Neurology

Stroke in Australia: No postcode untouched – Stroke Foundation – 14 July 2014

Posted on July 15, 2014. Filed under: Neurology | Tags: |

Stroke in Australia: No postcode untouched – Stroke Foundation – 14 July 2014

“The National Stroke Foundation commissioned Deloitte Access Economics to estimate the impact of stroke across Australia. This report sheds new light on the widespread impact of stroke on local communities. It contains federal electorate breakdowns of key information including the number of strokes, the scale of death from stroke, the number of people living with the effect of stroke and the number of people who live at risk of stroke.”

Media release – No postcode untouched by stroke – 14 July 2014

 

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Not just a funny turn: the real impact of TIA – Stroke Association [UK] – 10 April 2014

Posted on May 12, 2014. Filed under: Neurology |

Not just a funny turn: the real impact of TIA – Stroke Association [UK] – 10 April 2014

Brochure: Not just a funny turn: the real impact of TIA – Stroke Association [UK] – 10 April 2014

 

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The needs of stroke survivors in Australia – Stroke Foundation – 1 October 2013

Posted on October 1, 2013. Filed under: Neurology, Rehabilitation | Tags: |

The needs of stroke survivors in Australia – Stroke Foundation – 1 October 2013

“The increasing number of people surviving strokes is leading to a crisis in service provision as the health and community support systems struggle to keep pace with demand.

Decades-long lack of investment in stroke services and community support mechanisms mean more than 300,000 Australians are struggling to access the help they need for day-today activities such as dressing themselves, using the bathroom and communicating.

Meanwhile, the number of people living following a stroke is expected to almost double to more than 700,000 within the next two decades.

A new report, released today by the National Stroke Foundation, shows Australians are struggling every day due to a lack of access to essential support – a situation that is set to worsen as the number of stroke survivors grows. The report shows services are fragmented and access is dependent on where survivors live.

National Stroke Foundation Chief Executive Officer Dr Erin Lalor said the gaps in Australian stroke care, right across the stroke patient journey, were causing unnecessary pain and suffering.”

… continues on the site

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Navigating neurology services: helping strategic clinical networks to be a success story – The Neurological Alliance [UK] – 17 September 2013

Posted on September 24, 2013. Filed under: Neurology | Tags: , |

Navigating neurology services: helping strategic clinical networks to be a success story – The Neurological Alliance [UK] – 17 September 2013

Extract from the foreword:

“Neurology is at last on the map! NHS England has made improvements in the care of neurological conditions a priority by including them in the first wave of conditions to benefit from strategic clinical networks (SCNs). This is a unique opportunity to bring together the expertise of health providers, commissioners and management to redesign neurological care in the interests of patients and the NHS.

SCNs are based on the very successful cancer networks. They can help us bring together innovative ideas and approaches to managing neurological conditions and learn from each other’s experience. They are particularly appropriate when a coordinated approach involving many professional groups and organisations is needed to deliver large scale change across complex pathways of care.

Neurological conditions are therefore ideally suited to a SCN approach. So often in the past, improvements in care have failed because of inability to develop successful care pathways across health divides. We now have an opportunity to get this right.”

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Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science – Institute of Medicine Workshop Summary – 29 March 2013

Posted on April 2, 2013. Filed under: Mental Health Psychi Psychol, Neurology | Tags: , , , |

Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Model Study Protocols and Frameworks to Advance the State of the Science – Institute of Medicine Workshop Summary – 29 March 2013

“The 2011 IOM report, Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence, assessed the evidence for the effectiveness of using cognitive rehabilitation therapy (CRT) to treat people with traumatic brain injury (TBI). As the signature wound of the American military conflicts in Iraq and Afghanistan, TBI has increasingly gained attention over the past 15 years. As one form of treatment for TBI, CRT is a systematic, goal-oriented approach to helping patients overcome cognitive impairments. The 2011 IOM report’s conclusions revolved around the fact that there is little continuity among research studies of the effectiveness of different types of CRT, and there exist only small amounts of evidence demonstrating the effectiveness of using CRT to treat TBI, though the small amount of evidence generally indicates that CRT interventions have some effectiveness.

In October 2012, the IOM held a workshop to discuss the barriers for evaluating the effectiveness of CRT care and for identifying suggested taxonomy, terminology, timing, and ways forward for CRT research. This document summarizes the workshop.”

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The economic impact of stroke in Australia – Deloitte Access Economics report for the National Stroke Foundation – 17 March 2013

Posted on March 19, 2013. Filed under: Health Economics, Neurology | Tags: , , |

The economic impact of stroke in Australia – Deloitte Access Economics report for the National Stroke Foundation – 17 March 2013

“The bleak future of stroke revealed: over 700,000 survivors and counting.

The number of stroke survivors in Australia will grow to over 700,000 within 20 years, representing a true “social and economic catastrophe” unless Government commit to finally funding the nation’s second biggest killer and a leading cause of disability, according to the National Stroke Foundation.

Launching a new report in Melbourne today, Stroke Foundation chief executive Erin Lalor said despite the fact that stroke had been a National Health Priority Area since 1996 it had been systematically neglected by successive governments since that time.

“This report has shown us the high price Australia will pay for that neglect,” Dr Lalor said.

The Deloitte Access Economics Report, “The economic impact of stroke in Australia”, was commissioned by the National Stroke Foundation in 2012 and provides the first updated figures on the incidence, prevalence and cost of stroke in almost a decade.”

