national-clinical-guidelines-for-stroke-fourth-edition

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further strokes. Despite its importance for quality of life it is an area that is frequently neglected by clinicians when seeing patients after stroke. Evidence to recommendations There is little evidence of the risks and benefits of using sildenafil and similar drugs after stroke. No patients within 6 months of stroke and ischaemic heart disease were included in the original trials. There is no reason to suspect that people are at increased risk of side effects after stroke but the consensus of the working party is to wait for 3 months after stroke onset before prescribing, as long as blood pressure is controlled. A study of cerebral blood flow after administering sildenafil to people with cerebrovascular risk factors did not appear to cause any detrimental effects (Lorberboym et al 2010). 6.31.1 Recommendations A Every patient should be asked, soon after discharge and at their 6-months and annual reviews, whether they have any concerns about their sexual functioning. Partners should additionally be given an opportunity to raise any problems they may have. B Any patient who has a limitation on sexual functioning and who wants further help should: ● be assessed for treatable causes 6.31.2 Sources ● be reassured that sexual activity is not contraindicated after stroke and is extremely unlikely to precipitate a further stroke ● if suffering from erectile dysfunction, be assessed for the use of sildenafil or an equivalent drug ● avoid the use of sildenafil or equivalent drug for 3 months after stroke and until blood pressure is controlled ● be referred to a person with expertise in psychosexual problems if the problems remain unresolved. A Consensus; Schmitz and Finkelstein 2010; Thompson and Ryan 2009 B Consensus; Cheitlin et al 1999; Lorberboym et al 2010; Melnik et al 2007; Song et al 2011 6.32 Personal equipment and adaptations 6 Recovery phase from impairments and limited activities: rehabilitation People with a disability may have specific difficulties in using objects or in moving around their environment. Sometimes special equipment or adaptations may enable them to have more autonomy, and/or to be safer. Often specialist equipment may become more widely used (eg remote controls for televisions) and the distinction between healthrelated equipment and normal choice is not always clear. This section refers to equipment that is small and can move with the patient. © Royal College of Physicians 2012 109
National clinical guideline for stroke 6.32.1 Recommendations A Every patient should have their need for specialist equipment assessed individually in relation to their particular limitations and environment, the need being judged against its effects on: ● safety of the patient or other person during activity, and/or ● independence of the patient undertaking activity, and/or ● speed, ease or quality of activity being undertaken. B All aids, adaptations and equipment should be: ● appropriate to the patient’s physical and social context ● of known safety and reliability ● provided as soon as possible. C All people (patient or carers) using any equipment or aids should be: ● trained in their safe and effective use ● given details on who to contact, and how, in case problems arise. D The equipment should be reassessed at appropriate intervals to check: 6.32.2 Sources ● it is being used safely and effectively ● it is still needed ● it is still safe. A Consensus; Logan et al 2004; Mann et al 1999b; Sackley et al 2006 B Consensus; www.scope.org.uk/help-and-information/communication/aac or www.scope.org.uk/help-and-information/publications/no-voice-no-choice-finalreport C Consensus D Consensus; legal requirement 6.33 Environmental equipment and adaptations This refers to larger-scale equipment or adaptations, such as providing specialist hoists, or adapting kitchens. 6.33.1 Recommendations A Every patient after stroke who remains dependent in some activities should be assessed and should have their home assessed to determine whether equipment or adaptations can increase safety or independence. B Prescription and provision of equipment should be based on a careful assessment of: ● the patient and their particular impairments, and ● the physical environment it is to be used in, and ● the social environment it is to be used in. C All equipment supplied should be: ● of known (certified) reliability and safety ● checked at appropriate intervals. 110 © Royal College of Physicians 2012
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National clinical guideline for str
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The Royal College of Physicians The
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The Intercollegiate Stroke Working
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Conflicts of interest All working p
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Key recommendations Number Recommen
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Acknowledgements The Intercollegiat
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Glossary ABCD2 score Prognostic sco
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2 Commissioning of stroke services
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2.1.2 Implications needed by patien
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2.4 Commissioning rehabilitation se
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3 Organisation of stroke services 3
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symptoms who screen positive using
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● nursing staff specifically trai
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3.5.1 Recommendation 3.5.2 Source A
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3.8 Transfers of care - discharge f
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B Clinicians in all settings should
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E have protocols to guide the use o
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Evidence to recommendations It is r
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evidence from randomised trials is
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4 Acute phase care 4.0 Introduction
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E All patients with residual neurol
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esources to respond to the need. Pr
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D People with an acute non-disablin
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D Consensus; quality marker eight o
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[K] Any person with acute ischaemic
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prevent rebleeding are urgent. CT s
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anticoagulants including direct thr
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Evidence to recommendations Studies
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● risk of developing skin pressur
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4.16 Positioning Impairment of moto
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Cognitive impairments - general (6.
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E Patients with suspected TIA who a
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Lipid-lowering therapy (5.6.1) A Al
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● ask about and identify any abso
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formal review at least every 6 mont
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Depression and anxiety (6.35.1) A A
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Perception (6.42.1) A Any person wh
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days per week, at a level that enab
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language function should be assesse
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● organising and supporting venue
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Appendix 1 Evidence table reviewers
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Appendix 2 Peer reviewers Commissio
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Dr Katerina Hilari City University
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QM7 Urgent response All patients wi
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References Abbott AL (2009) Medical
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Cirstea MC, Levin MF (2007) Improve
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Fung TT, Chiuve SE, McCullough ML,
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Koyuncu E, Nakipoglu YG, Dogan A, O
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Mitchell PH, Veith RC, Becker KJ, B
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Rothwell P, Eliasziw M, Gutnikov S,
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therapy for stroke inpatients. Clin
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