May stroke current awareness

Library Services Musgrove Park and Somerset Partnership

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 9 May 2016

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Contents Click on a section title to navigate contents Page Results of Library Current Awareness Survey

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Colleague App

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Recent journal articles

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Books

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Cochrane Systematic Reviews

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Guidelines

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UpToDate & DynaMed Plus

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Reports, publications and resources

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Topic Alerts and Updates

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Twitter

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Training & Networking Opportunities, Conferences, Events

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Literature search service

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Training and Athens

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Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Tel: 01823 34 (2433)

Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

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RESULTS OF LIBRARY CURRENT AWARENESS SURVEY BACK TO TOP

During 2015-6 the library team introduced a number of new current awareness bulletins as a result of feedback from staff.

Along with the fortnightly Library Alert monthly updates were produced for: Dementia Stroke End of life Sign up to safety

Mentorship Cancer ITU

While we had some feedback that these bulletins were useful, we felt due to the cost in library staff time, it would be better to have more detailed evidence.

We circulated the survey via email to the various email lists, added a link on the Library webpage and also put reminders in the Library Alert and Staff Bulletin.

During the month when we received 211 replies on all bulletins covering both Taunton and Somerset and Somerset Partnership staff.

The final report can be found here

COLLEAGUE APP BACK TO TOP The MPH Staff App has specifically been produced and designed to offer both current and future employees relevant information related to their work. Whether seeking information about policies and procedures, following us on Twitter or even taking advantage of special offers, all can be found here.

Library monthly current awareness bulletins are also available.

To download, please follow this link Please note- The app has not been created by the library. If you have any problems downloading or accessing the app then you will need to contact the IT department.

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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.

MUSGROVE STAFF ONLY Click on the image to access full-text-available from 1970 to current using your OpenAthens password

Title: The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients.

Citation: Psychology, health & medicine, Jul 2016, vol. 21, no. 5, p. 632-638, 1465-3966 (July 2016) Author(s): Spurgeon, Laura, James, Gill, Sackley, Cath Abstract: Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test's validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients.

Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation. ________________________________________________________________________________ Title: Obstructive Sleep Apnea as an Independent Stroke Risk Factor: A Review of the Evidence, Stroke Prevention Guidelines, and Implications for Neuroscience Nursing Practice.

Citation: The Journal of neuroscience nursing : journal of the American Association of Neuroscience

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Nurses, Jun 2016, vol. 48, no. 3, p. 133-142, 1945-2810 (June 2016) Author(s): King, Sharon, Cuellar, Norma Abstract: Stroke is a leading cause of death and disability affecting nearly 800,000 people in the United States every year. Obstructive sleep apnea (OSA) is found in over 60% of patients with stroke/transient ischemic attack (TIA) and identified as an independent stroke risk factor in large epidemiology studies and Canadian Stroke Prevention Guidelines (SPG) but not in the United States.

The 2014 Secondary SPG recommend OSA screening and treatment as a consideration only, not a requirement. The twofold purpose of this article is, first, to present the evidence supporting OSA as an independent stroke risk factor in national SPG with mandatory recommendations and, second, to engage neuroscience nurses to incorporate OSA assessment and interventions into the nursing process and thereby promote excellence in stroke/TIA patient care.

A systematic literature search was conducted in Medline, CINAHL, and PubMed to identify research from 2003 through 2013 on the independent risk, mortality, and prevalence relationship between OSA and stroke/TIA including recurrence and recovery outcomes with continuous positive airway pressure (CPAP) therapy.

Twenty-eight research articles were reviewed: 14 observational cohorts, five case-control studies, four cross-sectional studies, and four randomized control trials representing 12 countries and 10,671 subjects.

OSA is highly prevalent in patients with stroke/TIA independently increasing stroke risk. CPAP studies revealed reduced stroke recurrence and improved recovery with feasible initiation in stroke units.

