Does reading about stroke increase stroke knowledge? The impact of different print materials

The purpose of this study was to determine whether print materials on stroke resulted in increased knowledge in a sample of lay people. One hundred and seventy-seven participants received (at random) one of five versions of a stroke information packet, or a control packet on colorectal cancer. Participants rated the materials on readability, understandability and usefulness immediately after reading. After a delay of 18 days on average, participants answered questions assessing stroke knowledge. Ratings of all packets were generally positive; however, stroke knowledge scores were significantly higher for the stroke information groups compared to the control group only for knowledge of causal mechanisms (stroke pathophysiology). While there was some indication that the fictionalized material on stroke was more effective than the expository materials, overall the impact of print materials on stroke knowledge, measured after a delay of at least 1 week, was minimal at best. Further research is needed to determine whether fictional contexts make some information more memorable.     

Developing a stroke intervention program: What do people at risk of stroke want?

OBJECTIVE: There is currently little research examining what individuals who are at risk of a stroke want from an invention program. In order to increase the usefulness of such programs, qualitative research methods were used explore invention design issues such as factors affecting accessibility of programs and preferred health information sources. METHODS: Thirty people, each with at least one stroke risk factor, participated in one of eight focus groups. RESULTS: Broad support was indicated for our proposed intervention. Participants perceived the value and likely success of such a program enhanced if it: (a) was integrated with, and supported by, other respected health services; (b) included social components (particularly important to women); (c) produced long-term benefits; and (d) included information that was personally relevant and practical in terms of implementing change. Three reasons emerged for continuing stroke education campaigns as a component of intervention programs; these were: (a) a lack of awareness among some participants of gaps in their stroke knowledge; (b) participants' explicit requests for specific rather than general information; and (c) the apparent failure of some participants to self-identify as at risk. CONCLUSION: This study yielded a number of important design considerations that should be taken into account when developing stroke intervention programs. PRACTICE IMPLICATIONS: We discuss ways of maximising the personal relevance of stroke prevention information along theoretically important dimensions, and consumers' recommendations for the design and delivery of stroke intervention programs.     

Xenon as neuroprotectant in acute stroke?

Stroke is one of the most common diseases worldwide. A current focus of research is to find neuroprotectants that can be given during acute stroke. One specific target is to find antagonists of the N-methyl-D-aspartate (NMDA) receptor in an attempt to limit glutamate associated neurotoxicity. Xenon has recently been found to be an NMDA receptor antagonist. I suggest that xenon be considered as a neuroprotectant in acute stroke, and discuss methods of testing this proposal.     

Is it important to classify ischaemic stroke?

Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.     

What happens to stroke patients after hospital discharge?

Of 231 stroke patients discharged from hospital, 34 patients (14.7%) had died when reviewed 6 months later. Of 195 survivors, 115 (58%) were independent and living in the community. The remaining 80 (42%) patients were dependent. The majority of dependent patients were in institutional care but 29 (36%) were residing in the community of whom a substantial number were not receiving physiotherapy, occupational therapy or day care. Patients who were dependent in nursing homes were less likely to have received physiotherapy (48% versus 70%) or occupational therapy (28% versus 60%) compared to disabled patients in hospital based extended nursing care. 45 patients (24%) had been re-admitted to hospital although only 48% of patients had been reviewed in hospital outpatients since discharge. 64% of patients were on anti-thrombotic treatment. This survey suggests that 6 months after hospital discharge, most stroke patients are still alive and living in the community. Many of the dependent survivors have ongoing unmet medical and rehabilitation needs.     

Psychosocial functioning of spouses in the chronic phase after stroke: Improvement or deterioration between 1 and 3 years after stroke?