… continues on the site

Deloitte Access Economics Report

Deloitte Access Economics Report Summary 2013

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Sentinel Stroke National Audit Programme (SSNAP) Acute organisational audit report Public Report for England, Wales and Northern Ireland – December 2012

Posted on January 4, 2013. Filed under: Neurology | Tags: |

Sentinel Stroke National Audit Programme (SSNAP) Acute organisational audit report Public Report for England, Wales and Northern Ireland – December 2012

Prepared by Royal College of Physicians, Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party

“This is the first report published under the auspices of the new national stroke audit, the Sentinel Stroke National Audit Programme (SSNAP). It publishes national and hospital level findings on the organisation of stroke services, in particular acute care organisation, specialist roles, staffing, TIA (mini stroke) services, communication between staff groups and with patients and carers, and pathway at discharge. The results reflect the organisation of stroke services as of 2 July 2012.

The report findings enable the organisation of stroke services at national level to be compared with national standards outlined in the fourth edition of the National Clinical Guideline for Stroke (2012) published by the Intercollegiate Stroke Working Party and, the NICE (National Institute for Health and Clinical Excellence) Clinical Guideline, the National Stroke Strategy 2007 and the NICE Quality Standard for Stroke (2010).”

… continues

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National Stroke Audit Rehabilitation Services Report 2012 – National Stroke Foundation – 3 November 2012

Posted on November 6, 2012. Filed under: Neurology | Tags: , |

National Stroke Audit Rehabilitation Services Report 2012 – National Stroke Foundation – 3 November 2012

Media release:  Many stroke rehabilitation services “remain substandard”: Report

“Some critical stroke rehabilitation services are either unavailable or “substandard” for many patients because of inadequate staffing, education and resources in our hospitals, according to a new report that examines inpatient stroke rehabilitation services in Australia.

The findings are released just days after the nation’s first stroke summit, where 70 survivors and carers from across Australia went to Parliament House in Canberra to demand better stroke awareness, funding, resources, care and support in Australia. The stroke summit, held at Parliament House in Canberra over two days this week (30-31 October), endorsed a Call to Action for stroke and outlined eight areas that urgently need improvement. They include better preparation to prevent stroke, better treatment for those who have had a stroke and better support so people can recover from their stroke.

The National Stroke Audit Rehabilitation Services Report 2012, released today, is a survey of 111 hospitals and 2821 stroke patients and represents more than 40 per cent of all Australian stroke patients admitted for inpatient rehabilitation in the 12-month period from 1 January 2011 to 31 December 2011.

Conducted by the National Stroke Foundation, the audit has made recommendations for better psychological services, discharge planning, rehabilitation coordination and family involvement in stroke recovery to be available to every stroke patient.”

… continues

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Pathways of Care for People with Stroke in Ontario Core – Canadian Institute for Health Information – 12 July 2012

Posted on July 17, 2012. Filed under: Health Mgmt Policy Planning, Neurology | Tags: |

Pathways of Care for People with Stroke in Ontario Core – Canadian Institute for Health Information – 12 July 2012

“This report provides information on pathways of stroke care in Ontario over a four-year period, by following individuals being treated for stroke across hospital settings; including emergency department, acute care, inpatient rehabilitation and complex continuing care. The report sheds light on some important transition points in a stroke patient’s hospital care and on how well the system is integrated and functions for patients. It also identifies key areas where improvements in stroke care can be considered. ”

Media release: Earlier diagnosis, improved flow across care settings key to timelier stroke care in Ontario. Study finds room for improvement in identification and treatment of stroke patients – 12 July 2012

“The number of stroke deaths is declining in Ontario and the rest of Canada, due in part to better management and treatment of the disease. However, a new study released today by the Canadian Institute for Health Information (CIHI) shows that there may still be room for improvement in the early diagnosis and treatment of stroke patients. For example, the study found that about 1 in 10 Ontario stroke patients seen in a hospital emergency department (ED)—representing more than 5,000 cases over a four-year-period—was documented as having had a stroke only after being admitted to a hospital ward.

The study found that these patients had no stroke or stroke symptoms (such as headache or dizziness) listed on their ED records and were less likely to have received a brain imaging scan during the course of their emergency stay than other stroke patients. Best practice recommends that suspected stroke patients should receive brain scans within one hour of their arrival in the ED to identify the type of stroke and appropriate course of treatment.

“Carrying out rapid assessments and confirming that a person has had a stroke most often begin in the ED. It is a coordinated effort among many providers and can present a challenge,” explains Dr. Paul Ellis, emergency physician at the University Health Network. “But the earlier this is done, the sooner appropriate treatment can begin and the greater the chances a patient can recover.” ”

… continues on the site

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Healthcare Cost and Utilization Project Projections: Cardiovascular/Cerebrovascular Conditions and Procedures 2011 to 2012 – 10 July 2012

Posted on July 16, 2012. Filed under: Cardiol / Cardiothor Surg, Chronic Disease Mgmt, Health Economics, Neurology | Tags: , , |

Healthcare Cost and Utilization Project Projections: Cardiovascular/Cerebrovascular Conditions and Procedures 2011 to 2012 – 10 July 2012

U.S. Agency for Healthcare Research and Quality, HCUP
by Steiner C, Barrett M, Weiss A.

