October stroke current awareness musgrove 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 3 October 2015

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

Books

Cochrane Systematic Reviews

Guidelines

UpToDate & DynaMed

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) 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: Neural complexity in patients with poststroke depression: A resting EEG study Citation: Journal of Affective Disorders, December 2015, vol./is. 188/(310-318), 0165-0327;15732517 (01 Dec 2015) Author(s): Zhang Y., Wang C., Sun C., Zhang X., Wang Y., Qi H., He F., Zhao X., Wan B., Du J., Ming D. Abstract: Background Poststroke depression (PSD) is one of the most common emotional disorders affecting post-stroke patients. However, the neurophysiological mechanism remains elusive. This study was aimed to study the relationship between complexity of neural electrical activity and PSD. Methods Resting state eye-closed electroencephalogram (EEG) signals of 16 electrodes were recorded in 21 ischemic poststroke depression (PSD) patients, 22 ischemic poststroke nondepression (PSND) patients and 15 healthy controls (CONT). Lempel-Ziv Complexity (LZC) was used to evaluate changes in EEG complexity in PSD patients. Statistical analysis was performed to explore difference among different groups and electrodes. Correlation between the severity of depression (HDRS) and EEG complexity was determined with pearson correlation coefficients. Receiver operating characteristic (ROC) and binary logistic regression analysis were conducted to estimate the discriminating ability of LZC for PSD in specificity, sensitivity and accuracy. Results PSD patients showed lower neural complexity compared with PSND and CONT subjects in the whole brain regions. There was no significant difference among different brain regions, and no interactions between group and electrodes. None of the LZC significantly correlated with overall depression severity or differentiated symptom severity of 7 items in PSD patients, but in stroke patients, significant correlation was found between HDRS and LZC in the whole brain regions, especially in frontal and temporal. LZC parameters used for PSD recognition possessed more than 85% in specificity, sensitivity and accuracy, suggesting the feasibility of LZC to serve as screening indicators for PSD. Increased slow wave rhythms were found in PSD patients and clearly correlation was confirmed between neuronal complexity and spectral power of the four EEG rhythms. Limitations Lesion location of stroke patients in the study distributed in different brain regions, and most of the PSD patients were mild or moderate in depressive severity. Conclusions Compared with conventional spectral analysis,

complexity of neural activity using LZC was more sensitive and stationary in the measurement of abnormal brain activity in PSD patients and may offer a potential approach to facilitate clinical screening of this disease. ________________________________________________________________________________ Title: Association of various blood pressure variables and vascular phenotypes with coronary, stroke and renal deaths: Potential implications for prevention Citation: Atherosclerosis, November 2015, vol./is. 243/1(161-168), 0021-9150;1879-1484 (November 01, 2015) Author(s): Harbaoui B., Courand P.-Y., Milon H., Fauvel J.-P., Khettab F., Mechtouff L., Cassar E., Girerd N., Lantelme P. Abstract: The relationship between blood pressure (BP) and cardiovascular diseases has been extensively documented. However, the benefit of anti-hypertensive drugs differs according to the type of cardiovascular event. Aortic stiffness is tightly intertwined with BP and aorta cross-talk with small arteries. We endeavored to elucidate which BP component and type of vessel remodeling was predictive of the following outcomes: fatal myocardial infarction (MI), fatal stroke, renal -, coronary- or cerebrovascular-related deaths. Large vessel remodeling was estimated by an aortography-based aortic atherosclerosis score (ATS) while small vessel disease was documented by the presence of a hypertensive retinopathy. We included 1031 subjects referred for hypertension workup and assessed outcomes 30 years later. After adjustment for major risk factors, ATS and pulse pressure (PP) were predictive of coronary events while mean BP (MBP) and retinopathy were not. On the contrary, MBP was predictive of cerebrovascular and renal related deaths while ATS and PP were not. Retinopathy was only predictive of cerebrovascular related deaths. Lastly, the aortic atherosclerosis phenotype and increased PP identified patients prone to develop fatal MI whereas the retinopathy phenotype and increased MBP identified patients at higher risk of fatal stroke. These results illustrate the particular feature of the resistive coronary circulation comparatively to the brain and kidneys' low-resistance circulation. Our results advocate for a rational preventive strategy based on the identification of distinct clinical phenotypes. Accordingly, decreasing MBP levels could help preventing stroke in retinopathy phenotypes whereas targeting PP is possibly more efficient in preventing MI in atherosclerotic phenotypes. ________________________________________________________________________________ Title: Positive psychological health and stroke risk: The benefits of emotional vitality Citation: Health Psychology, October 2015, vol./is. 34/10(1043-1046), 0278-6133;1930-7810 (01 Oct 2015) Author(s): Lambiase M.J., Kubzansky L.D., Thurston R.C. Abstract: Objective: Stroke is a leading cause of death and disability. Various forms of positive psychological health (e.g., emotional vitality) are associated with lower risk for heart disease. However, it is unclear whether positive psychological health may also be beneficial for stroke risk. The purpose of the present study was to examine prospectively the association between emotional vitality and incident stroke in a nationally representative sample of 6,019 participants in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Methods: Emotional vitality was assessed via self-report at study baseline in 1971-1975. Stroke cases were identified from hospital/nursing home discharge reports and death certificates. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals of incident stroke associated with a 1 SD increase in emotional vitality scores. Models were adjusted for traditional cardiovascular disease risk factors and subsequently for psychological distress. Results: Higher emotional vitality was associated with lower risk of incident stroke over a mean of 16.29 (SD = 4.75) years of follow-up (hazard ratio = 0.89; 95% confidence interval: 0.81, 0.99). Findings persisted when controlling for traditional cardiovascular disease risk factors and psychological distress. Conclusions: Higher levels of emotional vitality were prospectively associated with lower stroke risk in