OBJECTIVE: To describe the psychosocial functioning of spouses of stroke patients at 1 and 3 years after stroke and identify predictors of substantial negative change in psychosocial functioning. METHODS: Prospective study (N=119). Five domains of psychosocial functioning were assessed: burden, life satisfaction, depression, harmony in the relationship and social support. We used paired t-tests to describe changes and identified substantial changes using an Effect Size of 0.5 as the cut-off point. RESULTS: Fifty-one percent reported significant burden, 46% were dissatisfied with life and 51% reported depressive symptoms 1 year after the stroke. Changes in psychosocial functioning between 1 and 3 years post stroke were reported by 27%-57% of the spouses. Although burden improved, life satisfaction, social support and harmony in the relationship deteriorated significantly. The percentage of spouses with depressive symptoms remained stable. Spouses with young children were at risk of deteriorating psychosocial functioning. CONCLUSIONS: A large proportion of spouses experience serious caregiver burden, depression and decreased life satisfaction, 1 year as well as 3 years after the stroke, and harmony in the relationship, social support and life satisfaction decline over time. PRACTICE IMPLICATIONS: Rehabilitation programmes should give more attention to the relationship with the patient's partner, family life and the maintenance of a support network.     

What education do stroke patients receive in Australian hospitals?

Objective

This study evaluated the educational practices of staff working in acute stroke wards in Australian hospitals, including the coordination and methods of patient education provision, post-discharge education and support services available, and the education and support services that health professionals would like to provide.

Methods

Health professionals who worked in acute stroke wards in Australian hospitals were surveyed about the stroke education practices of staff in their ward. Thirty-four hospitals returned a completed questionnaire via email or fax.

Results

Verbal communication and written materials were the most frequently used methods of information provision. Twenty-three (67.6%) wards developed their own written education materials, five (14.7%) offered group education programs, and 19 (55.9%) offered education or support after discharge. Fourteen (41.2%) wards had a particular staff member responsible for coordinating the provision of education to patients and one (2.9%) ward had a written policy on stroke education. The majority (70.6%) of participants would like to be able to provide more education/support services.

Conclusion

The educational practices of the Australian hospitals surveyed were variable, with improvements needed in the coordination and documentation of patient education and the available follow-up services.

Practice implications

Health professionals need to be aware of the importance of education in the care of patients following stroke. Patients’ informational needs, while in hospital and after discharge, may be better met if staff in acute stroke wards had improved communication and coordination practices and ensured that stroke education was appropriately documented and supported by policy.     

Migraine, stroke and patent foramen ovale--connected or not?

A relationship between migraine with aura and patent foramen ovale (PFO) has been established in clinical studies, and is now related to previous observation that migraine and stroke are connected. Studies have shown that the prevalence of PFO in patients with migraine is about 2.5-fold than in patients without migraine. Up to now, there is no consensus on the treatment of PFO in primary or secondary prevention, so both surgical and conservative methods are used. Most nonrandomized studies (and 1 randomized placebo-controlled study) have shown that migraine attacks are reduced after PFO closure; however, recent studies show that a new onset or worsening of migraine headaches may occur after closure of PFO or atrial septal defects. Therefore, no definite conclusions can be made on the treatment of migraines by PFO closure.     

Immune responses in stroke: how the immune system contributes to damage and healing after stroke and how this knowledge could be translated to better cures?

Stroke is one of the leading causes of death and disability worldwide. The long‐standing dogma that stroke is exclusively a vascular disease has been questioned by extensive clinical findings of immune factors that are associated mostly with inflammation after stroke. These have been confirmed in preclinical studies using experimental animal models. It is now accepted that inflammation and immune mediators are critical in acute and long‐term neuronal tissue damage and healing following thrombotic and ischaemic stroke. Despite mounting information delineating the role of the immune system in stroke, the mechanisms of how inflammatory cells and their mediators are involved in stroke‐induced neuroinflammation are still not fully understood. Currently, there is no available treatment for targeting the acute immune response that develops in the brain during cerebral ischaemia. No new treatment has been introduced to stroke therapy since the discovery of tissue plasminogen activator therapy in 1996. Here, we review current knowledge of the immunity of stroke and identify critical gaps that hinder current therapies. We will discuss advances in the understanding of the complex innate and adaptive immune responses in stroke; mechanisms of immune cell‐mediated and factor‐mediated vascular and tissue injury; immunity‐induced tissue repair; and the importance of modulating immunity in stroke.     

