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Background: Interrupting prolonged sitting acutely lowers blood pressure in nonstroke populations. However, the dose–response effect in stroke survivors is unknown. The authors investigated different doses of light-intensity standing exercises that interrupt prolonged sitting and reduce blood pressure immediately and over 24 hours in stroke survivors. Methods: Within-participant, laboratory-based, dose escalation trial. Conditions (8 h) were prolonged sitting and 2 experimental conditions of standing exercises with increasing frequency (3 cohorts, 2 × 5 min to 6 × 5 min). The primary outcome is the mean systolic blood pressure. Results: Twenty-nine stroke survivors (aged 66 [12] y) participated. Frequent bouts of standing exercises lowered the mean systolic blood pressure following the 4 × 5-minute (−2.1 mm Hg; 95% confidence interval [CI], −3.6 to −0.6) and 6 × 5-minute conditions (−2.3 mm Hg; 95% CI, −4.2 to −0.5) compared with prolonged sitting. Diastolic blood pressure was lowered following the 6 × 5-minute condition (−1.4 mm Hg; 95% CI, −2.7 to −0.2). The 24-hour systolic blood pressure increased following the 2 × 5-minute condition (6.9 mm Hg; 95% CI, 3.1 to 10.6). Conclusions: Interrupting prolonged sitting with more frequent bouts of standing exercises lowers systolic and diastolic blood pressure in stroke survivors. However, reductions may only be short term, and investigations on sustained effects are warranted. [ABSTRACT FROM AUTHOR]

Background: Interrupting prolonged sitting can attenuate postprandial glucose responses in overweight adults. The dose–response effect in stroke survivors is unknown. The authors investigated the effects of interrupting 8 hours of prolonged sitting with increasingly frequent bouts of light-intensity standing-based exercises on the postprandial glucose response in stroke survivors. Methods: Within-participant, laboratory-based, dose-escalation trial. Participants completed three 8-hour conditions: prolonged sitting and 2 experimental conditions. Experimental conditions involved light-intensity standing-based exercises of increasing frequency (2 × 5 min to 6 × 5 min bouts). Postprandial glucose is reported. Results: Twenty-nine stroke survivors (aged 66 y) participated. Interrupting 8 hours of prolonged sitting with light-intensity standing-based exercises every 90 minutes significantly decreased postprandial glucose (positive incremental area under the curve; −1.1 mmol/L·7 h; 95% confidence interval, −2.0 to −0.1). In the morning (08:00–11:00), postprandial glucose decreased during the 4 × 5 minutes and 6 × 5 minutes conditions (positive incremental area under the curve; −0.8 mmol/L·3 h; 95% confidence interval, −1.3 to −0.3 and −0.8 mmol/L·3 h; 95% confidence interval, −1.5 to −0.2, respectively) compared with prolonged sitting. Conclusion: Interrupting 8 hours of prolonged sitting at least every 90 minutes with light-intensity standing-based exercises attenuates postprandial glucose in stroke survivors. During the morning, postprandial glucose is attenuated when sitting is interrupted every 60 and 90 minutes. [ABSTRACT FROM AUTHOR]

Evidence for post-stroke fatigue management is limited. We aimed to explore how Australian health professionals assess and assist fatigue management. Our objectives were to identify fatigue assessment tools and interventions used, explore clinician's confidence managing fatigue and explore whether management of post-stroke fatigue differs from management of fatigue related to other conditions. An online cross-sectional survey was completed by Australian health professionals (n = 60) providing services to people with fatigue. Analysis of open-ended questions identified common interventions and descriptive statistics were calculated for closed and dichotomized questions. Routine use of formal fatigue assessment tools was low (17%, n = 10). Most respondents reporting use of the Fatigue Impact Scale, Fatigue Assessment Scale and Fatigue Severity Scale. To address fatigue, respondents reported providing energy optimization strategies, education, and exercise interventions in clinical practice. Less frequently reported interventions were strategies to adapt tasks, sleep hygiene, psychology, nutrition, and pharmacology interventions. Respondents were "moderately" confident managing post-stroke fatigue. Respondents did not report differences between how they manage post-stroke fatigue and fatigue present in other conditions. Few Australian health professionals formally assess post-stroke fatigue. Management is multidisciplinary and based on evidence from fatigue management in other conditions. Most health professionals are not routinely using formal assessment tools for fatigue, possibly due to a lack of consensus on best practice in research. Common strategies recommended by health professionals include energy optimisation strategies, education and exercise. Comprehensive guidelines for post-stroke fatigue management are yet to be established. Health professionals should assess post-stroke fatigue using a validated tool to ensure an individualised approach to management based on the current available clinical guidelines. [ABSTRACT FROM AUTHOR]

Introduction: The focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke. Methods: Systematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term < 3 months, medium-term 3-12 months, and long-term > 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline. Perspectives: This living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments. [ABSTRACT FROM AUTHOR]