a representative sample of the U.S. population. Associations were independent of psychological distress. Results point to the potential importance of positive psychological functioning for cardiovascular health and for stroke prevention. Full text: Available ProQuest at Health Psychology ________________________________________________________________________________ Title: Body, participation and self transformations during and after in-patient stroke rehabilitation Citation: Scandinavian Journal of Disability Research, October 2015, vol./is. 17/4(300-320), 15017419;1745-3011 (02 Oct 2015) Author(s): Arntzen C., Hamran T., Borg T. Abstract: This study explores stroke survivors' experience of being part of an institutional rehabilitation context and what it means for the immediate experience of discharge home. The aim is to develop a deeper understanding of how the dynamic phenomenon body, participation in everyday life and sense of self interrelates and changes through stroke survivors' movement in and between the two contexts and what this phenomenon means for stroke survivors' process of change and wellbeing in the early rehabilitation trajectory. Repeated, retrospective, in-depth interviews were conducted with nine persons living with moderate impairment after stroke and their closest relatives. Phenomenological and critical psychological concepts are used for analysing the data. Stroke survivors' experience indicates that their time as in-patients is important for their safety in the early juncture. Being part of an institutional rehabilitation context mobilizes stroke survivors' to optimize focus, energy and hope of physical recovery. At the same time it appears to postpone feelings of uncertainty and grief as well as reflection on their situation. However, immediately after homecoming a critical passage in the stroke survivors' rehabilitation trajectory appears because the perception of body, participation in everyday life and the sense of self undergo profound changes. This study stresses the importance of broadening the scope of professional initiative and paying attention to the post-rehabilitation context of everyday life during the in-patient stay. ________________________________________________________________________________ Title: Cost and outcome in pediatric ischemic stroke Citation: Journal of Child Neurology, October 2015, vol./is. 30/11(1483-1488), 0883-0738;1708-8283 (22 Oct 2015) Author(s): Hamilton W., Huang H., Seiber E., Lo W. Abstract: The cost of childhood stroke receives little notice. The authors examined potential drivers of cost and outcome to test whether (1) neonatal strokes cost less than childhood strokes, (2) associated diseases influence cost, (3) arterial ischemic stroke is more costly than sinovenous thrombosis, and (4) cost correlates with outcome. The authors reviewed records of 111 children who sustained arterial ischemic stroke or sinovenous thrombosis between 2005 and 2010 to identify costs for the following year. They assessed outcomes in 46 with the Recovery and Recurrence Questionnaire and the Pediatric Quality of Life Inventory. Neonatal strokes cost less than childhood stroke. Strokes associated with congenital heart disease or vasculopathy cost the most, while perinatal or idiopathic strokes cost the least. Higher costs are correlated with worse impairment and poorer quality of life. Stroke etiology significantly influences the cost of pediatric stroke. Future costbenefit studies must consider etiology when estimating the incremental costs associated with stroke. ________________________________________________________________________________ Title: Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: A double-blind randomised controlled trial Citation: The Lancet Neurology, October 2015, vol./is. 14/10(992-1001), 1474-4422;1474-4465 (01 Oct 2015) Author(s): Catus F., De Fer B.B., Vilain C., Picaut P., Ayyoub Z., Banach M., Bensmail D., R Bentivoglio A., Boyer F., Brashear A., Csanyi A., Deltombe T., Denes Z., Edgley S., Gul F., Gracies