Patients with stroke/TIA have less OSA-associated daytime sleepiness and obesity, making the usual screening tools insufficient and CPAP adherence challenging. Treating OSA decreases stroke prevalence and mortality. OSA initiatives empower neuroscience nurses to integrate this OSA evidence into clinical practice and improve stroke/TIA patient outcomes. ________________________________________________________________________________ Title: Dual antiplatelet therapy after stroke or transient ischaemic attack - how long to treat?

The duration of aspirin plus clopidogrel in stroke or transient ischaemic attack: a systematic review and meta-analysis.

Citation: European journal of neurology, Jun 2016, vol. 23, no. 6, p. 1051-1057, 1468-1331 (June 2016) Author(s): Ge, F, Lin, H, Liu, Y, Li, M, Guo, R, Ruan, Z, Chang, T Abstract: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 90 days was recommended as the secondary prevention of minor ischaemic strokes or transient ischaemic attacks (TIAs) in 2014. However, whether the duration of 90 days is optimal for each patient remains unclear.

Therefore, the efficacy and safety of short-term (≤3 months) and prolonged (≼1 year) DAPT after stroke or TIA were assessed via a systematic review and meta-analysis.

The Cochrane Library, Clinical Trials.gov and PubMed were searched up to December 2014 and nine randomized controlled trials were included involving 21 923 patients.

Short-term DAPT significantly reduced the risk of ischaemic stroke recurrence by 41% and major vascular events by 30%, without increasing the risk of intracranial haemorrhage. Prolonged DAPT reduced the risk of ischaemic stroke recurrence by 12% and major vascular events by 10%. However, the risk of major bleeding and intracranial haemorrhage increased.

Short-term DAPT appears to be superior to prolonged DAPT. However, the difference in efficacy outcome needs to be carefully explained and confirmed by further well-designed randomized controlled trials.

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________________________________________________________________________________ Title: Intensive treadmill training in the acute phase after ischemic stroke.

Citation: International journal of rehabilitation research. Internationale Zeitschrift für Rehabilitationsforschung. Revue internationale de recherches de réadaptation, Jun 2016, vol. 39, no.

2, p. 145-152, 1473-5660 (June 2016) Author(s): Strømmen, Anna M, Christensen, Thomas, Jensen, Kai Abstract: The aim of the study was to (a) assess the feasibility of intensive treadmill training in patients with acute ischemic stroke, (b) test whether physical activity of the legs during training increases with time, and (c) evaluate to what extent training sessions contribute toward the overall physical activity of these patients. Twenty hospitalized patients with acute ischemic stroke trained on a treadmill twice daily for 30 min for 5 days and on day 30. Physical activity was measured as activity counts (AC) from accelerometers. A total of 196 of 224 initiated training sessions were completed.

Training started 41.5±14 h after symptom onset. Only nonserious adverse events occurred in 14.7% of the sessions. An intensity of at least 50% of the individual heart rate reserve was obtained in 31% of training sessions. There was a significant increase in AC/min in the legs during training sessions with increasing number of days, with the median AC being 133% higher on day 5 than on day 1. AC in the paretic leg during 60 min of training constituted median 53% of the daytime AC. Early intensive treadmill training in acute ischemic stroke patients is thus feasible and contributes considerably toward the patients' overall physical activity. ________________________________________________________________________________ Title: The contribution of antibiotics, pneumonia and the immune response to stroke outcome Citation: Journal of Neuroimmunology, June 2016, vol./is. 295-296/(68-74), 0165-5728;1872-8421 (15 Jun 2016) Author(s): Becker K.J., Zierath D., Kunze A., Fecteau L., Lee B., Skerrett S. Language: English Abstract: Background: Infections are common following stroke and associated with worse outcome.

