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This report (HCP 405, session 2009-10, ISBN 9780215553195), looks at the "Progress in improving stroke care" and follows an NAO report (HCP 291, ISBN 9780102963441) on the same topic. Stroke is one of the top three causes of death and the largest cause of adult disability in England, costing the NHS at least £3 billion a year in direct care costs, with wider economic costs of around £8 billion. A 2006 report (HCP 911, session 2005-06, ISBN 9780215029683) highlighted serious shortcomings across the whole stroke care pathway. The Committee welcomes demonstrable improvements in stroke care which the Department of Health has achieved since. The Department and NHS have increased the priority given to stroke, particularly the speed of the acute hospital response. However, improvements have not been universal. The Committee finds it totally unacceptable that the likelihood of receiving a timely brain scan or accessing specialist care is dependent on where and when you have a stroke. Also the improvements in hospital care are not yet matched by progress in delivering more effective support once stroke survivors leave hospital with many patients discharged from hospital continuing to struggle to obtain follow-up care and access to community rehabilitation services remains a post-code lottery. The Committee has set out a number of conclusions and recommendations.
The National Stroke Strategy (2007) is a comprehensive response to the concerns raised by the NAO in its 2005 report on stroke (HC 452, session 2005-06, ISBN 9780102935707). The strategy has been underpinned by strong national leadership and performance indicators as well as £59 million of central funding over the first two years, £30 million of which was allocated to local authorities specifically to provide support services to stroke patients and their carers. The NHS is now starting to deliver better care from stroke services, and outcomes for patients are also improving. Patients treated in a specialist stroke unit are more likely to survive, have fewer complications and regain their independence, but in 2008 only 17 per cent of stroke patients reached the stroke unit within four hours of arrival at hospital. Brain imaging is also very important for stroke patients but many patients are not given a scan quickly enough and access at weekends and evenings is significantly more limited. There is better awareness of the symptoms of stroke, and that it is a medical emergency, following the Department's 'Stroke: Act FAST' advertising campaign, launched in February 2009. The number of calls categorised as being a suspected stroke during April to June 2009 increased by 54 per cent in comparison with the same period in 2008. But a third of patients are not getting a follow-up appointment within six weeks and only a half of stroke survivors in the NAO's survey said that they were given advice on further stroke prevention when leaving hospital.
Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subsequent care, effective recovery and rehabilitation is increased. Acute Stroke Nursing provides an evidence-based, practical text facilitating the provision of optimal stroke care during the primary prevention, acute and continuing care phases. This timely and comprehensive text is structured to follow the acute stroke pathway experienced by patients. It explores the causes, symptoms and effects of stroke, and provides guidance on issues such as nutrition, continence, positioning, mobility and carer support. The text also considers rehabilitation, discharge planning, palliative care and the role of the nurse within the multi-professional team. Acute Stroke Nursing is the definitive reference on acute stroke for all nurses and healthcare professionals wishing to extend their knowledge of stroke nursing. Evidence-based and practical in style, with case studies and practice examples throughout Edited and authored by recognised stroke nursing experts, clinicians and leaders in the field of nursing practice, research and education The first text to explore stroke management from UK and international perspectives, and with a nursing focus
Prevention of Stroke sums up and critically analyzes our present knowledge and understanding of all major aspects of stroke prophylaxis, medical and surgical. The book is intended for not only neurologists and neurosurgeons directly involved with stroke patients, but also vascular surgeons, internists, family physicians, and health planners. Topics explored include the cellular basis of atherosclerosis; stroke risk factors; head and neck bruits in stroke prevention; the present status of anticoagulant prophylaxis; hypertension and stroke prevention; and prevention of cardioembolic stroke, as well as the efficacy of aspirin and of ticlopidine in stroke prevention. Surgical prophylaxis is examined through discussions of carotid endarterectomy, prevention of stroke from cerebral vascular malformations, prevention of aneurysmal subarachnoid hemorrhage, balloon transluminal angioplasty of the carotid artery in the head and neck, and prevention of recurrent stroke.
This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.
This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke.
This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives.
This issue is a dedicated supplement published in addition to the regular issues of 'Cerebrovascular Diseases' focussing on one specific topic. 'Cerebrovascular Diseases' is a well-respected, international peer-reviewed journal in Neurology. Supplement issues are included in the subscription.
Developmental evaluation (DE) offers a powerful approach to monitoring and supporting social innovations by working in partnership with program decision makers. In this book, eminent authority Michael Quinn Patton shows how to conduct evaluations within a DE framework. Patton draws on insights about complex dynamic systems, uncertainty, nonlinearity, and emergence. He illustrates how DE can be used for a range of purposes: ongoing program development, adapting effective principles of practice to local contexts, generating innovations and taking them to scale, and facilitating rapid response in crisis situations. Students and practicing evaluators will appreciate the book's extensive case examples and stories, cartoons, clear writing style, "closer look" sidebars, and summary tables. Provided is essential guidance for making evaluations useful, practical, and credible in support of social change.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.