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

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Glossary Body mass index (BMI) An index of body weight corrected for height. Botulinum toxin An injection which can relax muscles to reduce spasticity. Cardiovascular disease Disease of the heart and/or blood vessels. Care pathway A tool used by healthcare professionals to define the sequence and timings of a set of tasks or interventions that should be performed on a patient who enters a healthcare setting (eg a hospital) with a specific problem. Carotid angioplasty A surgical procedure that widens the internal diameter of the carotid artery, after it has been narrowed by atherosclerosis. Carotid arteries Main blood vessels in the neck, which supply oxygenated blood to the brain. Carotid duplex A technique that evaluates blood flow through a blood vessel, in this case ultrasound the carotid artery. Carotid A surgical procedure used to clear the inside of the carotid artery of endarterectomy (CEA) atheroma. Carotid stenosis The narrowing of the carotid arteries in the neck. Carotid stenting Insertion of a tube into the carotid artery in order to prop the artery open and reduce narrowing. Caval filter A device that is inserted into the veins to prevent a blood clot entering the lungs. Cerebral venous sinus thrombosis A blood clot that forms within a vein inside the brain. Cochrane review The Cochrane Library consists of a regularly updated collection of evidence-based medicine databases including the Cochrane Database of Systematic Reviews (reviews of randomised controlled trials prepared by the Cochrane Collaboration). Commissioner Person or organisation that decides how to allocate the health budget for a (health services) service. Compensatory strategies Learning an alternative way of completing a task. Computed tomography (CT) An X-ray technique used to examine the brain. Confidence When analysing a research study, this is the range (‘interval’) of possible interval (CI) results that statisticians are 95% confident the actual result lies between. Constraint induced Therapy that involves preventing the use of the unaffected side of the body movement therapy thus forcing the use of the affected side. Cost-effectiveness A sophisticated analysis looking at the costs and benefits of a treatment, to analysis enable different treatments to be compared. Often expressed in terms of ‘life-years gained’ or ‘diseases or deaths avoided’. Decompressive A surgical procedure for the treatment of raised pressure inside the brain hemicraniectomy from fluid, blood or swelling. A piece of skull is removed to allow the brain to swell. Deep vein thrombosis (DVT) A blood clot that develops in the large veins usually in the legs. Diabetes mellitus A metabolic disease in which a person has high blood sugar. Diagnostic accuracy The degree to which a diagnostic (or screening) tool or procedure is able to distinguish between cases and non-cases. See also ‘sensitivity’ or ‘specificity’. © Royal College of Physicians 2012 xix
National clinical guideline for stroke Doppler An imaging technique that measures blood flow and velocity through ultrasound blood vessels. Dyspepsia Indigestion. Dysphagia Difficulty in swallowing. Early supported A team offering rehabilitation in the community that replicates the stroke discharge unit care; this enables earlier home discharge than would be possible if the team was not available. Endarterectomy The surgical removal of plaque from a blocked artery to restore blood flow. Face arm speech test (FAST) A test used to screen for the diagnosis of stroke or TIA. Foot drop A condition in which the foot hangs limply whilst walking. Gastrointestinal bleeding Bleeding anywhere between the throat and the rectum. Gastrostomy A surgical opening into the stomach to enable feeding. Goal attainment Rehabilitation goals for particular tasks are set by the patient and therapists scaling together. Haemorrhage Bleeding caused by blood escaping into the tissues. Health Technology A way of comparing the cost-effectiveness (see above) of treatments, Appraisal (HTA) funded by the NHS. Hemianopia Blindness or some loss of vision in one part of the visual field. Homeostasis Regulation of internal environment (eg temperature regulated at 37°C). Hydrocephalus A build up of fluid within the skull. Hyperacute stroke unit A stroke unit that treats patients in the first few days of symptom onset. Hyperlipidaemia Raised levels of lipids (cholesterol, triglycerides or both) in the blood serum. Hypertension Raised blood pressure. Hypertensive encephalopathy Brain damage caused by raised blood pressure. Hypoglycaemia Blood sugar levels lower than the normal range. Hypoxia Blood oxygen levels outside the normal range, eg below 95% saturation. Incontinence Inability to control passing of urine and/or faeces. Infarct An area of cell death due to the result of a deprived blood supply. International A classification of health used as a framework by the World Health Classification of Functioning, Disability and Health (ICF) Organization (WHO) to measure health and disability. International A measure of the clotting ability of blood, usually following the use of some normalised ratio anticoagulant drugs (warfarin/heparin). It is calculated as the ratio of the (INR), prothrombin length of time it takes blood to clot over the time it would take the blood of time (PTT) and activated partial thromboplastic time (aPTT) a normal subject to clot. Lumbar puncture A diagnostic or therapeutic procedure that involves collection of fluid from the base of the spine. xx © 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 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 17 and 18: Acknowledgements The Intercollegiat
Page 19: Glossary ABCD2 score Prognostic sco
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
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Page 60 and 61: 4 Acute phase care 4.0 Introduction
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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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C People with stroke should be offe
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● avoiding the use of overhead ar
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Carers (informal, unpaid) (7.6.1) A
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● any continuing specialist treat
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Lipid-lowering therapy (5.6.1) B Al
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Occupational therapy concise guide
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C Bilateral arm training involving
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● be referred to a specialist in
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problems, such as using notebooks,
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Physiotherapy concise guide for str
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medically unstable, by an appropria
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numerical rating scale), the modifi
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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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