Stroke Guidelines Update 2023

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What should acute stroke services have for all staff involved in stroke care?

Regular performance reviews

A patient feedback system

An education programme (correct)

An on-call support team

How should acute stroke services contribute to improving care quality?

Through participation in audits and research (correct)

Through community awareness programs

By limiting patient admissions

By providing free consultations

Which document outlines the obligations of acute stroke services under the NHS Standard Contract?

Working Party consensus (correct)

Emergency stroke treatments manual

Resource guidelines for inpatient care

Audit compliance framework

Which area of healthcare does the evidence suggest has the highest risk for strokes occurring in hospital?

Emergency care Signup and view all the answers

What focus area is NOT a part of the education programme for stroke care staff?

Community outreach strategies Signup and view all the answers

What is necessary for effective diagnosis and treatment of transient ischemic attack (TIA) and minor strokes?

Access to specialist stroke units Signup and view all the answers

Which one of the following does NOT represent an area of focus for acute stroke services?

Rehabilitation of stroke survivors Signup and view all the answers

Which aspect is associated with the management of ischaemic strokes?

Use of anticoagulants Signup and view all the answers

What is a key reason for poor outcomes in stroke services?

Poor organization of services Signup and view all the answers

Which campaign aims to increase public awareness of stroke symptoms?

Face Arm Speech Time (FAST) Signup and view all the answers

What is an important aspect of public awareness campaigns for stroke?

They need to be regular and targeted at high-risk groups Signup and view all the answers

Which population groups are identified as at greater risk of stroke?

Older adults, minority ethnic groups, and those with lower education Signup and view all the answers

What has been identified as a more effective medium for stroke awareness campaigns?

Television advertisements Signup and view all the answers

The evidence linking public awareness to behavior change is considered to be:

Weak, especially among certain vulnerable demographics Signup and view all the answers

What defines a specialist in stroke services?

A professional with advanced qualifications and ongoing education Signup and view all the answers

What aspect of mass media campaigns for stroke awareness is highlighted as needing more research?

Improving public awareness and appropriate action Signup and view all the answers

What is the recommended staffing for stroke services in hyperacute, acute, and rehabilitation settings?

Staffing levels should match the recommendations in Table 2.5. Signup and view all the answers

What is required for stroke rehabilitation units that have non-medical consultant leadership?

They must have medical cover available daily. Signup and view all the answers

When should patients be referred to community stroke rehabilitation?

If they are not eligible for early supported discharge and have ongoing needs. Signup and view all the answers

What is the role of the multidisciplinary team for patients with limited life expectancy following a stroke?

To document the patient’s wishes about continued eating and drinking risks. Signup and view all the answers

Which medications should be considered for patients presenting within 24 hours of TIA or minor stroke?

Dual antiplatelet therapy with either aspirin and clopidogrel, or aspirin and ticagrelor. Signup and view all the answers

What is the time frame in which thrombolysis with alteplase or tenecteplase should be considered for acute ischaemic stroke patients?

Barring any contraindications, within 4.5 hours of known onset. Signup and view all the answers

What criteria need to be met for patients who were last known to be well more than 4.5 hours earlier to receive thrombolysis?

Evidence of potential salvageable brain tissue on imaging. Signup and view all the answers

What is the primary goal of establishing the intensity and duration of interventions in the community stroke rehabilitation team?

To create individualized care based on clinical need and patient goals. Signup and view all the answers

What should users of the guideline assume if an intervention is not mentioned?

It is not recommended for use. Signup and view all the answers

In what context should patients be offered treatments that are included with specific recommendations?

Only in the context of clinical trials. Signup and view all the answers

Who is responsible for deciding on the unlicensed or off-label use of medication?

Individual clinicians and their healthcare providers. Signup and view all the answers

What is the role of NICE, SMC, and NCPE concerning medication?

To evaluate technologies and provide advice on medications. Signup and view all the answers

What supports the production of this guideline?

Financial support from organizations. Signup and view all the answers

What is a primary purpose of ongoing randomised trials in the context of stroke services?

To model costs and benefits across various regions. Signup and view all the answers

Why might certain medications be recommended despite not being licensed for specific situations?

There is emerging evidence supporting their use in specific cases. Signup and view all the answers

What should be referenced for advice on the use of new and existing medicines?

Authorities like NICE, SMC, or NCPE. Signup and view all the answers

Which type of care is essential as soon as possible after the onset of a stroke?

Specialised stroke unit care. Signup and view all the answers

Which of the following statements about the recommendations in the guideline is true?

Some treatments may be used off-label but should be evaluated for efficacy. Signup and view all the answers

What is a requirement for a comprehensive stroke centre (CSC)?

Offering both thrombectomy and neurosurgery. Signup and view all the answers

Which of the following is NOT a recommended action for community-based clinicians upon encountering patients with sudden neurological symptoms?