Extract from the introduction:

“40 percent of Americans. Heart disease and stroke are the first and fourth leading causes of death in the United States, and these diseases are among the most common and costly reasons for hospital admissions.2,3 The prevalence of cardiovascular and cerebrovascular diseases increases with age, with cardiovascular disease occurring in fewer than 20 percent of adults age 20-39 but more than 70 percent of adults age 60-79. Gender differences in these diseases also exist, with increasing rates by age of first major cardiovascular events for both men and women, but with a 10-year lag in the rates among women. The Affordable Care Act provides up to $100 million for community programs targeted at reducing chronic diseases, including heart disease and stroke, and another $40 million for statewide efforts focused on chronic diseases.

Timely information on trends for cardiovascular/cerebrovascular conditions and procedures provides analysts and policy makers baseline information and can be used to help evaluate the impact of health improvement efforts. A novel initiative from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) is used in this report to produce timely, current inpatient statistics on cardiovascular/cerebrovascular conditions and procedures.

The HCUP State Inpatient Databases (SID) from 2001 to 2010 include about 330 million inpatient discharges from 46 States. The list of statewide data organizations that contribute to HCUP is available in Appendix I. In this report we use the historical SID data with early 2011 data from 10 HCUP States to develop national quarterly projections of 2011 and 2012 inpatient statistics for:

  • cardiovascular/cerebrovascular system conditions, overall
  • five specific cardiovascular/cerebrovascular conditions
  • cardiovascular/cerebrovascular system procedures, overall
  • four specific cardiovascular/cerebrovascular procedures.”

… continues on the site

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A Life More Ordinary: findings from the Long-Term Neurological Conditions Research Initiative [UK] published – 22 May 2012

Posted on May 23, 2012. Filed under: Chronic Disease Mgmt, Neurology |

A Life More Ordinary: findings from the Long-Term Neurological Conditions Research Initiative [UK] published – 22 May 2012

“A Life More Ordinary ‘provides a summary of the main findings from the Long-term Neurological Conditions Research Initiative (LTNC RI). The Initiative was funded by the Department of Health’s Policy Research Programme (DH PRP) in 2006, following the launch of the DH National Service Framework (NSF) in 2005.’ (Winchcombe 2012 p9).

The objectives of the initiative were to provide a baseline against which to assess progress on the objectives of the National Service Framework for Long Term Conditions, to determine the extent of met and unmet need, and to evaluate the impact of new initiatives, including the NSF itself. The report gives the main findings from all the studies and discusses the implications for policy and practice.”

… continues on the site

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Epilepsy Across the Spectrum: Promoting Health and Understanding – Institute of Medicine – 30 March 2012

Posted on April 2, 2012. Filed under: Neurology | Tags: , |

Epilepsy Across the Spectrum: Promoting Health and Understanding – Institute of Medicine – 30 March 2012

Full text

“Although epilepsy is one of the nation’s most common neurological disorders, public understanding of it is limited. Many people do not know the causes of epilepsy or what they should do if they see someone having a seizure. Epilepsy is a complex spectrum of disorders that affects an estimated 2.2 million Americans in a variety of ways, and is characterized by unpredictable seizures that differ in type, cause, and severity. Yet living with epilepsy is about much more than just seizures; the disorder is often defined in practical terms, such as challenges in school, uncertainties about social situations and employment, limitations on driving, and questions about independent living.

The IOM was asked to examine the public health dimensions of the epilepsies, focusing on public health surveillance and data collection; population and public health research; health policy, health care, and human services; and education for people with the disorder and their families, health care providers, and the public. The IOM makes recommendations ranging from the expansion of collaborative epilepsy surveillance efforts, to the coordination of public awareness efforts, to the engagement of people with epilepsy and their families in education, dissemination, and advocacy for improved care and services. Taking action across multiple dimensions will improve the lives of people with epilepsy and their families. The realistic, feasible, and action-oriented recommendations in this report can help enable short- and long-term improvements for people with epilepsy.”

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Allied Health Professionals QIPP Toolkits – NHS – 14 March 2012

Posted on March 22, 2012. Filed under: Allied Health, Diabetes, Dietetics, Neurology, Oncology, Physiotherapy |

Allied Health Professionals QIPP Toolkits – NHS – 14 March 2012

“The Strategic Health Authority AHP Leads for England have worked with NHS London who compiled the AHP QIPP Toolkits These are designed to help commissioners design services that are of high quality whilst reducing cost. The Toolkits will be launched by Karen Middleton and Jim Easton at the kings Fund in London on March 19th Clinicians and provider organisations can use the toolkits to stimulate discussion and help planning. The NHS needs to find £20 billion pounds of savings through working transformationally. These toolkits show how AHPs are a vital part of that solution. The toolkits have been designed collaboratively with all 12 Allied Health Professional Bodies who endorsed their content and have been co produced in many areas with National clinical directors.”

AHP Stroke toolkit

AHP ONS toolkit – Oral Nutritional Support

AHP Musculoskeletal (MSK) care toolkit

AHP Cancer toolkit

AHP Diabetes toolkit

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Euro Headache Index 2012 – Health Consumers Powerhouse – 13 March 2012

Posted on March 14, 2012. Filed under: Neurology | Tags: |

Euro Headache Index 2012 – Health Consumers Powerhouse – 13 March 2012

“As many as 50 million Europeans suffer from headache and migraine, for many with handicapping effects. Compared to other large diseases, there lacks outcomes data to tell what are the best therapies and if prevention matters. The first Euro Headache Index (EHI) compares in what way 29 European countries address and take care of headache and migraine, by healthcare and other measures. The Netherlands comes out number 1 on good headache environment, followed by Germany, Denmark and Austria.

The 2012 EHI looks into the following areas: Patients rights and information, Professional awareness and education, Access to healthcare, Medication/treatment and Prevention. In total there are 34 indicators for measurement.”

