Search

Background: Each year, 15 million people worldwide and 110,000 people in England have a stroke. Having a stroke increases the risk of having another. There are a number of additional known risk factors that can be modified by diet. The present study aimed to systematically review key nutrients and diets and their role in secondary prevention, as well as provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians' (RCP) National Clinical Guideline (NCG) for Stroke., Methods: Questions were generated by the research team, in consultation with the Virtual Stroke Group, an online professional interest group, and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Nine questions covering several individual nutrients and diet combinations were defined and searches conducted up until 31 October 2011 using five electronic databases (Embase, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using van Tulder criteria for randomised controlled trials (RCTs) and Quality of Reporting of Meta-analyses (QUORUM) criteria for systematic reviews., Results: Of 4287 abstracts were identified, 79 papers were reviewed and 29 systematic reviews and RCTs were included to provide evidence for the secondary prevention components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed., Conclusions: This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research., (© 2014 The British Dietetic Association Ltd.)

Background and Purpose: Strokes caused by lesions to certain brain areas are associated with poor outcome, which is important both prognostically and to understand the neural basis for recovery. However, lesion anatomy associations with outcome may occur because of effects on baseline severity rather than because of effects on recovery per se. Here, all common stroke locations were surveyed to determine the strongest lesion anatomy associations separately for baseline functional severity and proportional recovery. Since most recovery occurs early, the focus here is on functional changes over the first week., Method: Global functional scores (National Institutes of Health Stroke Scale) at baseline and proportional recovery over 1 week were derived from the records of 550 ischaemic stroke patients and related to magnetic resonance imaging lesion location using voxel-lesion mapping. The effects of lesions extending over more than one location were also considered. Cross-validation estimated the percentage of recovery rate variance (r(2) ) accountable by lesion location information., Results: High baseline severity was associated with lesions to the left capsule, striatum and thalamocortical white matter, whereas high recovery rate was associated with lesions to more superficial left fronto-temporal areas. Low recovery rates were associated with lesions to bilateral parietal, right insula, medial frontal, capsule and brainstem. Inclusion of these regions into a multivariate model of proportional recovery rate increased r(2) from 8% to 45%., Conclusion: The strongest stroke lesion location associations with 1-week recovery were identified, and it was shown that anatomical information accounts for a sizeable proportion of early recovery variability., (© 2014 The Author(s) European Journal of Neurology © 2014 EAN.)

Background: Stroke affects 15 million people each year worldwide and is one of the world's leading causes of death and physical disability. Stroke can result in a decline in nutritional status and this is associated with increased mortality and poor outcomes. The present work aimed to systematically review key aspects of the nutritional support of stroke patients at risk of malnutrition and to provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians' (RCP) 'National Clinical Guideline (NCG) for Stroke'., Methods: Questions were generated by the search team, together with contributions from members of the Virtual Stroke Group and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Six questions covering several areas of nutritional support after stroke were defined and searches were conducted through to 31 October 2011 using five electronic databases (Embase, Medline, CINAHL, Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using the van Tulder criteria for randomised controlled trials (RCTs) and the Quorum criteria for systematic reviews., Results: In total, 4215 abstracts were identified, 24 papers were reviewed and 13 systematic reviews and RCTs were included to provide evidence for the nutritional support components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed., Conclusions: This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research., (© 2013 The British Dietetic Association Ltd.)