in Medline, CINAHL, and PubMed to identify research from 2003 through 2013 on the independent risk, mortality, and prevalence relationship between OSA and stroke/TIA including recurrence and recovery outcomes with continuous positive airway pressure (CPAP) therapy. Results: Twenty-eight research articles were reviewed: 14 observational cohorts, five case-control studies, four cross-sectional studies, and four randomized control trials representing 12 countries and 10,671 subjects. Discussion: OSA is highly prevalent in patients with stroke/TIA independently increasing stroke risk. CPAP studies revealed reduced stroke recurrence and improved recovery with feasible initiation in stroke units. Patients with stroke/TIA have less OSA-associated daytime sleepiness and obesity, making the usual screening tools insufficient and CPAP adherence challenging. Treating OSA decreases stroke prevalence and mortality. OSA initiatives empower neuroscience nurses to integrate this OSA evidence into clinical practice and improve stroke/TIA patient outcomes.

Title: Dietitians on the stroke unit Citation: British Journal of Healthcare Assistants, May 2016, vol. 10, no. 5, p. 224-227, 1753-1586 (May 2016) Author(s): Carr, Paul, Martin, Sian, Lalor, Patricia Abstract: Dietitians assess, diagnose and treat diet and nutrition-related problems and diseases. Appropriate nutrition in hospital helps to treat and prevent malnutrition. Around 40% of patients are admitted into hospital already malnourished. They can become further malnourished while in hospital, because they are unable to eat at all, are unable to eat enough or are unable to effectively absorb the food they are eating. Malnutrition impairs the immune system, increasing the risk of infection and causes longer hospital stays, as people take longer to recover. Malnutrition increases the risk of pressure ulcers and it delays wound healing, causes loss of muscle, making it more difficult to mobilise, and lowers the patient's mood. What is the role of the dietitian on the stroke unit? To assess patients to determine their nutritional status, their nutritional requirements and their ability to meet their nutritional requirements. To develop an individual treatment plan for each patient. References Full Text: Available from Mark Allen Group in British Journal of Healthcare Assistants; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option

Title: Chronic stroke disease Citation: British Journal of Hospital Medicine, May 2016, vol. 77, no. 5, p. C66., 0007-1064 (May 1, 2016) Author(s): Briggs, Robert, O?Neill, Desmond Abstract: Despite a welcome decline in stroke-related mortality witnessed in recent decades, stroke remains the second leading cause of mortality worldwide, as well as a major cause of disability. Stroke disease occurs on a spectrum from initial presentation with acute stroke to progression to chronic stroke disease. However, it is generally not viewed in such terms, with the focus on acute and hyperacute stroke care often overshadowing that of chronic stroke. Even the traditional definition of stroke as an 'acute neurological event of presumed vascular origin lasting longer than 24 hours' does not accommodate chronic stroke disease. It is not uncommon for major international stroke conferences to overlook chronic stroke disease to such an extent that it is not represented in any form during the conference.

Title: Knowledge gaps in cardiovascular care of the older adult population Citation: Circulation, May 2016, vol./is. 133/21(2103-2122), 0009-7322;1524-4539 (24 May 2016) Author(s): Rich M.W., Chyun D.A., Skolnick A.H., Alexander K.P., Forman D.E., Kitzman D.W., Maurer M.S., Mcclurken J.B., Resnick B.M., Shen W.K., Tirschwell D.L. Abstract: The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults >75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged >75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world. Full Text: Available from Ovid fulltext collection in Circulation Available from Highwire Press in Circulation

Title: How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices. Citation: Journal of stroke, May 2016, vol. 18, no. 2, p. 121-128, 2287-6391 (May 2016) Author(s): Bridge, Francesca, Thijs, Vincent Abstract: The introduction of insertable cardiac monitoring devices has dramatically altered our understanding of the role of intermittent atrial fibrillation in cryptogenic stroke. In this narrative review we discuss the incidence, timing and relationship between atrial fibrillation and cryptogenic stroke, how to select patients for monitoring and the value and limitations of different monitoring strategies. We also discuss the role of empirical anticoagulation, and atrial fibrillation burden as a means of tailoring anticoagulation in patients at high risk of bleeding.