Using an animal model of pneumonia, we assessed the effect of infection and its treatment on the immune response and stroke outcome. Methods: Lewis rats were subjected to transient cerebral ischemia and survived for 4 weeks. One day after stroke animals were exposed to aerosolized Staphylococcus aureus, Pseudomonas aeruginosa or saline. Antibiotics (ceftiofur or enrofloxacin) were started immediately after exposure or delayed for 3 days. Behavioral tests were performed weekly. ELISPOT assays were done on lymphocytes from spleen and brain to assess autoimmune responses to myelin basic protein (MBP). Results: Among animals that received immediate antibiotic therapy, infection was associated with worse outcome in ceftiofur but not enrofloxacin treated animals. (The outcome with immediate enrofloxacin therapy was so impaired that further worsening may have been difficult to detect.) A delay in antibiotic therapy was associated with better outcomes in both ceftiofur and enrofloxacin treated animals. Infection was associated with an increased likelihood of developing T. h1(+) responses to MBP in non-infarcted brain (OR = 2.94 [1.07, 8.12]; P = 0.04), and T. h1(+) responses to MBP in spleen and non-infarcted brain were independently associated with a decreased likelihood of stroke recovery (OR = 0.16 [0.05, 0.51; P = 0.002 and OR = 0.32 [0.12, 0.84]; P = 0.02, respectively). Conclusions: Infection worsens stroke outcome in ceftiofur treated animals and increases T. h1 responses to MBP. These data may help explain how infection worsens stroke outcome and suggest that treatment of infection may contribute to this outcome.

Publication type: Journal: Article Source: EMBASE ________________________________________________________________________________

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Title: Early symptom measurement of Post-Stroke Depression (PSD) Citation: Journal of Affective Disorders, June 2016, vol./is. 197/(215-222), 0165-0327;1573-2517 (June 2016) Author(s): Li J., Oakley L.D., Brown R.L., Li Y., Ye M., Luo Y. Abstract: Background We reported the factor structure and psychometric properties of a new measure of early symptoms of Post-Stroke Depression (PSD). Methods Cross-sectional survey methods were used to administer the measure to hospitalized post-stroke patients (N=410) in southeast China, 7-30 days after mild to moderate stroke. Factor structure of the measure was evaluated using exploratory factor analysis (EFA) with first and second order confirmatory factor analysis (CFA). Measurement reliability of each factor and the total measure was assessed using Cronbach alpha coefficient, item-total correlation, item-subscale correlation and the composite coefficient. Discriminant validity was tested using the estimated correlation matrix and average variance extracted (AVE). Results The EFA extracted a theoretically consistent, clinically interpretable, 29-item, 6-factor model for early symptoms of PSD (dull, guilt, low, wakefulness, emotional, and nervous). A first order CFA retained the 6-factors but deleted 3 underperforming items.

The results of a second-order CFA for a 6-factor, 26-item model showed acceptable model fit (chi²/df=2.25, CFI=0.973, TLI=0.970, RMSEA=0.055 and WRMR=1.168) with acceptable reliability and discriminant validity. Limitations The study survey methods and purposive sampling procedures resulted in a clinically less homogenous final sample. Separate evaluation of predictive validity, criteria validity, test-retest reliability, and invariance to patient psychosocial characteristics of the measure is planned. Conclusions Our measure detected early symptoms of PSD in primarily first-ever stroke patients, an average of 11.07 days post stroke, well within the 14 day peak benchmark. ________________________________________________________________________________ Title: Occurrence of Obstructive Sleep Apnea Syndrome in Patients with Transient Ischemic Attack.