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Services for people with neurological conditions – National Audit Office [UK] – 16 December 2011

Posted on December 16, 2011. Filed under: Neurology | Tags: |

Services for people with neurological conditions – National Audit Office [UK] – 16 December 2011

“Since 2005, when the Department of Health introduced its National Service Framework for Long-term Conditions, people with neurological conditions have had better access to health services; but key indicators of quality – such as the rate of emergency hospital readmissions – have worsened. The Department does not know what the Framework and additional spending of nearly 40 per cent over four years have achieved.

The Framework was designed to improve care for people with neurological conditions but progress in implementing it has been poor.”  … continues

HC: 1586, 2010-2012
ISBN: 9780102977042

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Mind the gap: ways to enhance therapy provision in stroke rehabilitation – NHS Improvement – 2011

Posted on December 13, 2011. Filed under: Neurology, Rehabilitation | Tags: , |

Mind the gap: ways to enhance therapy provision in stroke rehabilitation – NHS Improvement – 2011

“Ways to enhance therapy provision in stroke rehabilitation This document explores some of the different models adopted by therapy services to deliver more rehabilitation and provides further detail about 45 minutes, process and outcomes.”
 
Contents
Introduction
National guidelines
Who can deliver more rehabilitation?
When – a seven day service?
How long – getting more out of the whole week?
Where can more therapy make a difference?
How – bridging the gap?
Conclusions
References
Case studies

Practical principles for improving stroke care 

1 – Improving psychological care after stroke 

2 – Developing an early supported discharge service 

 3 – Improving access to CT scanning 

4 – Transient Ischaemic Attack (TIA) 

5 – How to establish joint care planning 

6 – How to manage reviews for stroke survivors 

7 – Being the best in acute stroke 

8 – Developing a community stroke service

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Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention – AHRQ – October 2011

Posted on November 11, 2011. Filed under: Cardiol / Cardiothor Surg, Neurology, Preventive Healthcare, Rehabilitation | Tags: |

Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention – AHRQ – October 2011

AHRQ = US Agency for Healthcare Research and Quality

“Structured Abstract

Objectives: To review the available published literature to assess whether evidence supports a beneficial role for coordinated transition of care services for the postacute care of patients hospitalized with first or recurrent stroke or myocardial infarction (MI). This review was framed around five areas of investigation:

1.Key components of transition of care services.
2.Evidence for improvement in functional outcomes, morbidity, mortality, and quality of life.
3.Associated risks or potential harms.
4.Evidence for improvement in systems of care.
5.Evidence that benefits and harms vary by patient-based or system-based characteristics.

Data Sources: MEDLINE®, CINAHL®, Cochrane Database of Systematic Reviews, and Embase®.

Review Methods: We included studies published in English from 2000 to 2011 that specified postacute hospitalization transition of care services as well as prevention of recurrent stroke or MI.

Results: A total of 62 articles representing 44 studies were included for data abstraction. Transition of care interventions were grouped into four categories:

1.Hospital-initiated support for discharge was the initial stage in the transition of care process.
2.Patient and family education interventions were started during hospitalization but were continued at the community level.
3.Community-based models of support followed hospital discharge.
4.Chronic disease management models of care assumed the responsibility for long-term care.

Early supported discharge after stroke was associated with reduced total hospital length of stay without adverse effects on functional recovery, and specialty care after MI was associated with reduced mortality. Because of several methodological shortcomings, most studies did not consistently demonstrate that any specific intervention resulted in improved patient- or system-based outcomes. Some studies included more than one intervention, which made it difficult to determine the effect of individual components on clinical outcomes. There was inconsistency in the definition of what constituted a component of transition of care compared to “standard care.” Standard care was poorly defined, and nearly all studies were underpowered to demonstrate a statistical benefit. The endpoints varied greatly from study to study. Nearly all the studies were single-site based, and most (26 of 44) were conducted in countries with national health care systems quite different from that of the U.S., therefore limiting their generalizability.

Conclusions: Although a basis for the definition of transition of care exists, more consensus is needed on the definition of the interventions and the outcomes appropriate to those interventions. There was limited evidence that two components of hospital-initiated support for discharge (early supported discharge after stroke and specialty care followup after MI) were associated with beneficial effects. No other interventions had sufficient evidence of benefit based on the findings of this systematic review. The adoption of a standard set of definitions, a refinement in the methodology used to study transition of care, and appropriate selection of patient-centered and policy-relevant outcomes should be employed to draw valid conclusions pertaining to specific components of transition of care.”

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Stroke Foundation Acute Audit Organisational Report 2011 – 28 October 2011

Posted on November 1, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Neurology | Tags: |

Stroke Foundation Acute Audit Organisational Report 2011 – 28 October 2011

“The National Stroke Audit Acute Services Organisational Survey Report 2011, conducted by the National Stroke Foundation is the only program of its kind in Australia.

The report provides an overview of acute stroke services in Australia. It makes several important recommendations on stroke care based on data collected from 188 participating hospitals that reported almost 26,000 stroke admissions in 2010.

The report highlights that poor access to life-saving stroke care and treatment is causing avoidable death and disability in Australia.”

