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

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Dr Katerina Hilari City University London Ms Hannah Hawthorne Cumbria Partnership NHS Foundation Trust Mr Simon Horton University of East Anglia, School of Allied Health Professionals Professor David Howard Newcastle University Ms Jan Huddleston Lancashire Teaching Hospitals Trust Ms Jess Jones Southport and Ormskirk NHS Trust; Royal College of Speech and Language Therapists Ms Tamsyn Marsh-Patrick Warrington & Halton Hospitals NHS Foundation Trust Professor Jane Marshall City University London Dr Jane Maxim University College London Ms Sarah McClusky Bolton Hospitals NHS Foundation Trust Ms Carmell McNamee Bolton Hospitals NHS Foundation Trust Ms Victoria Merrill East Cheshire NHS Trust Ms Margaret Metcalfe County Health Partnership; Nottinghamshire Healthcare Trust Ms Natalie Mohr North Bristol NHS Trust Ms Jane Mortley Royal College of Speech and Language Therapists; Steps Consulting Ltd Ms Claire Moser On behalf of the Royal College of Speech and Language Therapists Ms Annette Munro Lancashire Teaching Hospitals NHS Trust Dr Rebecca Palmer University of Sheffield Ms Tessa Pemberton Cumbria Partnership Foundation Trust Ms Hannah Reynolds Independent speech and language therapist Ms Emma Richards Royal National Hospital for Rheumatic Diseases Ms Sally Rosenvinge Guy’s and St Thomas’ NHS Foundation Trust; King’s College London Biomedical Research Centre Ms Sarah Russ Salford Royal NHS Foundation Trust; Royal College of Speech and Language Therapists Ms Karen Sage University of Manchester; Royal College of Speech and Language Therapists Dr Christos Salis British Aphasiology Society Mr Cameron Sellars NHS Greater Glasgow and Clyde Dr Claerwen Snell Warrington & Halton Hospitals NHS Foundation Trust Ms Lucinda Somersett Gateshead Adult Speech and Language Therapy Services Ms Helen Spear Independent speech and language therapist Ms Christine Springate Oxford Health NHS Foundation Trust Ms Stephanie Ticehurst North Bristol NHS Trust Dr Mieke Van de Sandt Rijndam Rehabilitation Centre, the Netherlands Professor Rosemary Varley University College London Ms Helen Vernon Cumbria Partnership NHS Foundation Trust Vascular surgery Mr Richard Bulbulia Cheltenham General Hospital Professor Alun Davies Imperial College London Professor Allison Halliday University of Oxford Mr Mohsen Javadpour Society of British Neurological Surgeons Mr Shane MacSweeney Nottingham University Hospital Dr Kazem Rahimi University of Oxford Mr Ankur Thapar Imperial College London Appendix 2 Peer reviewers Voluntary sector Ms Margaret Goose RCP Stroke Committee; National Institute for Health Research Patient Public Involvement Clinical Studies Group Ms Maddy Halliday Stroke Association Mr John Murray Different Strokes; Stroke Research Network Ms Victoria Smith SkillsActive Ms Kate Swinburn UK Connect – communication disability network © Royal College of Physicians 2012 185
Appendix 3 National Stroke Strategy quality markers* QM1 Awareness raising Members of the public and health and care staff are able to recognise and identify the main symptoms of stroke and know it needs to be treated as an emergency. QM2 Managing risk Those at risk of stroke and those who have had a stroke are assessed for and given information about risk factors and lifestyle management issues (exercise, smoking, diet, weight and alcohol), and are advised and supported in possible strategies to modify their lifestyle and risk factors. Risk factors, including hypertension, obesity, high cholesterol, atrial fibrillation (irregular heartbeats) and diabetes, are managed according to clinical guidelines, and appropriate action is taken to reduce overall vascular risk. QM3 Information, advice and support People who have had a stroke, and their relatives and carers, have access to practical advice, emotional support, advocacy and information throughout the care pathway and lifelong. QM4 Involving individuals in developing services People who have had a stroke and their carers are meaningfully involved in the planning, development, delivery and monitoring of services. People are regularly informed about how their views have influenced services. QM5 Assessment – referral to specialist Immediate referral for appropriately urgent specialist assessment and investigation is considered in all patients presenting with a recent TIA or minor stroke. A system which identifies as urgent those with early risk of potentially preventable full stroke – to be assessed within 24 hours in high-risk cases; all other cases are assessed within seven days. Provision to enable brain imaging within 24 hours and carotid intervention, echocardiography and ECG within 48 hours where clinically indicated. QM6 Treatment All patients with TIA or minor stroke are followed up one month after the event, either in primary or secondary care. * Appendix 3 contains public sector information licensed under the Open Government Licence v1.0. 186 © 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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section covers only the immediate,
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7 Long-term management 7.0 Introduc
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● where appropriate refer the per
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experience appropriate to meet thei
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Profession-specific concise guideli
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● ensure that all relevant inform
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Page 192 and 193: Depression and anxiety (6.35.1) A A
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Page 212 and 213: References Abbott AL (2009) Medical
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