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  • 1
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    Online Resource
    Predictive Value of Newly Detected Atrial Fibrillation Paroxysms in Patients With Acute Ischemic Stroke, for Atrial Fibrillation After 90 Days
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 7 ( 2014-07), p. 2134-2136
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 7 ( 2014-07), p. 2134-2136
    Abstract: Extended cardiac monitoring immediately after acute ischemic stroke (AIS) increases paroxysmal atrial fibrillation (PAF) detection, but its reliability for detection or exclusion of longer term paroxysmal PAF is unknown. We evaluated the positive and negative predictive value (PPV and NPV) of AF detection early after AIS, for PAF confirmation 90 days later. Methods— We investigated 49 patients within 7 days of AIS for PAF according to current guidelines; 23 patients received 7 days of additional noninvasive cardiac event monitoring with an R-test device early after their stroke (ISRCTN 97412358). Ninety days after AIS, everyone underwent 7 days of cardiac event monitoring. We calculated the PPV and NPV of immediate PAF detection through extended cardiac event monitoring and through any investigative modality, for the presence of PAF on the 90-day event monitor. Results— PAF detected by a 7-day event monitor within 2 weeks of AIS had a PPV of 100% (95% confidence interval, 72%–100%) for PAF confirmation after 90 days. NPV after 7 days of event monitoring was 64% (95% confidence interval, 35%–87%). PAF detected early through any modality had a PPV of 100% (95% confidence interval, 76%–100%). However, the NPV in the absence of R-test monitoring was only 42% (95% confidence interval, 28%–58%). Conclusions— AF detection through any means immediately after stroke holds strong PPV for confirmation after 90 days, justifying treatment decisions on early monitoring alone. However, failure to identify AF through early monitoring has only modest NPV even after 7 days of monitoring; repeated investigation is desirable.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.005405
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Noninvasive Cardiac Event Monitoring to Detect Atrial Fibrillation After Ischemic Stroke : A Randomized, Controlled Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 9 ( 2013-09), p. 2525-2531
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 9 ( 2013-09), p. 2525-2531
    Abstract: Atrial fibrillation (AF) elevates risk of recurrent stroke but is incompletely identified by standard investigation after stroke, though detection rates correlate with monitoring duration. We hypothesized that 7 days of noninvasive cardiac-event monitoring early after stroke would accelerate detection of AF and thus uptake of effective therapy. Methods— We performed a pragmatic randomized trial with objective outcome assessment among patients presenting in sinus rhythm with no AF history, within 7 days of ischemic stroke symptom onset. Patients were randomized to standard practice investigations (SP) to detect AF, or SP plus additional monitoring (SP-AM). AM comprised 7 days of noninvasive cardiac-event monitoring reported by an accredited cardiac electrocardiology laboratory. Primary outcome was detection of AF at 14 days. Results— One-hundred patients were enrolled from 2 centers. Within 14 days of stroke, sustained paroxysms of AF were detected in 18% of patients undergoing SP-AM versus 2% undergoing SP ( P 〈 0.05). Paroxysms of any-duration were detected in 44% of patients undergoing SP-AM versus 4% undergoing SP ( P 〈 0.001). These differences persisted at 90 days. Anticoagulant therapy was commenced within 14 days in 16% of SP-AM patients versus none randomized to SP ( P 〈 0.01). This difference persisted to 90 days (22% versus 6%; P 〈 0.05). Conclusions— Routine noninvasive cardiac-event monitoring after acute stroke enhances detection of paroxysmal AF and early anticoagulation. Extended monitoring should be offered to all eligible patients soon after acute stroke. Guidelines on investigation for AF in stroke patients could be strengthened. Clinical Trial Registration— URL: http://www.controlled-trials.com/isrctn/ . Unique identifier: ISRCTN97412358.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.001927
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Improving the Efficiency of Stroke Trials : Feasibility and Efficacy of Group Adjudication of Functional End Points
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 12 ( 2013-12), p. 3422-3428
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 12 ( 2013-12), p. 3422-3428
    Abstract: Use of the modified Rankin scale (mRS) in multicenter trials may be limited by interobserver variability. We assessed the effect of this on trial power and developed a novel group adjudication approach. Methods— We generated power and sample size estimates from simulated trials modeled with varying mRS reliability. We conducted a virtual acute stroke trial across 14 UK sites to develop a group adjudication approach. Traditional mRS interviews, performed at local sites, were digitally recorded and scored by adjudication committee. We assessed the effect of translation by comparing scores in translated mRS interviews, originally conducted in English and Mandarin. Agreement was measured using κ and weighted κ (κ w ) statistics and intraclass correlation coefficient. Results— Statistical simulations suggest that improving mRS reliability from κ=0.25 to κ=0.5 or 0.7 may allow reductions in sample size of n=386 or 490 in a typical n=2000 study. Our virtual acute stroke trial included 370 participants and 563 mRS video assessments. We adjudicated mRS in 538 of 563 (96%) study visits. At 30 and 90 days, 161 of 280 (57.5%) and 131 of 258 (50.8%) clips showed interobserver disagreement. Agreement within the adjudication committee was good (30-day κ w =0.85 [95% confidence interval, 0.81–0.86]; 90-day κ w =0.86 [95% confidence interval, 0.82–0.88]) without significant or systematic bias in mRS scoring compared with the local mRS. Interobserver reliability of translated mRS assessments was similar to native language clips (native [n=69] κ w =0.91 [95% confidence interval, 0.94–0.99]; translated [n=89] κ w =0.90 [95% confidence interval, 0.83–0.96]). Conclusions— Achievable improvements in interobserver reliability may substantially reduce study sample size, with associated financial benefits. Central adjudication of mRS assessments is feasible (including across international centers), valid and reliable despite the challenges of mRS assessment in large clinical trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.002266