J.-M., Hedera P., Isaacson S., Isner-Horobeti M.-E., Jech R., Kaminska A., Khatkova S., Kocer S., Lejeune T., McAllister P., Marciniak C., Marque P., O'Dell M., Remy-Neris O., Rubin B., Rudzinska M., Simpson D., Skoromets A., Timerbaeva S.L., Valkovic P., Vecchio M., Walker H., Wimmer M. Abstract: Background: Resistance from antagonistic muscle groups might be a crucial factor reducing function in chronic hemiparesis. The resistance due to spastic co-contraction might be reduced by botulinum toxin injections. We assessed the effects of abobotulinumtoxinA injection in the upper limb muscles on muscle tone, spasticity, active movement, and function. Methods: In this randomised, placebo-controlled, double-blind study, we enrolled adults (aged 18-80 years) at least 6 months after stroke or brain trauma from 34 neurology or rehabilitation clinics in Europe and the USA. Eligible participants were randomly allocated in a 1:1:1 ratio with a computer-generated list to receive a single injection session of abobotulinumtoxinA 500 U or 1000 U or placebo into the most hypertonic muscle group among the elbow, wrist, or finger flexors (primary target muscle group [PTMG]), and into at least two additional muscle groups from the elbow, wrist, or finger flexors or shoulder extensors. Patients and investigators were masked to treatment allocation. The primary endpoint was the change in muscle tone (Modified Ashworth Scale [MAS]) in the PTMG from baseline to 4 weeks. Secondary endpoints were Physician Global Assessment (PGA) at week 4 and change from baseline to 4 weeks in the perceived function (Disability Assessment Scale [DAS]) in the principal target of treatment, selected by the patient together with physician from four functional domains (dressing, hygiene, limb position, and pain). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01313299. Findings: 243 patients were randomly allocated to placebo (n=81), abobotulinumtoxinA 500 U (n=81), or abobotulinumtoxinA 1000 U (n=81). Mean change in MAS score from baseline at week 4 in the PTMG was -03 (SD 06) in the placebo group (n=79), -12 (10) in the abobotulinumtoxinA 500 U group (n=80; difference -09, 95% CI -12 to -06; p<00001 vs placebo), and -14 (11) in the abobotulinumtoxinA 1000 U group (n=79; -11, -14 to -08; p<00001 vs placebo). Mean PGA score at week 4 was 06 (SD 10) in the placebo group (n=78), 14 (11) in the abobotulinumtoxinA 500 U group (n=80; p=00003 vs placebo), and 18 (11) in the abobotulinumtoxinA 1000 U group (n=78; p<00001 vs placebo). Mean change from baseline at week 4 in DAS score for the principal target of treatment was -05 (07) in the placebo group (n=79), -07 (08) in the abobotulinumtoxinA 500 U group (n=80; p=02560 vs placebo), and -07 (07) in the abobotulinumtoxinA 1000 U group (n=78; p=00772 vs placebo). Three serious adverse events occurred in each group and none were treatment related; two resulted in death (from pulmonary oedema in the placebo group and a pre-existing unspecified cardiovascular disorder in the abobotulinumtoxinA 500 U group). Adverse events that were thought to be treatment related occurred in two (2%), six (7%), and seven (9%) patients in the placebo, abobotulinumtoxinA 500 U, and abobotulinumtoxinA 1000 U groups, respectively. The most common treatment-related adverse event was mild muscle weakness. All adverse events were mild or moderate. Interpretation: AbobotulinumtoxinA at doses of 500 U or 1000 U injected into upper limb muscles provided tone reduction and clinical benefit in hemiparesis. Future research into the treatment of spastic paresis with botulinum toxin should use active movement and function as primary outcome measures. ___________________________________________________________________________ Title: Time to endovascular reperfusion and degree of disability in acute stroke Citation: Annals of Neurology, October 2015, vol./is. 78/4(584-593), 0364-5134;1531-8249 (01 Oct 2015) Author(s): Sheth S.A., Jahan R., Gralla J., Pereira V.M., Nogueira R.G., Levy E.I., Zaidat O.O., Saver J.L. Abstract: Objective Faster time from onset to recanalization (OTR) in acute ischemic stroke using endovascular therapy (ET) has been associated with better outcome. However, previous studies were based on less-effective first-generation devices, and analyzed only dichotomized disability outcomes, which may underestimate the full effect of treatment. Methods In the combined databases of the