Patient readiness for secondary prevention and lifestyle change following transient ischemic attack is not well understood. Understanding patient perspectives about the timing and delivery of secondary prevention education is essential to promote meaningful risk factor reduction in this population. A single, semi-structured, telephone interview was conducted with ten individuals (7 male, 3 female) within three months following a transient ischemic attack. Interviews explored transient ischemic attack experiences and post-event education. Data were analyzed using inductive thematic analysis. Individuals had a variety of experiences with secondary prevention education. Four themes emerged from these experiences including "what the hell happened?", "I mustn't have been quite ready", "what should I be doing?" and "we all see it in different ways." Individual knowledge, personal experience of transient ischemic attack, socio-environmental factors, and the format and content of education influenced patient readiness to receive secondary prevention education and adopt lifestyle changes. Readiness for risk-reduction education and lifestyle change following transient ischemic attack is individual and complex. Logistical factors including the location, time, and cost of education, timing of education delivery, and patient perspectives should be considered in the development and delivery of secondary prevention interventions for these people. Risk reduction and lifestyle change following transient ischemic attack is vital to prevent recurrent stroke. Patients are ready to receive risk reduction and lifestyle advice approximately one week after their transient ischemic attack. Programs designed to provide risk reduction and lifestyle education should be informed by the unique requirements of this population. Uptake of participation in secondary prevention programs may be maximized by offering flexibility in terms of timing post-event and modes of delivery (e.g. Telehealth). [ABSTRACT FROM AUTHOR]

Introduction: Emergency Medical Service (EMS) workers are critical to effective disaster response in Saudi Arabia. The World Health Organization requires countries and governments to have prepared emergency health workers and disaster action plans. Therefore, it is important to understand the disaster knowledge, skills, and preparedness of Saudi Arabian EMS workers. This study investigated factors influencing EMS workers' disaster knowledge, skills, and preparedness in the Saudi Arabian context. Method: A descriptive cross-sectional survey using The Disaster Preparedness Evaluation Tool was distributed to EMS workers in military and government hospitals across three Saudi Arabian cities. Responses were recorded on a 6-point Likert scale where higher scores indicated higher knowledge, skills, or preparedness. The results were analyzed using descriptive and inferential statistical analysis. Results: 272 EMS workers participated in this study. EMS workers reported a moderate level of knowledge (3.56), skills (3.44), and preparedness (3.73) for disasters. Despite the moderate level, EMS workers reported a high level of involvement in regular disaster drills (M=4.24, SD=1.274) and a strong interest in further disaster education opportunities (M=5.43, SD=1.121). Participants also reported a high skill level with the triage principles used in their workplace during a disaster (M=4.06, SD=1.218). The study findings revealed a significant positive correlation between disaster preparedness levels and age, years of experience, education level, and the facility worked in. Conclusion: EMS workers have moderate disaster knowledge, skills, and preparedness levels. Knowledge, skill, and preparedness have a significant relationship with the EMS workers' demographics. These findings demonstrate the need to invest in preparing Saudi Arabian EMS workers to effectively respond to bioterrorism disasters. [ABSTRACT FROM AUTHOR]

Introduction: Around two billion people globally were affected by natural disasters between 2008 and 2018. Countries are required to effectively prepare their healthcare workers for disaster response. A greater level of preparedness is associated with a more effective response to disasters. The World Health Organization requires countries and governments to have disaster plans and emergency health workers ready and prepared at all times. This integrative review aims to understand emergency healthcare workers' perceived preparedness for disaster management. Method: An integrative literature review using the PRISMA checklist guidelines was conducted to explore physicians, nurses, emergency medical services, and allied medical professionals' preparedness for disasters. Literature was searched from 2005, published in the English language and from MEDLINE (PubMed), Google Scholar, EMBASE, PsycINFO, SCOPUS, ProQuest and CINAHL databases. Reviews, case reports, clinical audits, editorials and short communications were excluded. Studies were critically appraised using the Mixed Methods Appraisal Tool. Results: The initial search yielded 9,589 articles. Twenty-seven articles were included following the application of the eligibility criteria. Included studies were geographically diverse including North America, the Middle East, and the Asia Pacific. Most studies (n=24) assessed the knowledge of healthcare workers in general disasters. Studies using the Disaster Preparedness Evaluation Tool reported moderate disaster preparedness and knowledge, while studies using other instruments largely reported inadequate disaster preparedness and knowledge. Regional variations were recorded, with high-income countries' reporting a higher perceived preparedness for disasters than low-income countries. Conclusion: The majority of emergency healthcare workers appear to have inadequate disaster preparedness. Previous disaster experience and training improved disaster preparedness. Future research should focus on interventions to improve emergency healthcare workers' preparedness for disasters. [ABSTRACT FROM AUTHOR]

Excessive sitting is detrimentally associated with cardiovascular disease and all-cause mortality. Frequent breaks in prolonged sitting can improve cardiometabolic responses in non-stroke populations. However, this has not been established in stroke survivors. This study will determine the most effective dose of activity breaks that (i) produce clinically meaningful improvements in mean systolic blood pressure (primary outcome), postprandial glucose, and insulin responses (secondary outcomes), and (ii) is safe and feasible. We hypothesis that systolic blood pressure, postprandial insulin, and glucose responses will improve with increasing doses of activity and be most effective at the maximum safe and feasible dose of activity. Thirty participants in the most effective dose will provide 80% power to detect a within-person, between-condition, difference of 3.5 mmHg in systolic blood pressure assuming a SD of 15 mmHg, within-person correlation of 0.9, and α = 0.05. Stroke survivors will complete 3 experimental conditions in a within-participant, dose escalation design including (i) uninterrupted sitting (8 h), (ii) Dose 1: uninterrupted sitting with bouts of light-intensity exercises while standing (initial dose involves two 5-min breaks), and (iii) Dose 2: two additional 5-min breaks above Dose 1. Ambulatory blood pressure will be collected every 30 min during experimental conditions and hourly for 24-h post-experimental conditions. Blood samples will be collected every 30 min during 2-h postprandial periods. This study will identify the most effective dose of light-intensity exercises while standing to improve cardiometabolic responses in stroke survivors.