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 4
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    SPIN (Scottish Pregnancy Intervention) study: a multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage
    American Society of Hematology ; 2010
    In:  Blood Vol. 115, No. 21 ( 2010-05-27), p. 4162-4167
    Details
    In: Blood, American Society of Hematology, Vol. 115, No. 21 ( 2010-05-27), p. 4162-4167
    Abstract: To assess whether treatment with enoxaparin and low-dose aspirin, along with intensive pregnancy surveillance, reduces rate of pregnancy loss compared with intensive pregnancy surveillance alone in women with history of 2 or more consecutive previous pregnancy losses, a parallel group, multicenter, randomized controlled trial was performed in the United Kingdom and New Zealand. Participants (n = 294) presenting for initial antenatal care at fewer than 7 weeks' gestation with history of 2 or more consecutive previous pregnancy losses at 24 or fewer weeks' gestation and no evidence of anatomic, endocrine, chromosomal, or immunologic abnormality were randomly assigned to receive either enoxaparin 40 mg subcutaneously and 75 mg of aspirin orally once daily along with intense pregnancy surveillance or intense pregnancy surveillance alone from random assignment until 36 weeks' gestation. The primary outcome measure was pregnancy loss rate. Of the 147 participants receiving pharmacologic intervention, 32 (22%) pregnancy losses occurred, compared with 29 losses (20%) in the 147 subjects receiving intensive surveillance alone, giving an odds ratio of 0.91 (95% confidence interval, 0.52-1.59) of having a successful pregnancy with pharmacologic intervention. Thus, we observed no reduction in pregnancy loss rate with antithrombotic intervention in pregnant women with 2 or more consecutive previous pregnancy losses. The trial was registered at http://www.controlled-trials.com as ISRCTN06774126.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2010-01-267252
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 5
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    Socioeconomic Status and Transient Ischaemic Attack/Stroke: A Prospective Observational Study
    S. Karger AG ; 2011
    In:  Cerebrovascular Diseases Vol. 31, No. 2 ( 2011), p. 130-137
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 31, No. 2 ( 2011), p. 130-137
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Lower socioeconomic status (SES) is associated with an increased risk of stroke but the mechanisms are unclear. We aimed to determine whether low-SES stroke/transient ischaemic attack (TIA) patients have a greater burden of vascular risk factors/co-morbidity and reduced health care access. 〈 i 〉 Methods: 〈 /i 〉 We prospectively studied 467 consecutive stroke and TIA patients from 3 Scottish hospitals (outpatients and inpatients) during 2007/2008. We recorded vascular risk factors, stroke severity, co-morbidity measures, investigations and health service utilisation. SES was derived from postcodes using Scottish Neighbourhood Statistics and analysed in quartiles. 〈 i 〉 Results: 〈 /i 〉 TIA/stroke patients in the lowest SES quartile were younger (64 years, SD 14.1) than those in the highest quartile (72 years, SD 12.9; p 〈 0.0001). They were more likely to be current smokers (42 vs. 22%; p = 0.001) but there was no association with other vascular risk factors/co-morbidity. There was a trend for those with lower SES to have a more severe stroke [modified National Institutes of Health Stroke Scale score and interquartile range: 4 (2–6) vs. 3 (1–5); multivariate p = 0.05]. Lower SES groups were less likely to have neuro-imaging (82 vs. 90%; p = 0.036) or an electrocardiogram (72 vs. 87%; p = 0.003), but differences were no longer significant on multivariate analysis. However, there was equal access to stroke unit care. 〈 i 〉 Conclusions: 〈 /i 〉 Low-SES TIA and stroke patients are younger and have a more severe deficit; an increased prevalence of smoking is likely to be a major contributor. We found equal access to stroke unit care for low-SES patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000321732
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482069-9
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  • 6
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    Ten-Years of the British Association of Stroke Physicians (BASP)
    SAGE Publications ; 2010
    In:  International Journal of Stroke Vol. 5, No. 6 ( 2010-12), p. 484-485
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 5, No. 6 ( 2010-12), p. 484-485
    Abstract: The British Association of Stroke Physicians (BASP) was set up almost 10 years ago to incorporate all medical specialties involved in stroke care. The aim was to drive up stroke service standards across the United Kingdom. BASP now has a membership of over 340 consultants and 240 trainees and has overseen substantial progress in the areas of training in stroke medicine, stroke research, educational meetings, stroke service development and the provision of advice and lobbying to government agencies. BASP members have been central to service improvements in recent years. Many challenges remain for stroke medicine in the United Kingdom but BASP is well placed to address these challenges.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1111/j.1747-4949.2010.00490.x