SWIFT and STAR trials, we identified patients treated with the Solitaire stent retriever with achievement of substantial reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b-3). Ordinal numbers needed to treat values were derived by populating joint outcome tables. Results Among 202 patients treated with ET with TICI 2b to 3 reperfusion, mean age was 68 (+/-13), 62% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range [IQR]: 14-20). Day 90 modified Rankin Scale (mRS) outcomes for OTR time intervals ranging from 180 to 480 minutes showed substantial time-related reductions in disability across the entire outcome range. Shorter OTR was associated with improved mean 90-day mRS (1.4 vs. 2.4 vs. 3.3, for OTR groups of 124-240 vs. 241-360 vs. 361-660 minutes; p < 0.001). The number of patients identified as benefitting from therapy with shorter OTR were 3-fold (range, 1.5-4.7) higher on ordinal, compared with dichotomized analysis. For every 15-minute acceleration of OTR, 34 per 1,000 treated patients had improved disability outcome. Interpretation Analysis of disability over the entire outcome range demonstrates a marked effect of shorter time to reperfusion upon improved clinical outcome, substantially higher than binary metrics. For every 5-minute delay in endovascular reperfusion, 1 of 100 patients has a worse disability outcome. ________________________________________________________________________________ Title: Speech Pathology Reliability for Stroke Swallowing Screening Items Citation: Dysphagia, October 2015, vol./is. 30/5(565-570), 0179-051X;1432-0460 (01 Oct 2015) Author(s): Daniels S.K., Pathak S., Stach C.B., Mohr T.M., Morgan R.O., Anderson J.A. Abstract: Swallowing screening is critical in rapid identification of risk of aspiration in patients presenting with acute stroke symptoms. Accuracy in judgments is vital for the success of the screening. This study examined speech-language pathologists' (SLPs) reliability in interpreting screening items. Swallowing screening was completed in 75 individuals admitted with stroke symptoms. Screening items evaluated were lethargy, dysarthria, wet voice unrelated to swallowing, abnormal volitional cough, and cough, throat clear, wet voice after swallowing, and inability to continuously drink with ingestion of 5 and 90 ml water. Two SLPs, each with more than 10 years of experience, made simultaneous independent judgments of the same observations obtained from the screening. Overall, generally high agreement was identified between the SLPs (k[SE] = 0.83[0.03]). Individual kappas ranged from 0.38 (fair) for non-swallowing wet voice to 0.95 (almost perfect) for cough after swallow, with one item omitted due to minimal variation. SLPs demonstrate high reliability in swallowing screening. Results, however, indicate some potential variability. Items associated with trial swallows had the highest reliability, whereas items related to judgments of speech and voice quality had the lowest. Although SLPs have dedicated training and ample opportunity to practice, differences in agreement are evident. Routine practice in hospital departments is recommended to establish and maintain sensitive perceptual discrimination. If other professionals are to provide swallowing screening, knowledge of SLPs' reliability levels must be considered when identifying screening items, creating education modules, and determining acceptable levels of agreement. ________________________________________________________________________________ Title: A Phase 1 exercise dose escalation study for stroke survivors with impaired walking Citation: International Journal of Stroke, October 2015, vol./is. 10/7(1051-1056), 1747-4930;17474949 (01 Oct 2015) Author(s): Dite W., Langford Z.N., Cumming T.B., Churilov L., Blennerhassett J.M., Bernhardt J. Abstract: Background: Targeted exercise and increased practice can improve the mobility of stroke survivors. However, many stroke survivors continue to have reduced physical work capacity and impaired walking, and experience frequent falls after participating in physical rehabilitation programs. Aim: In this Phase 1 study, we used a dose escalation method, common in pharmaceutical trials, to determine the maximum tolerable dose of multimodal exercise in community-dwelling stroke survivors with mobility impairment. Methods: Stroke survivors 14-59 months poststroke participated in a 12week (36 sessions) multimodal exercise program implemented using a cumulative 3+3 dose

escalation design (featuring increasing doses in successive cohorts of three participants), with set dose-limiting tolerance criteria. The exercise intervention included challenging balance activities, strength, and endurance training. The program was individualized and focused on task-specific requirements for walking in the community. Results: Six survivors participated before escalation was ceased. Four participants were able to tolerate up to 105h/week of exercise, which included 283min of endurance, 182min of task practice, 138min of strengthening, and 28min resting. The program led to increased walking distance (Six-Minute Walk Test) and faster mobility (4 Square Step Test, Timed Up and Go Test), with pre-postimprovements averaging 23-41%. Conclusions: This is the first multimodal exercise dose escalation study in stroke. The maximal dose of exercise identified was dramatically higher than the dose typically delivered to stroke survivors in current trials. We now plan to confirm safety and feasibility of this program in a larger Phase II trial. ________________________________________________________________________________ Title: Intakes of magnesium, potassium, and calcium and the risk of stroke among men Citation: International Journal of Stroke, October 2015, vol./is. 10/7(1093-1100), 1747-4930;17474949 (01 Oct 2015) Author(s): Adebamowo S.N., Spiegelman D., Flint A.J., Willett W.C., Rexrode K.M. Abstract: Background: Intakes of magnesium, potassium, and calcium have been inversely associated with the incidence of hypertension, a known risk factor for stroke. However, only a few studies have examined intakes of these cations in relation to risk of stroke. Aim: The aim of this study was to investigate whether high intake of magnesium, potassium, and calcium is associated with reduced stroke risk among men. Methods: We prospectively examined the associations between intakes of magnesium, potassium, and calcium from diet and supplements, and the risk of incident stroke among 42669 men in the Health Professionals Follow-up Study, aged 40 to 75 years and free of diagnosed cardiovascular disease and cancer at baseline in 1986. We calculated the hazard ratio of total, ischemic, and haemorrhagic strokes by quintiles of each cation intake, and of a combined dietary score of all three cations, using multivariate Cox proportional hazard models. Results: During 24 years of follow-up, 1547 total stroke events were documented. In multivariate analyses, the relative risks and 95% confidence intervals of total stroke for men in the highest vs. lowest quintile were 087 (95% confidence interval, 074-102; P, trend=004) for dietary magnesium, 089 (95% confidence interval, 076-105; P, trend=010) for dietary potassium, and 089 (95% confidence interval, 075-104; P, trend=025) for dietary calcium intake. The relative risk of total stroke for men in the highest vs. lowest quintile was 074 (95% confidence interval, 059-093; P, trend=0003) for supplemental magnesium, 066 (95% confidence interval, 050-086; P, trend=0002) for supplemental potassium, and 101 (95% confidence interval, 084-120; P, trend=083) for supplemental calcium intake. For total intake (dietary and supplemental), the relative risk of total stroke for men in the highest vs. lowest quintile was 083 (95% confidence interval, 070-099; P, trend=004) for magnesium, 088 (95% confidence interval, 0754; P, trend=6) for potassium, and 3 (95% confidence interval, 79-09; P, trend=84) for calcium. Men in the highest quintile for a combined dietary score of all three cations had a multivariate relative risk of 079 (95% confidence interval, 067-092; P, trend=0008) for total stroke, compared with those in the lowest. Conclusions: A diet rich in magnesium, potassium, and calcium may contribute to reduced risk of stroke among men. Because of significant collinearity, the independent contribution of each cation is difficult to define. ________________________________________________________________________________ Title: Sustained impact of UK FAST-test public education on response to stroke: A population-based time-series study Citation: International Journal of Stroke, October 2015, vol./is. 10/7(1108-1114), 1747-4930;17474949 (01 Oct 2015) Author(s): Wolters F.J., Paul N.L.M., Li L., Rothwell P.M. Abstract: Background: Urgent assessment is essential after stroke. Several countries have had public education campaigns, based on the FAST (Face-Arm-Speech-Time) test to reduce delays in