Hyperhomocysteinemia among ischemic stroke victims in the teaching hospital of Lomé

Hyperhomocysteinemia is an independent vascular risk factor involved in ischaemic stroke. Aim of this study was to evaluate the prevalence of hyperhomocysteinemia and the role of the metabolic determinants in ischaemic stroke. The study concerned 183?patients in the Department of neurology of the teaching hospital of Lome. The diagnosis of stroke was made on clinical and brain CT scan arguments. The dosage of homocysteinemia was carried out by the immunoenzymatic method (Abbott Diagnostic). Among 183?patients, 111 (61%) had a hyperhomocysteinemia. The total average homocysteinemia was of 22.0 μmol/L. The average homocysteinemia among men was of 22.4 μmol/L (5.2-198.0) and 18.80 μmol/L (4.2-50) among women with a positive correlation (P = 0.049 and 0.01) between homocysteinemia and the age among the men and women. The average homocysteinemia was of 17.2 μmol/L in the large ischaemic stroke; 23.0?μmol/L when associated with lacunes and 32.8 μmol/L when associated with lacunes and leucoaraiosis (p = 0.001). In conclusion, the hospital prevalence of the hyperhomocysteinemia was of 61%. Hyperhomocysteinemia was the second vascular risk factor after arterial hypertension in term of prevalence, probably from nutritional cause.     

Are stroke cases affected by sleep disordered breathings all the same?

Sleep disordered breathings (SDB) worsens the clinical prognosis of stroke patients. Continuous positive airway pressure (CPAP) is a promising effective treatment. Unfortunately, not all patients are compliant with CPAP, suggesting that it is not appropriate for all patients with obstructive sleep apnoea (OSA) after stroke. People with the highest likelihood of benefiting have to be identified. We present a classification of cases with stroke and SDB to be adopted in order to identify the best responders to CPAP treatment. We propose to classify patients in four subgroups: (1) patients who terminate the apnoea by arousing from sleep; these cases are those affected either by an anatomical or a functional obstruction of upper airways that may precede or are the consequence of stroke; (2) cases that alternate OSA to central sleep apnoea (CSA) cause of an altered loop gain; (3) cases in whom ischemic damages have altered the sleep microstructure (CAP); (4) cases that manifest a CSA as the direct consequence of stroke on the central neuronal drive to breath. So far, no study has investigated the consequences of stroke on sleep microstructure. In order to better elucidate these relationships, when reviewing the PSG tracings of stroke patients, the microstructure of sleep should be systematically analysed.     

Middle cerebral artery preponderance in ischemic stroke: A coincidence or fate?

Stroke is the leading cause of disability and the third leading cause of death in the United States. More than 700,000 persons per year suffer a first-time stroke in the United States, with 20% of these individuals dying within the first year after the stroke. Ischemic stroke accounts for majority of cases of stroke and within this subgroup also, anterior circulation stroke involving the middle cerebral artery (MCA) is the commonest one. There has been no speculation so far as to why this anatomical preponderance to middle cerebral artery exists in thrombotic stroke. While the role of nitric oxide (NO) as a vasculoprotective molecule has been well established, understanding the stimulus for its release and anatomical course of middle cerebral artery can provide a good justification for the clinical finding mentioned above. This bench to bedside correlation not only explains the predilection of ischemic thrombotic stroke to MCA but also highlights the significance of NO as a vasculoprotective molecule in cerebrovascular disease which has not been emphasized earlier.     

Hormone replacement therapy and stroke: risk, protection or no effect?