Citation: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, May 2016, vol. 25, no. 5, p. 1249-1253, 1532-8511 (May 2016) Author(s): Schipper, Mirjam H, Jellema, KornĂŠ, Rijsman, Roselyne M Abstract: Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder with episodes of upper airway obstructions. Patients with cardiovascular diseases such as myocardial infarction and stroke show a high prevalence of OSAS. Several studies focus on stroke and not on transient ischemic attack (TIA), suggesting it could be a symptom after stroke. We analyzed the occurrence of OSAS in high-risk patients with TIA. There were 555 patients suspected for TIA by the general practitioner who were referred to our TIA daycare clinic. They were screened for OSAS using 3 screening factors: snoring (yes/no), body mass index greater than or equal to 30, and Epworth Sleepiness Score greater than 10. When 2 out of 3 were positive, patients received a polysomnography. An apnea-hypopnea index (AHI) of 5-15 is defined as mild OSAS, AHI 15-30 as moderate OSAS, and AHI greater than 30 as severe OSAS. Seventy-seven patients received a polysomnography. Twenty-five patients had a diagnosis of TIA and 18 had a diagnosis of cerebral ischemia, whereas 34 had other diagnoses. Twenty of the 25 (80%) TIA patients had OSAS, compared to 16 of the 34 (47%) patients without a vascular diagnosis (P = .010). When excluding patients with a cardiovascular history, we found 15 of the 20 patients with OSAS, compared to 14 out of 30 patients (P = .047).

There is a significant higher occurrence of OSAS in TIA patients compared to patients without a vascular diagnosis, even after excluding patients with a history of cardiovascular events. ________________________________________________________________________________

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Title: Is early rehabilitation a myth? Physical inactivity in the first week after myocardial infarction and stroke.

Citation: Disability & Rehabilitation, 2016, vol./is. 38/15(1493-1499), 09638288 Author(s): Lay, Sarah, Bernhardt, Julie, West, Tanya, Churilov, Leonid, Dart, Anthony, Hayes, Kate, Cumming, Toby B. ________________________________________________________________________________ Title: Determinants of Self-Rated Health Three Months after Stroke.

Citation: Journal of Stroke & Cerebrovascular Diseases, 2016, vol./is. 25/5(1027-1034), 10523057 Author(s): Larsen, Louise Pape, Johnsen, Soeren Paaske, Andersen, Grethe, Hjollund, Niels Henrik Language: English Abstract: Objectives: Self-rated health is an important aspect of life after stroke. The aim of this study was to compare self-rated health in a population of stroke patients to the general Danish population and to analyze to what extent clinical and patient-related factors influence self-rated health 3 months after stroke.Methods: We sent questionnaires on self-rated health (Short Form-12 Health Survey) to all patients younger than 80 years with first-time stroke admitted to any hospital in the Central Denmark Region between October 1, 2008, and December 31, 2011 (N = 2414). Information on clinical and patient-related determinants of self-rated health was obtained from population-based national health registers.Results: Compared to the general population, stroke patients rated their health lower than the general Danish population. The largest differences were found in domains of physical health, and only minor differences were identified in mental health between the study and the general Danish population. Stroke severity, comorbidity, smoking, educational level, and age were strongly associated with self-reported health. For patients with a "very severe" stroke, the adjusted odds ratios (ORs) of reduced mental health were 1.6 (95% confidence interval [CI]: 1.3-2.6) and 5.1 (95% CI: 2.7-9.6) for low physical health, compared to patients with "mild stroke." Patients with a Charlson Comorbidity Index score of 3 or higher had a higher risk of low mental health (OR 1.9 [95% CI: 1.3-2.6]) and low physical health (OR 2.8 [95% CI: 1.9-4.0]) than patients with no additive diseases.Conclusions: Stroke had a marked impact of self-rated health, particularly physical health.

Higher stroke severity and level of comorbidity were important risk factors of reduced self-rated health. ________________________________________________________________________________ Title: Key Factors Associated with Major Depression in a National Sample of Stroke Survivors.