seeking attention. However, the impact of these campaigns on patient behavior is uncertain. Methods: We prospectively determined patient behavior after incident major stroke (NIHSS>3) in a UK population based study (Oxford Vascular Study) before (2002-2008) and after (2009-2013) introduction of the FAST TV-campaign and assessed any sustained impact of campaign continuation. Results: Among 668 consecutive patients with major stroke, medical attention was sought by a bystander in 553 (896%). Patients were more likely to present directly to emergency services (OR=218, 95%CI:154-309, P<00001) after the campaign and to arrive at hospital within 3h (OR=218, 155-306, P<00001). Median [IQR] time to seeking attention fell from 53 [15-265] to 31 [7-120] minutes (P=0005) and median time to hospital arrival from 185 [88-885] to 119 [78-256] minutes (P<00001). On time-series analysis improvements in hospital arrival within 3h and use of emergency medical services were significantly associated to initiation of the campaign (aOR=311, 153-629, P=0002; and 222, 105-467, P=0036, respectively), independent of trend, age, sex, ethnicity, educational level, social class, prior stroke and stroke severity, and have been sustained to 2013. Conclusion: Delays to seeking and receiving medical attention after major stroke in the UK. fell strikingly in 2009, coinciding with the start of the FAST TV campaign. That medical attention was sought by a bystander in nearly 90% of cases illustrates the importance of mass-media public education rather than focused programs in high-risk groups for major stroke. ________________________________________________________________________________ Title: Prognostic Significance of Regional Arterial Stiffness for Stroke in Hypertension Citation: Pulse, September 2015, vol./is. 3/(98-105), 2235-8676;2235-8668 (08 Sep 2015) Author(s): Kubozono T., Ohishi M. Abstract: Background: Hypertension is strongly associated with cardiovascular disease. It has been reported that arterial stiffness is related to cardiovascular mortality and morbidity in hypertensive patients and that the physiological evaluation of arterial stiffness may assist clinicians in the early detection of atherosclerosis. Summary: It has been demonstrated that increased arterial stiffness is an independent predictor of cardiovascular disease, including stroke. Arterial stiffness is associated with structural changes in the brain. However, the stiffness responses of muscular arteries are different from those of elastic arteries, and so the impact of arterial stiffness and the conclusions to be drawn may be different depending on the region in which the measurement is taken. Key Messages: In this review, we summarize the current literature describing the association between arterial stiffness, including carotid-femoral and brachial-ankle pulse wave velocity and cardio-ankle vascular index, and cardiovascular disease, specifically stroke. We discuss the utility and prognostic significance of regional arterial stiffness measurements. ________________________________________________________________________________ Title: Short-and long-term stroke risk after urgent management of transient ischaemic attack: The bologna TIA clinical pathway Citation: European Neurology, September 2015, vol./is. 74/(1-7), 0014-3022;1421-9913 (22 Sep 2015) Author(s): Guarino M., Rondelli F., Favaretto E., Stracciari A., Filippini M., Rinaldi R., Zele I., Sartori M., Faggioli G., Mondini S., Donti A., Strocchi E., Degli Esposti D., Muscari A., Veronesi M., D'Addato S., Spinardi L., Faccioli L., Pastore Trossello M., Cirignotta F. Abstract: Background: Rapid management can reduce the short stroke risk after transient ischaemic attack (TIA), but the long-term effect is still little known. We evaluated 3-year vascular outcomes in patients with TIA after urgent care. Methods: We prospectively enrolled all consecutive patients with TIA diagnosed by a vascular neurologist and referred to our emergency department (ED). Expedited assessment and best secondary prevention was within 24 h. Endpoints were stroke within 90 days, and stroke, myocardial infarction, and vascular death at 12, 24 and 36 months. Results: Between August 2010 and July 2013, we evaluated 686 patients with suspected TIA; 433 (63%) patients had confirmed TIA. Stroke at 90 days was 2.07% (95% confidence interval (CI), 1.1-3.9) compared with