Despite declining death rates due to stroke over the last several decades, stroke remains the third leading killer (after heart disease and cancer) of women in most developed countries. Because stroke not only kills but also leaves many survivors mentally and physically impaired, control of the disease must be through primary prevention. Several observations lead to the speculation that estrogen may reduce stroke risk. This paper reviews the epidemiologic studies that have evaluated the association of hormone replacement therapy (HRT) and stroke. In the past 25 years, 29 studies have produced no conclusive evidence of a beneficial effect. The lack of consistency in stroke endpoints, definition of HRT user, estrogen preparation, and influence of combined regimen might account in part for the unclear relationship. Nonetheless, the preponderance of evidence suggests that HRT does not increase stroke risk. Some data indicate that estrogen users have a moderately reduced risk of fatal stroke, but details about the optimal dose, duration and type of estrogen are insufficient. The apparent difference in the findings of studies of fatal and non-fatal stroke suggests that estrogen may prevent the most lethal form of stroke or may improve survival. Additional data from ongoing randomized clinical trials in the coming years may help resolve the question of the effect of HRT on stroke morbidity and mortality.     

A brain in flame; do inflammasomes and pyroptosis influence stroke pathology?

Stroke is one of the leading causes of death and disability worldwide. Inflammation plays a key role across the time course of stroke, from onset to the post‐injury reparative phase days to months later. Several regulatory molecules are implicated in inflammation, but the most established inflammatory mediator of acute brain injury is the cytokine interleukin‐1. Interleukin‐1 is regulated by large, macromolecular complexes called inflammasomes, which play a central role in cytokine release and cell death. In this review we highlight recent advances in inflammasome research and propose key roles for inflammasome components in the progression of stroke damage.     

Pediatric cerebellar stroke associated with elevated titer of antibodies to β2-glycoprotein

Antibodies to 2-glycoprotein I (anti-2GPI) have been associated with recurrent thrombosis and pregnancy morbidity. However, the prevalence of anti-2GPI in children suffering from cerebral and cerebellar infarction is unknown. We report on a 10-month-old boy who had an ischemic cerebellar stroke, secondary to antiphospholipid syndrome with high titers of immunoglobulin G anti-2GPI (first titer: 132U) anticardiolipin antibodies and lupus anticoagulant tests were negative. All other causes of infarction were excluded. To our knowledge, this is the first reported case of childhood cerebellar ischemic stroke with only anti-2GPI but no antibodies detectable in standard antiphospholipid assays.     

Does higher quality primary health care reduce stroke admissions? a national cross-sectional study

Background

Hospital admission rates for stroke are strongly associated with population factors. The supply and quality of primary care services may also affect admission rates, but there is little previous research.

Aim

To determine if the hospital admission rate for stroke is reduced by effective primary and secondary prevention in primary care.

Design and setting

National cross-sectional study in an English population (52 763 586 patients registered with 7969 general practices in 152 primary care trusts).

Method

A combination of data on hospital admissions for 2006–2009, primary healthcare staffing, practice clinical quality and access indicators, census sources, and prevalence estimates was used. The main outcome measure was indirectly standardised hospital admission rates for stroke, for each practice population.

Results

Mean (3 years) annual stroke admission rates per 100 000 population varied from zero to 476.5 at practice level. In a practice-level multivariable Poisson regression, observed stroke prevalence, deprivation, smoking prevalence, and GPs/100 000 population were all risk factors for hospital admission. Protective healthcare factors included the percentage of stroke or transient ischaemic attack patients whose last measured total cholesterol was ≤5 mmol/l (P<0.001), and ability to book an appointment with a GP (P<0.003). All effect sizes were relatively small.

Conclusion

Associations of stroke admission rates with deprivation and smoking highlight the need for smoking-cessation services. Of the stroke and hypertension clinical quality indicators examined, only reaching a total cholesterol target was associated with reduced admission rates. Patient experience of access to primary care may also be clinically important. In countries with well-developed primary healthcare systems, the potential to reduce hospital admissions by further improving the clinical quality of primary healthcare may be limited.