You'll be interested that there is NO discussion of 100% recovery which means they are NEVER going to do anything towards that! The takeaway is don't have a stroke because your stroke medical 'professionals' aren't really professional in my opinion!
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? I would like to know what your definition of professionalism in stroke is.
You'll want 100% recovery when you become the 1 in 4 per WHO that has a stroke
You might be interested in…Stroke Irish Medical Times
Dr Ray O’Connor takes a look at the latest clinical papers on the treatment of stroke, and how high-quality rehabilitation can minimize(NOT RECOVER!) the impact of the condition
Globally, stroke is the second leading cause of death, and the third leading cause of death and disability combined. Around 100,000 people have strokes each year, and around 1.3 million people in the UK have survived a stroke. High-quality rehabilitation can minimise the physical, emotional, cognitive, and social impacts for people who have had a stroke, and their carers. It can also yield substantial cost savings to society.
The National Institute for Health and Care Excellence (NICE) guidance on stroke rehabilitation in adults was updated in October 2023.1 The guideline summary published in the BMJ earlier this year2 covers selected new and updated recommendations and focuses on those most relevant to primary care and community rehabilitation settings.
Dr Ray O’Connor
The main recommendations are as follows. Stroke rehabilitation total therapy time should be based on the person’s needs, with the amount increasing to at least three hours a day, on at least five days a week. Fatigue is common; use a validated scale for early assessment. Offer vision and hearing assessment. Consider referral to community participation programmes suited to the person’s rehabilitation goals.
Interestingly the American Heart Association and the American Stroke Association also jointly published stroke prevention guidelines this year3 It is an extensive document covering over 80 pages with 735 references.
The ‘Top Ten Take-home Messages’ for busy clinicians are listed. A brief summary is as follows. Everyone should have access to and regular visits with a primary care health professional to identify and achieve opportunities to promote brain health. Screening for and addressing adverse social determinants of health is important in the approach to prevention of incident stroke.
The Mediterranean diet is a dietary pattern that has been shown to reduce the risk of stroke. Physical activity is essential for cardiovascular health and stroke risk reduction. Glucagon-like protein-1 receptor agonists have been shown to be effective not only for improving management of type 2 diabetes but also for weight loss and lowering the risk of cardiovascular disease and stroke.
Blood pressure management is critical for stroke prevention. Antiplatelet therapy is recommended for patients with antiphospholipid syndrome or systemic lupus erythematosus without a history of stroke or unprovoked venous thromboembolism to prevent stroke. Prevention of pregnancy-related stroke can be achieved primarily through management of hypertension.
Treatment of verified systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg during pregnancy and within six weeks postpartum is recommended. Endometriosis, premature ovarian failure (before 40 years of age), and early-onset menopause (before 45 years of age) are all associated with an increased risk for stroke.
Therefore, screening for all three of these conditions is a reasonable step in the evaluation and management of vascular risk factors in these individuals to reduce stroke risk. Finally, the authors recommend that understanding transgender health is essential to truly inclusive clinical practice.
Treatment of acute stroke, before a distinction can be made between ischemic and haemorrhagic types, is challenging. This randomised controlled trial4 studied whether very early blood-pressure control in the ambulance improves outcomes among patients with undifferentiated acute stroke.
The subjects were 2404 Chinese patients with mean age of 70 years with stroke that caused a motor deficit and with elevated systolic blood pressure (≥150 mm Hg). The authors randomly assigned patients who were assessed in the ambulance within two hours after the onset of symptoms, to receive immediate treatment to lower the systolic blood pressure (target range, 130 to 140 mm Hg) (intervention group) or usual blood-pressure management (usual-care group).
The results were that prehospital BP reduction did not improve functional outcomes. Interestingly, 46.5 per cent subsequently received a diagnosis of haemorrhagic stroke.
Inflammation has been associated with incidence and recurrence of stroke, and risk of stroke was reduced in patients who have coronary artery disease and who were treated with colchicine. This multicentre, double blind, randomised, placebo controlled trial from China5 looked to assess the efficacy and safety of colchicine versus placebo on reducing the risk of subsequent stroke after high risk non-cardioembolic ischaemic stroke or transient ischaemic attack within the first three months of symptom onset.
The participants were 8,343 patients aged 40 years of age or older. Patients were randomly assigned 1:1 within 24h of symptom onset to receive colchicine (0.5 mg twice daily on days 1-3, followed by 0.5 mg daily thereafter) or placebo for 90 days. Unfortunately, no differences were noted in treatment effects on subsequent stroke between the low dose colchicine and the placebo groups.
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