the ABCD<sup>2</sup>-predicted risk of 9.1%. The long-term stroke risk was 2.6% (95% CI, 1.14.2), 3.7% (95% CI, 1.6-5.9) and 4.4% (95% CI, 1.9-6.8) at 12, 24 and 36 months, respectively. The composite outcome of stroke, myocardial infarction, and vascular death was 3.5% (95% CI, 1.7-5.1), 4.9% (95% CI, 2.5-7.4), and 5.6% (95% CI, 2.8-8.3) at 12, 24, and 36 months, respectively. Conclusions: TIA expedited management driven by vascular neurologists was associated with a marked reduction in the expected early stroke risk and low long-term risk of stroke and other vascular events. ________________________________________________________________________________ Title: Improving post-stroke recovery: The role of the multidisciplinary health care team Citation: Journal of Multidisciplinary Healthcare, September 2015, vol./is. 8/(433-442), 1178-2390 (22 Sep 2015) Author(s): Clarke D.J., Forster A. Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Full text: Available National Library of Medicine at Journal of Multidisciplinary Healthcare ________________________________________________________________________________ Title: The value of routine transthoracic echocardiography in defining the source of stroke in a community hospital Citation: Journal of Clinical Outcomes Management, September 2015, vol./is. 22/9(407-411), 10796533 (01 Sep 2015) Author(s): Bellemare R.H., Cheruserry J., Meisenberg B., Maxted W.C. Abstract: Background: Acute stroke or cerebrovascular accident (CVA) is a common indication for hospitalization and can have devastating consequences, particularly in the setting of recurrence. Cardiac sources are potentially remediable; thus, a transthoracic echocardiogram (TTE) is frequently ordered to evaluate for a cardiac source of embolism. Objective: To evaluate the utility of performing TTE on patients experiencing a CVA or transient ischemic attack (TIA) to evaluate for a cardiac source of embolism. Methods: Retrospective review of TTE reports and patient electronic medical records at Anne Arundel Medical Center, a 385-bed community hospital. Medical charts for all CVA patients receiving a TTE between February 2012 to April 2013 were reviewed for TTEs showing unequivocal cardiac sources of embolism as evaluated by the reviewing cardiologist. Patient information and clinical morbidities were also noted to construct a composite demographic of CVA patients. Results: One TTE of 371 (0.270%) identified a clear cardiac embolus. Risk factors for stroke included hypertension (n = 302), cardiovascular disease (n = 204), cardiomyopathy (n = 131), and diabetes (n = 146). Conclusion: In the setting of stroke, TTE is of limited value when determining the etiology of stroke and should be used provisionally rather than routinely in evaluating patients experiencing CVA or TIA. ________________________________________________________________________________

Title: Neurostimulation for cognitive rehabilitation in stroke (NeuroCog): Study protocol for a randomized controlled trial