Title: One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. Citation: New England Journal of Medicine, 2016, vol./is. 374/16(1533-1542), 00284793 Author(s): Amarenco, Pierre, Lavallee, Philippa C., Labreuche, Julien, Albers, Gregory W., Bornstein, Natan M., Canhao, Patricia, Caplan, Louis R., Donnan, Geoffrey A., Ferro, Jose M., Hennerici, Michael G., Molina, Carlos, Rothwell, Peter M., Sissani, Leila, Skoloudfk, David, Steg, Philippe Gabriel, Touboul, Pierre-Jean, Shinichiro Uchiyama, Vicaut, Eric, Wong, Lawrence K. S., LavallĂŠe, Philippa C Abstract: Background: Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. Methods: We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD(2) score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. Results: From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan-Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan-Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD(2) score of 6 or 7 were each associated with more than a doubling of the risk of stroke. Conclusions: We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD(2) score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.). Full Text: Available from NEW ENGLAND JOURNAL OF MEDICINE in Library MPH Available from ProQuest in New England Journal of Medicine, The

Title: Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics. Citation: Neurology, 2016, vol./is. 86/23(2146-2153), 00283878 Author(s): Gioia, Laura C., Zewude, Rahel T., Kate, Mahesh P., Liss, Kim, Rowe, Brian H., Buck, Brian, Jeerakathil, Thomas, Butcher, Ken Abstract: Objective: To assess the natural history of prehospital blood pressure (BP) during emergency medical services (EMS) transport of suspected stroke and determine whether prehospital BP differs among types of patients with suspected stroke (ischemic stroke, TIA, intracerebral hemorrhage [ICH], or stroke mimic).Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database containing electronic records of patients transported by EMS to the emergency department (ED) with suspected stroke during an 18-month period was conducted. Hospital charts and neuroimaging were utilized to determine the final diagnosis (ischemic stroke, TIA, ICH, or stroke mimic).Results: A total of 960 patients were transported by EMS to ED with suspected stroke. Stroke was diagnosed in 544 patients (56.7%) (38.2% ischemic stroke, 12.2% TIA, 5.3% ICH) and 416 (43.2%) were considered mimics. Age-adjusted mean prehospital systolic BP (SBP) was higher in acute stroke patients (155.6 mm Hg; 95% confidence interval [CI]: 153.4-157.9 mm Hg) compared to mimics (146.1 mm Hg; 95% CI: 142.5-148.6 mm Hg; p < 0.001). Age-adjusted mean prehospital SBP was higher in ICH (172.3 mm Hg; 95% CI: 165.1-179.7 mm Hg) than in either ischemic stroke or TIA (154.7 mm Hg; 95% CI: 152.3-157.0 mm Hg; p < 0.001). Median (interquartile range) SBP drop from initial prehospital SBP to ED SBP was 4 mm Hg (-6 to 17 mm Hg). Mean prehospital SBP was strongly correlated with ED SBP (r = 0.82, p < 0.001).Conclusions: Prehospital SBP is higher in acute stroke relative to stroke mimics and highest in ICH. Given the stability of BP between initial EMS and ED measurements, it may be reasonable to test the feasibility and safety of prehospital antihypertensive therapy in patients with suspected acute stroke. Full Text: Available from Ovid fulltext collection in Neurology

Title: Emergency Department Management of Transient Ischemic Attack: A Survey of Emergency Physicians. Citation: Journal of Stroke & Cerebrovascular Diseases, 2016, vol./is. 25/6(1517-1523), 10523057 Author(s): Oostema, J. Adam, Brown, Michael D., Reeves, Mathew Abstract: Background: Patients are at high risk for stroke following a transient ischemic attack (TIA). The ideal setting for evaluating and treating patients with TIA has not been established, resulting in variability in emergency department (ED) TIA management. We conducted a survey to describe ED TIA management and factors that influence disposition determination for TIA patients.Methods: We administered a mail survey to 480 randomly selected members of the Michigan College of Emergency Physicians. Survey questions addressed current ED TIA management, the acceptability of the ABCD(2) risk-stratification tool, and disposition recommendations for a series of hypothetical TIA patients.Results: A total of 188 (39%) responses were received. Head computed tomography (96.2%) and antiplatelet therapy (88.2%) were the most commonly reported ED interventions. Over 85% of respondents reported admitting most or all TIA patients. The ABCD(2) score had low acceptability among emergency medicine physicians and was rarely incorporated into practice (10.7%). Respondents identified a short-term risk of stroke of less than 2% (95% confidence interval: 1.6-2.4) as an acceptable threshold for discharge; however, most respondents recommended admission even for low-risk TIA patients. Those with access to an outpatient TIA clinic were less likely to admit lowrisk TIA patients; those with access to an observation unit were more likely to admit.Conclusions: In this survey, ED physicians preferred hospital admission for most TIA patients, including those at low

risk for stroke. The ABCD(2) risk-stratification tool had low acceptability. Further research is needed to refine risk-stratification tools and define the optimal setting for TIA evaluations.