Link to Report   
Link to Summary  
Link to Media Release

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The national audit of services for people with multiple sclerosis 2011 – Royal College of Physicians and the MS Trust – September 2011

Posted on October 18, 2011. Filed under: Neurology |

The national audit of services for people with multiple sclerosis 2011 – Royal College of Physicians and the MS Trust – September 2011

“This is the third audit of the NHS’s performance in providing healthcare services to people with MS using six recommendations and a sentinel marker proposed by the National Institute of Health and Clinical Excellence (NICE) in Management of multiple sclerosis in primary and secondary care (2003).  In addition, we measured compliance with seven of the eleven National Service Framework for Long-term Conditions (2005) quality requirements that are particularly relevant to MS services.”

Executive summary 

Press release

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Psychological care after stroke: improving stroke services for people with cognitive and mood disorders – NHS Improvement – 23 August 2011

Posted on August 29, 2011. Filed under: Neurology | Tags: |

Psychological care after stroke: improving stroke services for people with cognitive and mood disorders – NHS Improvement – 23 August 2011

This new publication from NHS Improvement is intended to be a pragmatic guide for services who would like to improve psychological support for people with stroke. The target audience is clinical staff working in stroke services who would like to make local improvements but also stroke networks, SHA leads and commissioners of stroke services interested in large scale improvement in psychological support after stroke.”

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UK Carotid Endarterectomy Audit. Round 3 Public Report – Royal College of Physicians – June 2011

Posted on June 29, 2011. Filed under: Neurology | Tags: , |

UK Carotid Endarterectomy Audit. Round 3 Public Report – Royal College of Physicians – June 2011

“This new report (2011), funded by the Healthcare Quality Improvement Partnership (HQIP), presents the latest finding from Round 3 of the National Carotid Interventions Audit. The audit focussed on the process and outcomes of patients undertaking carotid endarterectomy between 1st October 2009 and 30th September 2010. It covers many of the aspects of the pathway, from the characteristics of the patient, the key delays prior to surgery, the surgery itself and any post operative outcomes.”

“Foreword
The increasing public expectation of early referral and high quality stroke management can only be met by clinicians demonstrating that the care provided is improving in line with evidence based standards. The carotid intervention audit, a joint audit by the Vascular Society of Great Britain & Ireland and the Royal College of Physicians of London, now reports the results of surgical care against national standards for the third time. This report contains both good news and aspirations for improvement. Round three sees the highest level of participation and recorded cases in this national audit since its inception. Along with increasing participation, there are further reductions in the time between symptoms, referral and treatment.

Whilst these improvements are good news for patients and clinicians, there is some way to go before the surgical component of the stroke pathway can be regarded as mature. The NICE standard of 14 days from symptom to treatment is not yet achieved and the National Stroke Strategy target of 48 hours by 2017 looks like a major challenge. The clinical community needs to collectively re-double its efforts and refine the pathway of care. This will require an increased awareness of the importance of the symptoms of impending stroke and a commitment to rapid referral, investigation and treatment. NHS organisations will need to ensure rapid access to clinicians, imaging and surgical teams. Clinical teams will need to recognise TIA as an emergency requiring a rapid response to deliver high quality care in a timely manner.”

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Six-month review after stroke – South London Cardiac and Stroke Network

Posted on June 29, 2011. Filed under: Neurology | Tags: |

Six-month review after stroke – South London Cardiac and Stroke Network

“Stroke is a long term condition. As such, survivors experience changes in their needs over time. Reviews can help ensure patients and carers receive appropriate support and access to services as their needs require.”

“There is clearly a strong onus on commissioners to establish robust review processes for stroke patients. However, the lack of evidence to guide the delivery of these reviews raises many questions: What should a review consist of? Who should lead the review? How should it be delivered? What are the benefits? What are the resource implications?
This guidance therefore seeks to answer these questions, focusing primarily on the six month review due to its inclusion in the ASI programme. This work has been informed by patient and carer engagement activities that have been undertaken in South London, combined with feedback from service models piloted and implemented elsewhere, and work undertaken by the national Stroke Improvement Programme (SIP) team.”

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Local adult neurology services for the next decade: Report of a working party – Royal College of Physicians and the Association of British Neurologists – June 2011

Posted on June 29, 2011. Filed under: Health Mgmt Policy Planning, Health Systems Improvement, Neurology |

Local adult neurology services for the next decade: Report of a working party – Royal College of Physicians and the Association of British Neurologists – June 2011
ISBN 978-1-86016-372-2
Royal College of Physicians. Local adult neurology services for the next decade.
Report of a working party. London: RCP, 2011.

Extract from the executive summary:

“Neurological disorders are very common, accounting for about one in ten general practitioner consultations, around 10% of emergency medical admissions (excluding stroke) and disability for one in 50 of the UK population. They include many different conditions of varying severity, some very common and others exceedingly rare, from migraine to motor neuron disease.

Patients require access to different parts of the neurological care pathway at different stages of their illness (acute admission, outpatient care and long-term care). However, these are currently poorly planned and organised. Good management requires better integrated primary, secondary and tertiary resources to achieve a neurology network that is easily accessible, provides local care where appropriate and, when necessary, involves the regional neurosciences centre.”

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The Quality of Stroke Care in Canada – Canadian Stroke Network – 2011

Posted on June 21, 2011. Filed under: Neurology | Tags: |

The Quality of Stroke Care in Canada – Canadian Stroke Network – 2011

Extract from the executive summary

“Stroke is a leading cause of death and adult disability. Of all chronic diseases in Canada, stroke is among the most impactful. Sixty per cent of people who have a stroke report that they need help afterwards and 80% have restrictions to their daily activities. In 2005, the Canadian Stroke Strategy set out to ensure every province in Canada was  organized to deliver the best possible stroke care. Over six years, progress has been achieved nation-wide (Appendix A).