Citation: Journal of Stroke & Cerebrovascular Diseases, 2016, vol./is. 25/5(1090-1095), 10523057 Author(s): Hirata, Sarah, Ovbiagele, Bruce, Markovic, Daniela, Towfighi, Amytis Abstract: Background: Depression, one of the most common complications encountered after stroke, is associated with poorer outcomes. The aim of this study was to determine the factors independently associated with and predictive of poststroke depression (PSD).Methods: We assessed the prevalence of depression (Patient Health Questionnaire [PHQ-8] score >10) among a national sample of adults (≥20 years) with stroke who participated in the National Health and Nutrition Examination Surveys from 2005 to 2010. Logistic regression and random forest models were used to determine the factors associated with and predictive of PSD, after adjusting for sociodemographic and clinical factors.Results: Of the 17,132 individuals surveyed, 546 stroke survivors were screened for depression, and 17% had depression, corresponding to 872,237 stroke survivors with depression in the United States. In the logistic regression model, after adjustment for sociodemographic variables, poverty (poverty index <200% versus ≥200%, odds ratio [OR] 2.61, 95% confidence interval [CI] 1.235.53) and 3 or more medical comorbidities (OR 1.59, 95% CI 1.01-2.49) were associated with higher odds of PSD; increasing age was associated with lower odds of PSD (per year OR .95, 95% CI .94.97). In the random forest model, the 10 most important factors predictive of PSD were younger age, lower education level, higher body mass index, black race, poverty, smoking, female sex, single

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marital status, lack of cancer history, and previous myocardial infarction (specificity = 70%, sensitivity = 64%).Conclusion: Although numerous factors were predictive of developing PSD, younger age, poverty, and multiple comorbidities were strong and independent factors. More aggressive screening for depression in these individuals may be warranted.

The following articles were published at NEJM.org to coincide with a meeting of the European Stroke Organisation Conference.

ORIGINAL ARTICLE

Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke C.S. Anderson and Others

EDITORIAL

Finding the Right t-PA Dose for Asians with Acute Ischemic Stroke C. Sila ORIGINAL ARTICLE

Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack S.C. Johnston and Others

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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.

Please note that some books detailed below may not be available in your local library and would need to be ordered for you.

Some books from our electronic book collection- click on book cover and log in with your OpenAthens password to browse free online or to request access.

How I rescued my brain: a psychologistâ&#x20AC;&#x2122;s remarkable recovery from stroke and trauma Roland 2015

Risk factors for cerebrovascular disease and stroke Seshadri 2016

From the back of the book: As a psychologist specialising in court assessments, David Roland often saw the toughest, most heartbreaking cases. The emotional trauma had begun to take its toll and then the global financial crisis hit, leaving his family facing financial ruin. So when he found himself in a local emergency ward with little idea of where he was or how he got there, doctors wondered if he had had a nervous breakdown - if the strain of treating individuals with mental-health problems had become too much. Eventually they discovered the truth: David had suffered a stroke, which had resulted in brain injury. He faced two choices: give up or get his brain working again. Drawing on the principles of neuroplasticity, David set about re-wiring his brain. Embarking on a search that brought him into contact with doctors, neuroscientists, yoga teachers, musicians, and a Buddhist nun, he found the tools to restore his sense of self: psychotherapy, exercise, music, mindfulness, and meditation. How I Rescued My Brain is the story of David's neurological difficulties and his remarkable cognitive recovery.

From the back of the book: Risk Factors for Cerebrovascular Disease and Stroke addresses the relationship of a wide variety of vascular risk factors in the spectrum of cerebrovascular diseases. The authors aim to provide information on developments of genetic, environmental and lifestyle-related risk factors of various subtypes of stroke, and MRI-markers of cerebrovascular disease. The burden of cerebrovascular disease extends far beyond that of acute clinical events such as stroke, with <"covert>" vascular injury on brain MRI being highly prevalent in older community-dwelling persons. Therefore, improving our understanding of the risk factors for stroke and cerebrovascular disease is of paramount importance for improving prevention strategies. Secular trends in stroke epidemiology, risk factors, and intermediate markers (including carotid ultrasound, brain MRI and circulating biomarkers) are presented. Cutting edge information on genetic, environmental and lifestyle-related risk factors of various subtypes of stroke and MRI-markers of cerebrovascular diseases are displayed. This important book is an essential reference to physicians interested in more effective primary prevention of stroke.

