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NIHR Signal Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation
General practice software that generated screen reminders for patients with atrial fibrillation did not increase the proportion taking oral anticoagulants appropriately by six months. This NIHR-funded trial included GPs in 47 surgeries in England and found that at the start only 63% of eligible patients with atrial fibrillation were being prescribed anticoagulants. Six months later the rate had increased to 66% in intervention practices and 64% in those following usual practice, a non-significa...
NIHR Signal Exercise therapy may still improve balance when started a long time after a stroke
Exercise therapy may improve balance for people in the chronic phase of recovery six or more months after stroke. The most effective training regimens seem to be those that focus on balance, weight shifting and gait training. Though significant, the improvements in function may still be small. Often little recovery can be expected beyond six months of stroke, and available treatments may be limited. This review found that exercise therapy in this population gave small improvements, generally in...
NIHR Signal Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke
Restoring blood flow to the brain within a few hours of having a stroke improves a person’s chances of recovery. Early use of drugs to dissolve clots (thrombolysis) has been the mainstay of management in recent years and there has also been rapid development of devices to remove clots. Using evidence from trials published in the last five years, this review found mechanical removal of clots was more effective than thrombolysis alone whereas earlier research of older techniques had suggeste...
NIHR Signal Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical importance is uncertain
This systematic review and meta-analysis found that electrical stimulation produced a small, but statistically significant improvement, in tight muscles (spasticity) for people recovering from stroke. The clinical importance of the improvement is uncertain. For example, electrical stimulation improved joint flexibility by an average of 2.87 degrees and spasticity improved by 0.3 on a 5 point scale. Stimulation was only found to work when used alongside other therapies, such as structured exercis...
NIHR Signal Centralising stroke services improves chances of patients getting the right care
This study of two models of organising stroke care showed that fully centralised services were more likely to deliver clinically effective treatments. This NIHR-funded study looked at stroke care audit data before and after introducing two different models of centralised stroke services in London and Manchester. The audit recorded the proportion of stroke patients in each location who received each of seven effective care interventions, such as brain scans or clot-busting drugs within the recomm...
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