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Haematocrit in the high normal, as well as the pathological, range may be a risk factor for the development of stroke. As stroke is one of the most important causes of physical handicap attempts to reduce its incidence further are justified. Repeated small volume venesection without volume replacement is a simple method of haematocrit reduction which could be used in a controlled trial if shown to be safe and practicable. Forty three male patients (33 evaluable) with haematocrit above 0.46 without primary proliferative or secondary polycythaemia, were entered into an open study to assess the clinical, haemorheological and haematological sequelae of serial venesection. Haematocrit was reduced from a median of 0.49 to 0.385 which necessitated removal of 2.75 1 of blood (range 1.5 - 4.25 1). This resulted in a marked reduction in blood viscosity which correlated significantly with the change in haematocrit. Although haematocrit has been postulated to affect blood pressure through an effect on blood viscosity and hence peripheral resistance, no clinically significant reduction in blood pressure was observed. Despite producing a slight reactive thrombocytosis, serial venesection was not shown to increase thrombogenic activity. Bleeding time was prolonged significantly and there was a trend for a reduction in platelet adhesion. The reduction in platelet adhesion correlated significantly with the reduction in haematocrit. Maintenance of haematocrit below 0.45 necessitated further venesection on average once every 2 months during follow-up for one year. Two patients with a previous history suffered further strokes which were considered unlikely to be related to venesection. One patient had worsening of angina and 2 patients experienced intermittent palpitations when haematocrit was reduced to 0.40; these events were considered possibly due to an increase in cardiac output as a consequence of lowered haematocrit. Except in patients with cardiac disease, repeated small volume venesection without volume replacement is a safe and practicable method of reducing haematocrit.

Excerpt: The recent study by Tiamkao et al 1 that was published in the Journal of Stroke and Cerebrovascular Diseases concluded that “Stroke in the young generally has a favorable outcome” and that “factors associated with a nonfavorable outcome of stroke in the young were cardiac abnormalities and alcohol intake.” However, this conclusion is not supported by the data in their study because of a slight misinterpretation of the data and limitations of the study, as explained subsequently.

Yes / Background: Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Methods: Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Results: Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. Conclusions: Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery. / This paper is part of the SMART programme of research funded by Engineering and Physical Sciences Research Council (EPSRC).

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Screening acute stroke patients for dysphagia (difficulty swallowing) is recommended within 24 hours due to risks of morbidity and mortality. A review of the international literature identified no universal consensus for a valid method of screening. This thesis describes a multi-method Action Research (AR) programme of study focused on the design, development and evaluation of a reliable and valid dysphagia screening tool (the ‘Head Dysphagia Screen for Stroke’ or HeDSS) for use by Registered General Nurses (RGNs). As a component of the assessment phase of the AR programme, a survey of dysphagia screening practices in England and Wales highlighted widely varied screening practices. Many of these practices were based on limited research evidence, reflecting the lack of consensus for valid dysphagia screening criteria reported in the literature. The design phase of the AR programme involved the development of the HeDSS tool, which centred on the use of research-based screening criteria. Focus group activity determined nurses’ perceptions of the design and subsequent refinement of the HeDSS tool. The intervention and evaluation phases of the AR programme followed three empirical stages. Stage one established the inter-rater reliability of the Speech and Language Therapist Researcher’s (SLTR’s) clinical dysphagia assessment, which acted as a reference standard against which the validity of the HeDSS tool was to be measured. Clinical judgements for the presence and absence of dysphagia in the same 30 referred patients were compared between the SLTR and a Speech and Language Therapist (SLT) of equivalent experience. Inter-rater reliability was substantial (k = .71). The second empirical stage established inter-rater reliability of the HeDSS measurement outcomes (indicative signs of dysphagia and appropriateness of referral for SLT clinical dysphagia assessment) when employed by two RGNs compared against the SLTR when screening two samples of 20 acute stroke patients. Rater agreement was substantial (k = .71 and k = .79, for detection of signs of dysphagia and k = .79 and k = .87 for appropriateness of referral). The final empirical stage evaluated the concurrent validity of the HeDSS tool measurement outcomes when employed by a second sample of two RGNs compared with the SLTR’s clinical dysphagia assessment outcomes in a sample of 100 acute stroke patients. The HeDSS tool measurement outcomes correlated highly with the clinical dysphagia assessment outcomes (sensitivity .88 - .96 and specificity .85 - .88 for detection of dysphagia; sensitivity .90 - .96 and specificity .84 - .88 for determining patients appropriate for assessment). Correlation coefficient measures confirmed high concurrent validity for the HeDSS tool (Phi ranged between .76 - .82). This study is the first in the UK to establish a reliable and valid dysphagia screening tool for use with acute stroke patients and has significantly advanced the professional knowledge base within this domain of practice. It is recommended that a multi-centred programme of research be undertaken to replicate this study with a larger nurse and patient sample.

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No description available.