Title: Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: A qualitative interview study Citation: BMJ Open, 2016, vol./is. 6/5(no pagination), 2044-6055 (2016) Author(s): Jamison J., Graffy J., Mullis R., Mant J., Sutton S. Abstract: Objectives: To understand the perspectives of stroke survivors, caregivers and general practitioners (GPs) on a polypill approach, consisting of blood pressure and cholesterol-lowering therapies, with or without aspirin, for the secondary prevention of stroke. Methods: A qualitative interview study was undertaken in 5 GP surgeries in the East of England. 28 survivors of stroke/transient ischaemic attack (TIA) were interviewed, 14 of them with a caregiver present, along with a convenience sample of 5 GPs, to assess attitudes towards a polypill and future use. Topic guides explored participants attitudes, potential uptake and long-term use, management of polypill medication and factors influencing the decision to prescribe. Data were analysed using a grounded theory approach. Key themes are presented and illustrated with verbatim quotes. Results: The analysis identified 3 key themes: polypill benefits, polypill concerns and polypill lessons for implementation. Stroke/TIA survivors were positive about the polypill concept and considered it acceptable in the secondary prevention of stroke. Perceived benefits of a polypill included convenience resulting in improved adherence and reduced burden of treatment. Caregivers felt that a polypill would improve medication-taking practices, and GPs were open to prescribing it to those at increased cardiovascular risk. However, concerns raised included whether a polypill provided equivalent therapeutic benefit, side effects through combining medications, consequences of nonadherence, lack of flexibility in regulating dosage, disruption to current treatment and suitability to the wider stroke population. Conclusions: Participants acknowledged potential advantages in a polypill approach for secondary prevention of stroke; however, significant concerns remain. Further research on the efficacy of a polypill is needed to reassure practitioners whose concerns around inflexibility and treatment suitability are likely to influence the decision to prescribe a polypill for secondary prevention of stroke. Acceptability among survivors, caregivers and GPs is likely to determine the uptake and subsequent use of a polypill in the future. Full Text: Available from National Library of Medicine in BMJ Open Available from Highwire Press in BMJ Open

Title: Exploring recruitment issues in stroke research: a qualitative study of nurse researchers' experiences. Citation: Nurse Researcher, 2016, vol./is. 23/5(8-14), 13515578 Author(s): Boxall, Leigh, Hemsley, Anthony, White, Nicola Abstract: AIM: To explore the practice of experienced stroke nurse researchers to understand the issues they face in recruiting participants.

BACKGROUND: Participant recruitment is one of the greatest challenges in conducting clinical research, with many trials failing due to recruitment problems. Stroke research is a particularly difficult area in which to recruit; however various strategies can improve participation. DISCUSSION: Analysis revealed three main types of problems for recruiting participants to stroke research: those related to patients, those related to the nurse researcher, and those related to the study itself. Impairments affecting capacity to consent, the acute recruitment time frame of most stroke trials, paternalism by nurse researchers, and low public awareness were especially pertinent. CONCLUSION: The disabling nature of a stroke, which often includes functional and cognitive impairments, and the acute stage of illness at which patients are appropriate for many trials, make recruiting patients particularly complex and challenging. IMPLICATIONS FOR PRACTICE: An awareness of the issues surrounding the recruitment of stroke patients may help researchers in designing and conducting trials. Future work is needed to address the complexities of obtaining informed consent when patient capacity is compromised.

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Protocols from May 2016 Advanced management services for transient ischaemic attacks and minor stroke Reviews from June 2016 Speech and language therapy for aphasia following stroke

GUIDELINES BACK TO TOP th

National Clinical Guideline for Stroke, 4 edition 2012 NICE Guidelines Mechanical clot retrieval for treating acute ischaemic stroke- NICE interventional procedure guidance [IPG548] Published date: February 2016 Secondary prevention after a myocardial infarction- NICE quality standard [QS99] Published date: September 2015 Cardiovascular risk assessment and lipid modification- NICE quality standard [QS100] Published date: September 2015 Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillationNICE technology appraisal guidance [TA355] Published date: September 2015