Citation: Trials, September 2015, vol./is. 16/1, 1745-6215 (September 29, 2015) Author(s): Andrade S.M., Fernandez-Calvo B., Boggio P.S., de Oliveira E.A., Gomes L.F., Pinheiro Junior J.E.G., Rodrigues R.M., de Almeida N.L., Moreira G.M.S., Alves N.T. Abstract: Background: Stroke patients may present severe cognitive impairments, primarily related to executive functions. Transcranial direct current stimulation has shown promising results, with neuromodulatory and neuroplastic effects. This study is a double-blind, sham-controlled clinical trial aiming to compare the long-term effects of stimulation in two different cognitive regions after a stroke. Methods/Design: Sixty patients who suffer from chronic strokes will be randomized into one of four groups: dorsolateral prefrontal cortex, cingulo-opercular network, motor primary cortex and sham stimulation. Each group will receive transcranial direct current stimulation at an intensity of 2mA for 20minutes daily for 10 consecutive days. Patients will be assessed with a Dysexecutive Questionnaire, Semantic Fluency Test, categorical verbal fluency and Go-no go tests, Wechsler Adult Intelligence Scale, Rey Auditory-Verbal Learning Test, Letter Comparison and Pattern Comparison Tasks at baseline and after their tenth stimulation session. Those who achieve clinical improvement with neurostimulation will be invited to receive treatment for 12months as part of a follow-up study. Discussion: Long-term stimulation could be analyzed in regard to possible adaptive changes on plasticity after structural brain damage and if these changes are different in terms of clinical improvement when applied to two important cognitive centers. Trials registration: Clinicaltrials.gov, NCT02315807. 9 December 2014. Full text: Available National Library of Medicine at Trials Full text: Available National Library of Medicine at Trials ________________________________________________________________________________ Title: Thoracic aortic calcification is associated with incident stroke in the general population in addition to established risk factors Citation: European Heart Journal Cardiovascular Imaging, 2015, vol./is. 16/6(684-690), 20472404;2047-2412 (2015) Author(s): Hermann D.M., Lehmann N., Gronewold J., Bauer M., Mahabadi A.A., Weimar C., Berger K., Moebus S., Jockel K.-H., Erbel R., Kalsch H. Abstract: Aims The aorta is a major source of cerebral thromboembolism, but its role in stroke pathogenesis is notwell understood due to its poor accessibility for non-invasive imaging.We examined whether thoracic aortic calcification (TAC), a marker of aortic plaque load, is associated with stroke in addition to established risk factors. Methods and results A total of 3930 subjects from the population-based Heinz Nixdorf Recall study (45-75 years; 47.1% men) without previous stroke, coronary heart disease, or myocardial infarction were evaluated for incident stroke events over 109.0+/-23.3 months. Cox proportional hazards regressions were used to examine associations with stroke of TAC in addition to established risk factors (age, sex, systolic blood pressure, LDL, HDL, diabetes, and smoking) and coronary artery calcification (CAC). 101 incident strokes occurred during the follow-up period. Subjects suffering a stroke had significantly higher TAC values at baseline than the remaining subjects (median = 83.1 [Q1;Q3 = 4.7;472.9] vs. 15.7 [0.0;117.1]; P < 0.001). In a multivariable Cox proportional hazards regression, log(TAC + 1) (hazards ratio [HR] = 1.09 [95% confidence interval = 1.00-1.19]; P = 0.044) was associated with stroke in addition to established risk factors. Further analyses revealed that log(DTAC +/- 1), i.e. calcification of the descending aorta (1.11 [1.02-1.20]; P = 0.016), but not log(ATAC + 1), i.e. calcification of the ascending aorta (1.02 [0.931.11]; P = 0.713), was associated with stroke. The HR for log(TAC + 1) decreased to 1.06 (0.97-1.16; P = 0.202), when log(CAC + 1) was also inserted into multivariable analyses. Conclusion Calcification of the thoracic aorta, more specifically its descending segment, is associated with incident stroke in addition to established risk factors. CAC outperforms aortic calcification as a stroke predictor.

Full text: Available Highwire Press at European Heart Journal - Cardiovascular Imaging ________________________________________________________________________________ Title: Recurrent ischemic events and risk factors in patients with symptomatic intracranial artery stenosis Citation: European Review for Medical and Pharmacological Sciences, 2015, vol./is. 19/14(26082613), 1128-3602 (2015) Author(s): Wang P.-Q., Liu J.-J., Wang A.-P., Zhang G.-B., Cao Z.-H., Wang P., Zhou P.-Y. Abstract: OBJECTIVE: To evaluate the recurrent ischemic events and risk factors in patients with symptomatic intracranial artery stenosis. PATIENTS AND METHODS: Patients with acute cerebral infarction or transient ischemia attach (TIA) and intracranial arterial stenosis confirmed through CTA examination, were enrolled from the Department of Neurology. All cases were followed-up regularly and divided into recurrent group and non-recurrent group according to occurrence of cerebrovascular events. Major observation index: (1) the occurrence of endpoint; (2) new stroke in responsible artery; (3) drug therapy compliance was used. RESULTS: A total of 142 cases fulfilled the inclusion criteria, among them 121 cases (85.2%) completed the follow-up, and in 16 cases (13.2%) ischemic cerebrovascular stroke events occurred within one year, while among these vascular lesions recurred on the ipsilateral side in 12 cases (75%). Single factor analysis showed that difference between recurrent group and non-recurrent group on irregular use of statins (p = 0.017), diabetes mellitus (p = 0.017) and severe arterial stenosis (p = 0.030) were statistically significant. Logistic regression analysis showed that irregular use of statins (OR=3.719, p = 0.005), diabetes (OR=1.842. p = 029) and severe arterial stenosis (OR=1.503. p = 0.045) were correlated with the recurrence of symptomatic intracranial artery stenosis. CONCLUSIONS: Patients with symptomatic intracranial artery stenosis had a higher recurrence rate of stroke; whereas patients with irregular use of statins, diabetes and severe arterial stenosis had a higher recurrence risk of stroke. ________________________________________________________________________________