Taunton and SomPar NHS staff - Have you visited the EBL eBook catalogue?

10 Follow the links below and login via OpenAthens to read online books free for 5-10 minutes each day, send requests for eBook loans or purchase suggestions eBook catalogue

About OpenAthens

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Protocols from April/May 2016 Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome Advanced management services for transient ischaemic attacks and minor stroke

GUIDELINES BACK TO TOP th

National Clinical Guideline for Stroke, 4 edition 2012 NICE Guidelines Mechanical clot retrieval for treating acute ischaemic stroke- NICE interventional procedure guidance [IPG548] Published date: February 2016 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 fibrillationNICE technology appraisal guidance [TA355] Published date: September 2015

UPTODATE & DYNAMED PLUS BACK TO TOP What’s new from our clinical decision-making tools on the topic of stroke.

UpToDate –Access for Musgrove Staff only DynaMed Plus – Access for Somerset Partnership Staff only Please contact library staff for details on how to access these resources; you will need an Athens password if accessing from home.

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REPORTS, PUBLICATIONS AND RESOURCES BACK TO TOP NICE Pathway on Stroke 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.

The Sentinel Stroke National Audit Programme- 2 reports Post-acute organisational audit Presents the findings on the organisation of care for stroke survivors once they leave hospital. The audit highlights the number and location of post-acute stroke services across the UK and outlines what a patient might expect in accessing these services.

Is stroke care improving? The second SSNAP annual report The second annual SSNAP report reveals today that despite steady progress in stroke care, further work needs to be done to ensure that patients have access to key interventions and assessments when they are admitted to hospital.

Raconteur Report- Understanding Stroke Stroke is one of the biggest health issues people face today, taking a life every 13 minutes and costing the nation an estimated ÂŁ9 billion a year in health and social costs. Yet the condition ranks low in terms of public perception and research funding, and the UK lags behind some other nations in improving patient outcomes. This report highlights the need to raise research funding, along with awareness of the condition, and identifies key risk factors. It also showcases major technological and medical breakthroughs.

Inpatient Rehab Facility Is the Best Option for Stroke Recovery A set of new guidelines were released on adult stroke rehabilitation needing intensive and multidisciplinary treatment. According to a joint statement from the American Heart Association and American Stroke Association, rehabilitation after a stroke needs "a sustained and coordinated effort" by a team of professionals, and the best place to get that is an inpatient rehabilitation facility.

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TOPIC ALERTS AND UPDATES BACK TO TOP ABSTRACTS AVAILABLE VIA LINKS BELOW - FOR FULL-TEXT PLEASE ASK LIBRARY STAFF NHS Evidence Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke N Engl J Med. 2016 May 10. [Epub ahead of print]

Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials Lancet, Published Online: 18 May 2016 Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care Lancet, Published Online: 10 May 2016

Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack New England Journal of Medicine, May 10, 2016 Elsevier Practice Updates Association between hospitalization and care after transient ischemic attack or minor stroke Neurology April 26, 2016 vol. 86 no. 17 1582-1589

Medscape Topic Alerts Barriers and facilitators to staying in work after stroke: insight from an online forum BMJ Open 2016;6 April FREE FULL TEXT Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial Radiology, Jun 2016, Vol. 279:888â&#x20AC;&#x201C;897 One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke N Engl J Med 2016; 374:1533-1542 April 21, 2016 The lack of documentation of preferences in a cohort of adults who died after ischemic stroke Neurology, Published online before print April 8, 2016 Cardiovascular Disease After Aromatase Inhibitor Use JAMA Oncol. Published online April 21, 2016.

Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion Published online before print April 28, 2016

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Medline Plus Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies.

Heart. 2016 Apr 18 epub ahead of print FREE FULL TEXT

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 th

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10th World Stroke Congress- 26 -29 October, Hyderabad, India

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 appropriate 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.

Musgrove staff click here to access literature search form Somerset Partnership staff click here to access literature search form

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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.

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