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

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evidence from randomised trials is available, and many other interventions that are used reasonably frequently. However, it has not made recommendations concerning new and emerging therapies. Because we are frequently asked about these, we have put together the recommendations below – which reflect good clinical practice. 3.16.1 Recommendations A Any clinician wishing to use an intervention not considered within this guideline should: ● investigate and review the available evidence, especially the risks and disadvantages ● investigate whether there are any relevant clinical trials available to take part in locally ● offer the patient (or his or her representative if s/he is unable to participate in decision-making) information about any research study available, and arrange for entry to the trial if the patient agrees ● discuss with the patient (or his or her representative if s/he is unable to participate in decision-making) the risks and benefits of the intervention so that an informed choice can be made. B Interventions not considered within this guideline may be used provided that: ● any available opportunity for participation in evaluative research has been considered 3.16.2 Source ● the clinician or clinical team has the appropriate knowledge and skill ● the patient (or his or her representative if s/he is unable to participate in decisionmaking) is aware of the lack of evidence, and the perceived risks and benefits. A–B Consensus 3.17 Improving public awareness of stroke In recent years mass-media campaigns, such as the Face Arm Speech Test (FAST) campaign, have been launched with the aim of increasing public awareness of the symptoms and signs of stroke. Awareness of stroke treatments and stroke prevention are also important. Evidence to recommendations 3 Organisation of stroke services The current research does indicate some potential trends with regards to mass media campaigns, for example: television may be more effective than posters and newspaper advertisements; campaigns need to be re-occurring rather than short-term and one-off and there are methodological weaknesses in the research (Jones et al 2010). Furthermore, the evidence of a direct link between awareness and recommended behaviour is very weak. Much more research in the whole area of improving awareness and appropriate behaviour is needed (Lecouturier et al 2010a). Increasing public awareness of stroke is an area of huge investment and importance and more robust research is needed which could: © Royal College of Physicians 2012 35
National clinical guideline for stroke > ascertain the level of stroke awareness and response in an appropriate and representative sample of the UK population in a robust manner probably based on both unprompted and prompted recall > be supported by qualitative work to explore the relationship between awareness and response > specifically investigate further beliefs and attitudes which may influence response > involve the development of campaigns that are theoretically well developed for the target audience. This would be appropriate for both mass media and more directed campaigns > include the robust evaluation of campaigns in a manner that allows for clear relationships to be drawn between intervention and result. 3.17.1 Recommendation 3.17.2 Source A Mass-media public awareness campaigns should be conducted within the framework of a formal evaluation. A Lecouturier et al 2010b; consensus 36 © 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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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 and 20: Glossary ABCD2 score Prognostic sco
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Page 60 and 61: 4 Acute phase care 4.0 Introduction
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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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