Despite the impact of stroke on Canadians and the progress to date, there has never been a comprehensive pan-Canadian report on the quality of stroke care. For this reason, the Canadian Stroke Network collected data representing 38,210 patients admitted with stroke from 295 hospitals across Canada over the period 2008-2009. This data, supplemented with data from national health databases, resulted in The Quality of Stroke Care in Canada. The purpose of this report is to describe the quality of stroke care being provided to Canadians and to make recommendations on how it may be improved. Key findings and recommendations from The Quality of Stroke Care in Canada are described below.”  … continues

 

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National Sentinel Stroke Audit 2010 – Royal College of Physicians – May 2011

Posted on May 20, 2011. Filed under: Neurology | Tags: , |

National Sentinel Stroke Audit 2010 – Royal College of Physicians – May 2011

“Stroke care still improving but concerns remain
The final report of the National Sentinel Stroke Audit shows that care for patients with stroke is still improving 12 years after the start of the audit. 88% of patients spent at least some time on a stroke unit which is excellent progress from 74% in 2008.  Patients on stroke units have better outcomes than those admitted to and treated on general wards.

The audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP), was carried out on behalf of the Intercollegiate Stroke Working Party by the Royal College of Physicians’ Clinical Standards Department, and covers 100% of eligible hospitals in England, Wales and Northern Ireland.”

Report

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Traumatic Brain Injury and Depression – Agency for Healthcare Research and Quality [US] – 13 April 2011

Posted on April 27, 2011. Filed under: Mental Health Psychi Psychol, Neurology | Tags: |

Traumatic Brain Injury and Depression – Agency for Healthcare Research and Quality [US] – 13 April 2011

AHRQ has released a new systematic review of 115 clinical studies involving depression after traumatic brain injury (TBI).  Comparative Effectiveness Review of Traumatic Brain Injury and Depression, prepared by researchers at the AHRQ’s Vanderbilt Evidence-based Practice Center addresses key questions on depression after traumatic brain injury and finds there are many research gaps.  However, there are treatments available for people with depression and people should understand their options.

Depression After Brain Injury: A Guide for Patients and Their Caregivers – 13 April 2011

Depression After Traumatic Brain Injury – Clinician Guide – 13 April 2011

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Project Retrosight: Understanding the returns from cardiovascular and stroke research: The Policy Report – RAND – March 2011

Posted on March 18, 2011. Filed under: Cardiol / Cardiothor Surg, Neurology, Research | Tags: |

Project Retrosight: Understanding the returns from cardiovascular and stroke research: The Policy Report – RAND – March 2011
by Steven Wooding, Stephen Hanney, Alexandra Pollitt, Martin Buxton, Jonathan Grant

“This project explores the impacts arising from cardiovascular and stroke research funded 15-20 years ago and attempts to draw out aspects of the research, researcher or environment that are associated with high or low impact.

The project is a case study-based review of 29 cardiovascular and stroke research grants, funded in Australia, Canada and UK between 1989 and 1993. The case studies focused on the individual grants but considered the development of the investigators and ideas involved in the research projects from initiation to the present day. Grants were selected through a stratified random selection approach that aimed to include both high- and low-impact grants. The key messages are as follows: 1) The cases reveal that a large and diverse range of impacts arose from the 29 grants studied. 2) There are variations between the impacts derived from basic biomedical and clinical research. 3) There is no correlation between knowledge production and wider impacts 4) The majority of economic impacts identified come from a minority of projects. 5) We identified factors that appear to be associated with high and low impact.

This report presents the key observations of the study and an overview of the methods involved. It has been written for funders of biomedical and health research and health services, health researchers, and policy makers in those fields. It will also be of interest to those involved in research and impact evaluation.” 

Research Brief on Project Retrosight

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Videoconference consultants boost emergency stroke care – 16 February 2011

Posted on February 17, 2011. Filed under: Neurology, Rural Remote Health, Telehealth | Tags: |

Videoconference consultants boost emergency stroke care.  Allowing consultants to order drugs remotely is saving lives and money, according the medical lead of the NHS Stroke Improvement Programme – 16 February 2011

“Dr Damian Jenkinson said that letting groups of hospitals share stroke consultants, who use videoconferencing to examine patients and view brain scans, increases the use of clot-busting drugs.

There are too few consultants to provide round-the-clock cover at every major hospital in person, he told the Mobile and Wireless Healthcare conference in Birmingham: “We need network solutions to make this happen.”

Consultants aim to use the clot-busting drugs within three hours of a stroke taking place, as they help arrest the rapid death of brain cells caused by the condition.

Jenkinson, who is national clinical lead for the NHS Stroke Improvement Programme, said Lancashire and Cumbria had calculated that it would be able to provide the drugs to 400 patients from the 4,000 stroke admissions the area makes each year, rather than 20 as at present. In doing so it would save £2m annually, in return for one-off spending of £285,000 and annual costs of £115,000, with the savings including reduced hospital stays.”

…continues on the site

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Do quality improvements in primary care reduce secondary care costs? – The Health Foundation (UK) – 15 February 2011

Posted on February 16, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics, Neurology, Primary Hlth Care | Tags: |

Do quality improvements in primary care reduce secondary care costs? – The Health Foundation (UK) – 15 February 2011

Primary research into the impact of the Quality and Outcomes Framework on hospital costs and mortality

“A leading edge study published by the Health Foundation today shows an association between achievement of the Quality and Outcomes Framework (QOF) indicators and a reduction in hospital costs and lives saved, particularly for stroke care.