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2211666-7
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  • 7
    Online Resource
    Online Resource
    Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis
    Wiley ; 2010
    In:  Cochrane Database of Systematic Reviews
    Details
    In: Cochrane Database of Systematic Reviews, Wiley
    Type of Medium: Online Resource
    ISSN: 1465-1858
    URL: Article
    DOI: 10.1002/14651858.CD005066.pub2
    Language: English
    Publisher: Wiley
    Publication Date: 2010
    detail.hit.zdb_id: 2038950-4
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  • 8
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    Online Resource
    Interventions for disorders of eye movement in patients with stroke
    Wiley ; 2011
    In:  Cochrane Database of Systematic Reviews
    Details
    In: Cochrane Database of Systematic Reviews, Wiley
    Type of Medium: Online Resource
    ISSN: 1465-1858
    URL: Article
    DOI: 10.1002/14651858.CD008389.pub2
    Language: English
    Publisher: Wiley
    Publication Date: 2011
    detail.hit.zdb_id: 2038950-4
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  • 9
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    Non-pharmacological interventions for caregivers of stroke survivors
    Wiley ; 2011
    In:  Cochrane Database of Systematic Reviews Vol. 2011, No. 10 ( 2011-10-05)
    Details
    In: Cochrane Database of Systematic Reviews, Wiley, Vol. 2011, No. 10 ( 2011-10-05)
    Type of Medium: Online Resource
    ISSN: 1465-1858
    URL: Article
    DOI: 10.1002/14651858.CD008179.pub2
    Language: English
    Publisher: Wiley
    Publication Date: 2011
    detail.hit.zdb_id: 2038950-4
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  • 10
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    Deterioration of Gait and Balance over Time: The Effects of Age-Related White Matter Change - The LADIS Study
    S. Karger AG ; 2013
    In:  Cerebrovascular Diseases Vol. 35, No. 6 ( 2013), p. 544-553
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 35, No. 6 ( 2013), p. 544-553
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Cross-sectional studies have shown an association between the severity of age-related white matter change (ARWMC) and lower body motor function. However, the association between prevalent ARWMC and incident deterioration of balance and gait remains insufficiently investigated. This study investigates if the degree of prevalent ARWMC has a differential effect on lower body motor function as it changes over time, hypothesizing that individuals with more severe baseline white matter pathology experience greater clinical deterioration independent of potential confounders. This is of clinical relevance: given the increasing use of neuroimaging, incidental white matter pathology is common; being able to delineate natural trajectories of balance and gait function given ARWMC may improve patient advice and help optimize allocation of care. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 639 non-disabled elderly individuals with prevalent ARWMC (grading of severity of ARWMC using the Fazekas scale) were followed up yearly for 3 years, as part of the Leukoaraiosis and Disability Study. The primary outcome variable, reflecting the temporal course of gait and balance function, was the change of scores on the Short Physical Performance Battery (SPPB) over time versus the severity of ARWMC. We used linear mixed modelling to analyse change over time. Explorative analysis was carried out investigating the effect of age on potential deterioration of gait and balance function. We used propensity scores to adjust for multiple confounders that affect both the exposure (i.e. ARWMC) and outcome. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Subjects' lower body motor function deteriorated by 2.6% per year. However, after adjustment for baseline motor impairment and potential confounders, only subjects with moderate [-0.22 points per year on the SPPB (equals -2.3%); 95% CI -0.35 to -0.09, p 〈 0.001] or severe [-0.46 points per year (equals -4.7%); 95% CI -0.63 to -0.28, p 〈 0.0001] ARWMC show a loss of function. Age shows differential effects: relatively younger elderly subjects have similar temporal dynamics in SPPB change independent of their individual degree of ARWMC severity; however, subjects with severe ARWMC and who are older than 75.9 years deteriorate significantly more rapidly than their counterparts with only mild or moderate white matter pathology. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Only moderate and severe ARWMC is independently associated - on average - with a deterioration of gait and balance. Albeit the possibility of unmeasured confounding and other methodological constraints, there is nonetheless evidence of large interindividual variability: some subjects with moderate or severe ARWMC stay stable over time or even show improvement. Furthermore, there is explorative analysis showing that younger elderly subjects may be able to better compensate even severe ARWMC. These individuals' gait and balance function stays relatively stable over time, whereas their older counterparts deteriorate significantly. This may point towards a threshold effect given ARWMC.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000350725
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482069-9
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