UPTODATE & DYNAMED PLUS BACK TO TOP What’s new from our clinical decision-making tools on the topic of stroke. UpToDate –Access for Musgrove Staff only DynaMed Plus – Access for Somerset Partnership Staff only 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 Study: ‘mini strokes should treated immediately with aspirin’

REPORTS, PUBLICATIONS AND RESOURCES BACK TO TOP NICE Pathway on Stroke UK Stroke Forum- hosted by Stroke Association Stroke Association website- contains information about support groups, conferences, fundraising, research and professional advice including toolkits and posters. The Sentinel Stroke National Audit Programme- 2 reports Post-acute organisational audit Presents the findings on the organisation of care for stroke survivors once they leave hospital. The audit highlights the number and location of post-acute stroke services across the UK and outlines what a patient might expect in accessing these services. Is stroke care improving? The second SSNAP annual report The second annual SSNAP report reveals today that despite steady progress in stroke care, further work needs to be done to ensure that patients have access to key interventions and assessments when they are admitted to hospital. Raconteur Report- Understanding Stroke Stroke is one of the biggest health issues people face today, taking a life every 13 minutes and costing the nation an estimated £9 billion a year in health and social costs. Yet the condition ranks low in terms of public perception and research funding, and the UK lags behind some other nations in improving patient outcomes. This report highlights the need to raise research funding, along with awareness of the condition, and identifies key risk factors. It also showcases major technological and medical breakthroughs. Stroke severity worse for shift workers New research provides further evidence of the harms of shift work, after finding it may increase stroke severity by interfering with the body's internal clock, with men faring worst. Air pollution is now a leading stroke risk factor Each year around the world, approximately 15 million people have a stroke. Of these, 6 million die and 5 million are left permanently disabled, making stroke the second leading cause of disability. Now, a new study implicates air pollution as a leading risk factor for stroke worldwide.

TOPIC ALERTS AND UPDATES BACK TO TOP ABSTRACTS AVAILABLE VIA LINKS BELOW - FOR FULL-TEXT PLEASE ASK LIBRARY STAFF Statin Medication Use and Nosocomial Infection Risk in the Acute Phase of Stroke Journal of Stroke and Cerebrovascular Diseases, Published online: June 9 2016 NHS Evidence Obstructive Sleep Apnea as an Independent Stroke Risk Factor: A Review of the Evidence, Stroke Prevention Guidelines, and Implications for Neuroscience Nursing Practice. J Neurosci Nurs. 2016 Jun;48(3):133-42 Elsevier Practice Updates Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial Radiology, June 2016 Volume 279, Issue 3 Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke N Engl J Med 2016; 374:2313-2323 Hospitalized Infection as a Trigger for Acute Ischemic Stroke- The Atherosclerosis Risk in Communities Study Stroke 2016; 47: 1612-1617 Aspirin resistance is associated with increased stroke severity and infarct volume Neurology May 10, 2016 vol. 86 no. 19 1808-1817 Cardiovascular events after ischemic stroke in young adults Neurology May 17, 2016 vol. 86 no. 20 1872-1879 Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack NEJM, May 10, 2016 FREE FULL TEXT Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial Lancet, Published Online: 10 May 2016 Predictive value of transcranial evoked potentials during mechanical endovascular therapy for acute ischaemic stroke: a feasibility study J Neurol Neurosurg Psychiatry 2016;87:6 598-603 Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation- A Prospective Magnetic Resonance Imaging Study Stroke, Published online before print May 24, 2016

Better outcomes for hospitalized patients with TIA when in stroke units Neurology May 31, 2016 vol. 86 no. 22 2042-2048

Medscape Topic Alerts Where to Focus Efforts to Reduce the Blackâ&#x20AC;&#x201C;White Disparity in Stroke Mortality Stroke, Published online before print June 2, 2016 TRIP Database Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data J Physiother. 2016 Jun 16. [Epub ahead of print]

Medline Plus Association Between Midlife Cardiorespiratory Fitness and Risk of Stroke: The Cooper Center Longitudinal Study Stroke. 2016 Jun 9 FREE FULL TEXT

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 Stroke Association- Events for Professionals- ongoing events throughout the year th

10th World Stroke Congress- 26 -29 October, Hyderabad, India

LITERATURE SEARCH SERVICE BACK TO TOP Looking for the latest evidence-based research but havenâ&#x20AC;&#x2122;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 appropriate 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. Musgrove staff click here to access literature search form Somerset Partnership staff click here to access literature search form

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.