Delay transfer until additional tests are completed. Signup and view all the answers

What is the role of a stroke rehabilitation unit (SRU)?

To focus solely on inpatient rehabilitation. Signup and view all the answers

What is an important consideration for those configuring stroke services in a region?

Considering the co-location of various emergency services. Signup and view all the answers

What is a suggested action if a patient shows persisting neurological symptoms after initial screening?

Transfer them to a hyperacute stroke unit with pre-alert notification. Signup and view all the answers

What component is essential for maintaining the quality of stroke services during reconfiguration?

Robust governance infrastructure. Signup and view all the answers

What is the primary focus of community stroke rehabilitation services?

Co-ordinating the transfer of care from hospital to home Signup and view all the answers

Which recommendation states that patients with mild to moderate disability should begin treatment within 24 hours of discharge?

Recommendation A Signup and view all the answers

What should be the basis for establishing the intensity and duration of intervention by the community stroke rehabilitation team?

The clinical need tailored to goals and outcomes Signup and view all the answers

In what settings should stroke rehabilitation ideally be provided?

In the patient's own home or residential facilities Signup and view all the answers

Which aspect is NOT emphasized for early supported discharge services?

Delivering treatment only during weekdays Signup and view all the answers

What is a critical characteristic of the multidisciplinary team structure in stroke rehabilitation?

Collaboration among various specialists is essential Signup and view all the answers

What does the recommendation regarding therapy intensity propose?

It should match the intensity provided if the patient remained in a stroke unit Signup and view all the answers

What is the role of home environment assessment in the transfer of care?

To guide the rehabilitation process after discharge Signup and view all the answers

Study Notes

Stroke Guideline Changes

Guideline now covers United Kingdom and Republic of Ireland.
Stroke services need specialist medical, nursing, and rehabilitation staffing.
Stroke rehabilitation units need a consultant specializing in stroke rehab (medical or non-medical).
Non-medical consultant led units need daily medical cover (doctors or GPs) for 7 days a week.
Patients with ongoing rehab needs but not for early supported discharge should be referred for community stroke rehab.
Community rehab intensity, duration, and goals are set by the stroke specialist and the patient.
Multidisciplinary services need a core team structure.
Teams must consider patients' wishes regarding eating and drinking for patients with limited life expectancy.

Acute Care Recommendations

Aspirin and clopidogrel or aspirin and ticagrelor should be considered for patients within 24 hours of a TIA or minor stroke.
Thrombolysis with alteplase or tenecteplase is considered for ischaemic strokes within 4.5 hours of onset.
Thrombolysis with alteplase is considered for ischaemic strokes between 4.5 to 9 hours of onset if there's potential for brain tissue salvage (CT perfusion or MRI).

Treatments Not Mentioned

If an intervention isn't mentioned, it's not recommended.

Clinical Research Participation

Some recommendations suggest treatments should only be offered in clinical trials if evidence is uncertain.

Medication Licensing

Guideline recommendations don't specify if a medication is licensed.
Clinicians must decide on unlicensed/off-label use referring to relevant regulators.
Guidelines may recommend non-licensed medications (e.g., aspirin in acute stroke).

Public Awareness Campaigns

Regular public awareness campaigns targeting stroke risk groups is essential.
Campaigns should be evaluated and targeted at high-risk groups.
Campaigns need repeating, rather than being one-off events; TV is more effective than print media.

Specialist Stroke Services

Specialist stroke healthcare providers need relevant qualifications and continuing professional development.

Acute Medical Service Organization

Specialized stroke units are important for reducing long-term brain damage, disability, and healthcare costs.
Acute stroke services can be a comprehensive stroke center (CSC)or an acute stroke center (ASC) providing different levels of care.

Inpatient Stroke Services

Community clinicians should screen for hypoglycemia and stroke/TIA in people with sudden neurological symptoms.
Acute stroke services should train staff and healthcare professionals in stroke care.
Acute stroke services should participate in national and local auditing, research, and quality programs
Stroke patients present in hospitals should be screened for hypoglycemia, and stroke or TIA. Refer those with continuing neurological issues to a hyperacute unit quickly.

Early Supported Discharge and Community Rehab

Hospital stroke patients with mild to moderate disability should be offered early supported discharge.
Early supported discharge and community stroke rehab services should be provided by a dedicated service, and therapy should maintain the same intensity.
Co-ordination from hospital discharge to home is crucial.
Community rehab services are crucial for co-ordinating transfers of care within the community.
Stroke rehabilitation should be provided in the person’s home or place of residence.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the recent changes in stroke guidelines affecting the UK and Republic of Ireland. Participants will learn about staffing needs, rehabilitation protocols, and acute care recommendations crucial for effective stroke management.