The primary research, which analyses newly available data to establish the impact of QOF on hospital costs and mortality, finds that a single point increase in the QOF stroke score, across England, could lead to 2,385 fewer deaths in a year.

Do quality improvements in primary care reduce secondary care costs?‘ also estimates that improvements in primary care for stroke may have reduced secondary care costs by £165 million, over a four year period from 2004 to 2008, measured by a 10 per cent increase in the mean practice QOF stroke score.”

Full report
Summary

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Neurothrombectomy Devices for Treatment of Acute Ischemic Stroke – Agency for Healthcare Research & Quality [US] – technical brief published 18 January 2011

Posted on February 1, 2011. Filed under: Neurology | Tags: , |

Neurothrombectomy Devices for Treatment of Acute Ischemic Stroke – Agency for Healthcare Research & Quality [US] – research begun 20 Feb 2010, technical brief published 18 January 2011

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Supporting life after stroke: A review of services for people who have had a stroke and their carers – Care Quality Commission (UK) – January 2011

Posted on January 18, 2011. Filed under: Neurology | Tags: , , |

Supporting life after stroke: A review of services for people who have had a stroke and their carers – Care Quality Commission (UK) – January 2011

“Stroke can be a devastating and life changing event for people. However, our review found that the extent to which they are supported to cope with life after stroke varies significantly across England. The best services are built around the individual – with their care being planned to take account of the needs, circumstances and preferences of the person who has had a stroke, their carers and family. People in these areas are more likely to experience a smooth and coordinated return home from hospital and to have access to a broad range of services to help them recover from, and cope with, the effects of stroke.”

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Insights from stroke survivors and providers of stroke care in rural England: Summary report – Commission for Rural Communities – 20 December 2010

Posted on January 14, 2011. Filed under: Neurology, Rural Remote Health | Tags: , |

Insights from stroke survivors and providers of stroke care in rural England: Summary report – Commission for Rural Communities – 20 December 2010

“This summary report traces the ‘care pathway’ that stroke sufferers typically follow in rural areas– from emergency care, through acute and rehabilitative care in hospital, to care received afterpatients return home.

Concern for the adequacy of service delivery in a rural context has been a major theme of thework of the Commission for Rural Communities (CRC) and its predecessor bodies for manyyears – not least because in any survey of rural people accessibility to services always figures asa major concern.

This report provides insights from users and providers about both the delivery of stroke-related services in England and the challenge that rurality poses for those services. By examining how living in a rural area affects stroke patients’ experiences, this summary is a first stage in tacklingproblems of access.”

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Motor neurone disease – non-invasive ventilation – NICE Guidance – July 2010

Posted on August 12, 2010. Filed under: Neurology, Respiratory Medicine | Tags: , |

Motor neurone disease – non-invasive ventilation – NICE Guidance – July 2010

The use of non-invasive ventilation in the management of motor neurone disease

Description

This clinical guideline offers evidence-based advice on the use of non-invasive ventilation for people with motor neurone disease. It is the full guideline and contains all the recommendations, details of how they were developed, and reviews of the evidence they were based on.

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Cost of caring for stroke patients double that of earlier estimates, [Canadian] study finds – 8 June 2010

Posted on June 11, 2010. Filed under: Neurology | Tags: |

Cost of caring for stroke patients double that of earlier estimates, study finds

“Quebec City – Health-care costs for patients in just the first six months after they have a stroke is more than $2.5 billion a year in Canada, according to a study presented today at the Canadian Stroke Congress.

The Canadian Stroke Network’s Burden of Ischemic Stroke (BURST) study found that the direct and indirect health-care costs for new stroke patients tally an average $50,000 in the six-month period following a new stroke. There are about 50,000 new strokes in Canada each year.

Earlier and widely quoted estimates, based on the most recent data from Health Canada’s Economic Burden of Illness (1998), indicated that the total cost of stroke in Canada was $2.4 billion a year for both new stroke patients and long-term survivors. There are 300,000 people living with stroke in Canada.

“Our old estimates of how much stroke costs the economy are way off base,” says Dr. Mike Sharma, who together with Dr. Nicole Mittman of Sunnybrook Health Sciences Centre, led the BURST study, which is the first prospective national economic analysis on stroke costs.

“The cost of stroke is far more than we expected – at least double previous estimates.”

BURST researchers examined the health-care costs of 232 hospitalized stroke patients in 12 sites across Canada at discharge, three months, and six months, and one year. The study looked at both disabling and non-disabling stroke.

Hospitalization, medication, physician services, diagnostic imaging, homecare and rehabilitation all contribute to the bill. There are also indirect costs, including disability leave, lost wages, assisted devices, caregivers, and out-of-pocket expenses for families such as personal assistance products or changes to homes to accommodate disabilities.”

…continues on the website

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[UK] Department of Health: Progress in improving stroke care – National Audit Office – 3 February 2010

Posted on February 9, 2010. Filed under: Health Systems Improvement, Neurology | Tags: , , |

UK] Department of Health: Progress in improving stroke care – National Audit Office – 3 February 2010

HC: 291, 2009-10
ISBN: 9780102963441

* Executive summary (PDF – 139KB)
* Full report (PDF – 958KB)
* Press notice (HTML)
* Methodology (PDF – 69KB)
* Progress In Improving Stroke Care: A Good Practice Guide (PDF – 516KB)

“Care for people who have had a stroke has significantly improved since we reported in 2005. The publication and early implementation of the stroke strategy have begun to make a real difference and have helped to put in place the right mechanisms to bring about these improvements. There is still work to be done though: the poorer performers must be dragged up to the same standard as the best, so that the gains that have been made are sustained and value for money improved further. The Department should focus on ensuring that health, social care and employment services are working together much more effectively.”

