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

Recommendations

Info

Lipid-lowering therapy (5.6.1) A All patients who have had an ischaemic stroke or TIA should be offered treatment with a statin drug unless contraindicated. Treatment: ● should be initiated using a drug with low acquisition cost such as simvastatin 40 mg daily ● should be intensified if a total cholesterol of
Primary care concise guide for stroke 2012 National clinical guideline for stroke should be assessed by a therapist with experience in neurological rehabilitation. Pain management (6.19.1.1) B All patients complaining of, or experiencing pain, should have the cause of the pain diagnosed. C Patients should be referred to a specialist pain service if, after the local service has tried management, the patient’s pain is: ● still severe and causing distress and not controlled rapidly, or ● still leading to significant limitation on activities or social participation. Neuropathic pain (central post-stroke pain) (6.19.3.1) A Every patient whose pain has been diagnosed by someone with appropriate expertise in neuropathic pain should be given oral amitriptyline, gabapentin or pregabalin as firstline treatment. Musculoskeletal pain (6.19.4.1) A Any patient with musculoskeletal pain should be carefully assessed to ensure that movement, posture and moving and handling techniques are optimised to reduce the pain. B Any patient continuing to experience pain should be offered pharmacological treatment with simple analgesic drugs taken regularly. Swallowing problems: assessment and management (6.21.1) I Any stroke patient discharged from specialist care services with continuing problems with swallowing food or liquid safely should: ● be trained, or have carers trained, in the identification and management of swallowing difficulties ● should have regular reassessment of their dysphagia beyond the initial acute assessment to enable accurate diagnosis and management ● should have their nutritional status and dietary intake monitored regularly by a suitably trained professional. Nutrition: assessment and management (6.23.1) C Nutritional support should be initiated for all stroke patients identified as malnourished or at risk of malnutrition. This may include specialist dietary advice, oral nutrition supplements, and/or tube feeding. Bowel and bladder impairment (6.24.1) D Stroke patients with troublesome constipation should: ● have a prescribed drug review to minimise use of constipating drugs ● be given advice on diet, fluid intake and exercise ● be offered oral laxatives ● be offered rectal laxatives only if severe problems remain. Extended activities of daily living (domestic and community) (6.26.1) A Any patient whose activities have been limited should be: ● assessed by an occupational therapist with expertise in neurological disability ● taught how to achieve activities safely and given as many opportunities to practise as reasonable under supervision, provided that the activities are potentially achievable ● assessed for, provided with and taught how to use any adaptations or equipment needed to perform activities safely. Driving (6.27.1) B The person or team responsible for any stroke patient who wishes to drive should: 164 © Royal College of Physicians 2012
Page 1 and 2:
National clinical guideline for str
Page 3 and 4:
The Royal College of Physicians The
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
The Intercollegiate Stroke Working
Page 11 and 12:
Conflicts of interest All working p
Page 13 and 14:
Key recommendations Number Recommen
Page 15 and 16:
Page 17 and 18:
Acknowledgements The Intercollegiat
Page 19 and 20:
Glossary ABCD2 score Prognostic sco
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 36 and 37:
2 Commissioning of stroke services
Page 38 and 39:
2.1.2 Implications needed by patien
Page 40 and 41:
2.4 Commissioning rehabilitation se
Page 42 and 43:
3 Organisation of stroke services 3
Page 44 and 45:
symptoms who screen positive using
Page 46 and 47:
● nursing staff specifically trai
Page 48 and 49:
3.5.1 Recommendation 3.5.2 Source A
Page 50 and 51:
3.8 Transfers of care - discharge f
Page 52 and 53:
B Clinicians in all settings should
Page 54 and 55:
E have protocols to guide the use o
Page 56 and 57:
Evidence to recommendations It is r
Page 58 and 59:
evidence from randomised trials is
Page 60 and 61:
4 Acute phase care 4.0 Introduction
Page 62 and 63:
E All patients with residual neurol
Page 64 and 65:
esources to respond to the need. Pr
Page 66 and 67:
D People with an acute non-disablin
Page 68 and 69:
D Consensus; quality marker eight o
Page 70 and 71:
[K] Any person with acute ischaemic
Page 72 and 73:
prevent rebleeding are urgent. CT s
Page 74 and 75:
anticoagulants including direct thr
Page 76 and 77:
Evidence to recommendations Studies
Page 78 and 79:
● risk of developing skin pressur
Page 80 and 81:
4.16 Positioning Impairment of moto
Page 82:
section covers only the immediate,
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136: National clinical guideline for str
Page 148 and 149: 7 Long-term management 7.0 Introduc
Page 150 and 151: ● where appropriate refer the per
Page 152 and 153: experience appropriate to meet thei
Page 154 and 155: Profession-specific concise guideli
Page 156 and 157: ● ensure that all relevant inform
Page 158 and 159: C People with stroke should be offe
Page 160 and 161: ● avoiding the use of overhead ar
Page 162 and 163: Carers (informal, unpaid) (7.6.1) A
Page 164 and 165: ● any continuing specialist treat
Page 166 and 167: Lipid-lowering therapy (5.6.1) B Al
Page 168 and 169: Occupational therapy concise guide
Page 170 and 171: C Bilateral arm training involving
Page 172 and 173: ● be referred to a specialist in
Page 174 and 175: problems, such as using notebooks,
Page 176 and 177: Physiotherapy concise guide for str
Page 178 and 179: medically unstable, by an appropria
Page 180 and 181: numerical rating scale), the modifi
Page 182 and 183: Cognitive impairments - general (6.
Page 184 and 185: E Patients with suspected TIA who a
Page 188 and 189: ● ask about and identify any abso
Page 190 and 191: formal review at least every 6 mont
Page 192 and 193: Depression and anxiety (6.35.1) A A
Page 194 and 195: Perception (6.42.1) A Any person wh
Page 196 and 197: days per week, at a level that enab
Page 198 and 199: language function should be assesse
Page 200: ● organising and supporting venue
Page 204 and 205: Appendix 1 Evidence table reviewers
Page 206 and 207: Appendix 2 Peer reviewers Commissio
Page 208 and 209: Dr Katerina Hilari City University
Page 210 and 211: QM7 Urgent response All patients wi
Page 212 and 213: References Abbott AL (2009) Medical
Page 214 and 215: Cirstea MC, Levin MF (2007) Improve
Page 216 and 217: Fung TT, Chiuve SE, McCullough ML,
Page 218 and 219: Koyuncu E, Nakipoglu YG, Dogan A, O
Page 220 and 221: Mitchell PH, Veith RC, Becker KJ, B
Page 222 and 223: Rothwell P, Eliasziw M, Gutnikov S,
Page 224: therapy for stroke inpatients. Clin
show all

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

Create successful ePaper yourself

Delete template?

Save as template?