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. We now have a subscription to EBL Electronic Books and would be interested to know if there are any titles you feel would be of benefit to be added to our collection. The catalogue can be browsed here; you will need your OpenAthens password to access it. You can request books either on the site itself or by emailing us on library@tst.nhs.uk

New book added to stock

From the back of the book: This concise and informative Textbook of Stroke Medicine is aimed at doctors preparing to specialize in stroke care and strokologists looking for concise but in-depth scientific guidance on stroke management. Its practical approach covers all important issues of prevention, diagnosis, and treatment of cerebrovascular diseases. Dedicated chapters give a thorough review of all clinical issues. Fully revised throughout, the new edition has expanded sections on topics of rising practical importance, such as diagnostic imaging, stroke unit management, monitoring and management of complications including infections, recommendations for thrombolysis, interventions and neurosurgical procedures, and clear and balanced recommendations for secondary prevention. Neuropsychological syndromes are explained and an upto-date view on neurorehabilitation is presented. The authors are all experts in their field and many of them have been working together in a teaching faculty for the European Master in Stroke Medicine Programme, which is supported by the European Stroke Organization.

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Full-text evidence-based systematic reviews prepared by the Cochrane collection Reviews from September and October 2015 Constraint-induced movement therapy for upper extremities in people with stroke Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack Parenteral fluid regimens for improving functional outcome in people with acute stroke

Protocols from September and October 2015 Action observation for upper limb rehabilitation after stroke Arm basis training and arm ability training: two impairment-oriented exercise training techniques for improving arm function after stroke

GUIDELINES BACK TO TOP th

National Clinical Guideline for Stroke, 4 edition 2012 NICE Guidelines 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 fibrillation- NICE technology appraisal guidance [TA355] Published date: September 2015

UPTODATE & DYNAMED BACK TO TOP Whatâ&#x20AC;&#x2122;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.

REPORTS, PUBLICATIONS AND RESOURCES BACK TO TOP 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. NICE Pathway on Stroke Sentinel Stroke National Audit Programme This is the SSNAP results portal. Here you will find results for the clinical, organisational, and postacute organisational audit. The SSNAP clinical audit measures the processes of care provided to stroke patients and results are disseminated on a quarterly basis. The SSNAP Organisational Audit reports biennially. The latest report was based on the structure of stroke services on 1st July 2014, and results were made available in December 2014. The post-acute organisational audit will measure the structures of stroke services in the post-acute setting, the results of which will be available in Summer 2015. Occupational therapy for stroke survivors in UK care homes: findings of an RCT study Sitting, apparently doing nothing, in the lounge of care home may be many peopleâ&#x20AC;&#x2122;s image of residential care. This article reports an important study that tested a programme of activity for care home residents who were stroke survivors.

TOPIC ALERTS AND UPDATES BACK TO TOP ABSTRACTS AVAILABLE VIA LINKS BELOW - FOR FULL-TEXT PLEASE ASK LIBRARY STAFF Elsevier Practice Updates Assessment of the CHA2DS2-VASc Score in Predicting Ischemic Stroke, Thromboembolism, and Death in Patients With Heart Failure With and Without Atrial Fibrillation JAMA. 2015;314(10):1030-1038. Age ≥80 Years Is Not a Contraindication for Intra-Arterial Therapy after Ischemic Stroke Cerebrovasc Dis 2015;40:121-128 FREE FULL TEXT Real-World Experience with Insertable Cardiac Monitors to Find Atrial Fibrillation in Cryptogenic Stroke Cerebrovasc Dis 2015;40:175-181 FREE FULL TEXT

Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial Lancet 2015 Sep 03;[EPub Ahead of Print]

Medscape Topic Alerts Cardiogenic Stroke Despite Low CHA2DS2-VASc Score: Assessing Stroke risk by Left Atrial Appendage Anatomy (ASK LAA) Journal of Cardiovascular Electrophysiology Volume 26, Issue 9, pages 915–921, September 2015

Midlife Alcohol Consumption and the Risk of Stroke in the Atherosclerosis Risk in Communities Study Stroke, Published online before print September 24, 2015

TRIP Database The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: A randomized controlled trial. Clin Rehabil. 2015 Oct 8. Risk of stroke in retinal vein occlusion. Neurology. 2015 Oct 9. Feasibility and Preliminary Efficacy of Visual Cue Training to Improve Adaptability of Walking after Stroke: Multi-Centre, Single-Blind Randomised Control Pilot Trial. PLoS One. 2015 Oct 7;10(10):e0139261.

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 UK Stroke Forum Conference December 2015 th

25 European Stroke Conference April 2016 10th World Stroke Congress October 2016 th

British Association of Stroke Physicians- Trainees Weekend- 18 -19 March 2016, Birmingham th

BMJ Masterclass- Stroke- 11 December 2015, London

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 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.