Amyas Morse, Head of the National Audit Office, 3 February 2010

“The Department of Health’s strategy for stroke care has increased the priority and awareness of the condition and started to improve patients’ care and outcomes, concludes a report by the National Audit Office published today. Actions taken since 2006 have improved the value for money of stroke care; but improvements have not been universal and improvements in follow-up care have not matched those of acute care services.

The National Stroke Strategy is a comprehensive response to the concerns raised by the NAO in its 2005 report on stroke. 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. With this clear focus from Ministers and the Department, the NHS is now starting to deliver better care from stroke services, and outcomes for patients are also improving. The NAO estimates that stroke patients’ chances of dying within ten years have reduced from 71 to 67 per cent since 2006.

Patients treated in a specialist stroke unit are more likely to survive, have fewer complications and regain their independence, and all relevant hospitals in England now have such a unit, although the services provided and time spent in the unit vary. Stroke patients should be immediately admitted to a specialist stroke unit; however 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.

However, health and social care services are not working as well together as they could. 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.”

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Emergency department stroke and transient ischaemic attack care bundle – NHMRC – 9 December 2009

Posted on December 10, 2009. Filed under: Emergency Medicine, Neurology | Tags: , , , |

Emergency department stroke and transient ischaemic attack care bundle – NHMRC – 9 December 2009

“Improving the management of acute stroke and transient ischaemic attack (TIA) in the emergency department (ED) was identified as a priority by the NICS emergency care community of practice (EC CoP).

In response, NICS initiated a project to develop a set of evidence-based resources to improve the implementation of guideline recommendations for acute stroke and TIA management in the ED.”  … continues on the website

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Report reveals that brain and spinal cord injury costs the Australian community $10.5B – 27 July 2009

Posted on July 27, 2009. Filed under: Neurology | Tags: , |

Report reveals that brain and spinal cord injury costs the Australian community $10.5B
July 27, 2009

“A landmark report released today reveals for the first time the high cost of traumatic brain injury (TBI) and spinal cord injury (SCI) in Australia.

The report, completed by Access Economics on behalf of the Victorian Neurotrauma Initiative (VNI), shows that the lifetime costs of brain and spinal cord injuries occurring in 2008 alone is $10.5 billion.

“Whilst we acknowledge that we can’t put a figure on the human costs of brain and spinal injury, it is important to understand the financial burden to the individual and the wider community” said Dr Alex Collie, Director, VNI.

While relatively uncommon, brain and spinal cord injury typically occurs at a young age and individuals are disabled for the rest of their lives resulting in very high costs. In addition to the physical injury, many aspects of daily functioning are affected: the ability to work, go out with friends, participate in the community, and even go on holiday.

Lynne Pezzullo of Access Economics notes that “the report examines all financial costs – the huge cost to the individual, unpaid costs by their carers, the significant cost to the government and the hidden costs to the wider community.”

“The report also highlights that the direct financial costs of brain and spinal cord injury are comparable or greater than the costs of conditions considered high cost, such as dementia and multiple sclerosis”, said Ms Pezzullo.

“The good news is that there are interventions that are cost-effective and help improve the lives of individuals living with brain and spinal cord injury” said
Dr Collie.

The report found that the use of saline to resuscitate individuals with traumatic brain injury was cost-saving and the use of continuous positive airway pressure to treat sleep disorders in quadriplegia was cost effective.

The research demonstrating the effectiveness of both interventions was funded by the VNI and the Transport Accident Commission (TAC). Traumatic brain and spinal cord injury most commonly occurs in young adults involved in transport accidents.”

The economic cost of spinal cord injury and traumatic brain injury in Australia (1.31Mb)   from Access Economics

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Please mind the gap: Parkinson’s disease services today – UK – July 2009

Posted on July 14, 2009. Filed under: Neurology, Patient Participation | Tags: |

Please mind the gap: Parkinson’s disease services today – UK – July 2009

“The All Party Parliamentary Group for Parkinson’s disease (APPG) has published a report in July 2009 into access to health and social care services for people affected by Parkinson’s disease.

The report – Please mind the gap: Parkinson’s disease services today (PDF, 1.3MB) – reveals major inequalities in access to information and services for people with Parkinson’s and their families.

The report is the result of a parliamentary Inquiry which has run since November 2008.

Over 360 people with Parkinson’s, their carers, individual health and social care professionals and organisations helped shape the report by submitting written evidence.”

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Stockings offer no benefit after stroke – 26 May 2009 – ABC report and Lancet articles

Posted on May 28, 2009. Filed under: Neurology |

Stockings offer no benefit after stroke ABC Science article 28 May 2009 by Helen Carter

Articles from Lancet 26 May 2009:
Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial
In Press, Corrected Proof, Available online 26 May 2009
The CLOTS Trials Collaboration

Thigh-length compression stockings and DVT after stroke
In Press, Corrected Proof, Available online 26 May 2009
Philip MW Bath, Timothy J England

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Getting the best from neurological services: A guide for people affected by conditions of the brain, spine and nervous system – UK

Posted on April 8, 2009. Filed under: Neurology, Patient Participation | Tags: |

Guidance from the   Neurological Alliance.    Published  30 January 2009
Primary audience:      Public, Health and social care professionals
ISBN 1 901893 33 2              40 p.

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