Research Interests: Stroke rehabilitation, Medicine, Physical Medicine and Rehabilitation, Physical Therapy, Activities of Daily Living, and 11 moreHumans, Walking, Two Stroke Engine, Adult, Guidance and Counseling Intervention Programs, Task Performance and Analysis, Extremities, Motor activity, Recovery of Function, Randomized Controlled Trials as Topic, and Medical and Health Sciences
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Objective: To develop and evaluate a qualitative and quantitative instrument for selecting the ideal mobility aid for those with mobility disorders. Setting: A district general hospital-based geriatric unit. Subjects: Elderly inpatients... more
Objective: To develop and evaluate a qualitative and quantitative instrument for selecting the ideal mobility aid for those with mobility disorders. Setting: A district general hospital-based geriatric unit. Subjects: Elderly inpatients and outpatients with mobility disorders. Interventions: Structured assessments with different mobility aids to select the most suitable. Outcome measures: Safety, stance, stability, step/stride pattern and speed were considered. Results: The 'S' test successfully selected an aid for all 49 subjects. For most this aid offered marked improvement in qualitative and quantitative aspects of gait when compared with the subject's usual aid. Conclusions: The 'S' test is an effective tool for selecting mobility aids within an institutional setting.
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Research Interests: Cardiology, Primary Care, Primary Health Care, Health Care, Medicine, and 15 moreMultivariate Analysis, Humans, Internal Medicine, Blood Pressure, Atrial Fibrillation, Ambulatory, Aged, Medical Emergency, Public health systems and services research, Pulse, A, Logistic Models, Ambulatory Blood Pressure, opportunistic screening, and mass Screening
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Introduction Long COVID (LC), the persistent symptoms ≥12 weeks following acute COVID-19, presents major threats to individual and public health across countries, affecting over 1.5 million people in the UK alone. Evidence-based... more
Introduction Long COVID (LC), the persistent symptoms ≥12 weeks following acute COVID-19, presents major threats to individual and public health across countries, affecting over 1.5 million people in the UK alone. Evidence-based interventions are urgently required and an integrated care pathway approach in pragmatic trials, which include investigations, treatments and rehabilitation for LC, could provide scalable and generalisable solutions at pace. Methods and analysis This is a pragmatic, multi-centre, cluster-randomised clinical trial of two components of an integrated care pathway (Coverscan™, a multi-organ MRI, and Living with COVID Recovery™, a digitally enabled rehabilitation platform) with a nested, Phase III, open label, platform randomised drug trial in individuals with LC. Cluster randomisation is at level of primary care networks so that integrated care pathway interventions are delivered as “standard of care” in that area. The drug trial randomisation is at individual l...
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Background: There is limited information on long-term outcomes after stroke in sub-Saharan Africa (SSA). Current estimates of case fatality rate (CFR) in SSA are based on small sample sizes with varying study design and report... more
Background: There is limited information on long-term outcomes after stroke in sub-Saharan Africa (SSA). Current estimates of case fatality rate (CFR) in SSA are based on small sample sizes with varying study design and report heterogeneous results. Aims: We report CFR and functional outcomes from a large, prospective, longitudinal cohort of stroke patients in Sierra Leone and describe factors associated with mortality and functional outcome. Methods: A prospective longitudinal stroke register was established at both adult tertiary government hospitals in Freetown, Sierra Leone. It recruited all patients ⩾ 18 years with stroke, using the World Health Organization definition, from May 2019 until October 2021. To reduce selection bias onto the register, all investigations were paid by the funder and outreach conducted to raise awareness of the study. Sociodemographic data, National Institute of Health Stroke Scale (NIHSS), and Barthel Index (BI) were collected on all patients on admis...
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Objective: To examine changes in leisure participation following stroke/transient ischaemic attack (TIA) and explore its relationship to modifiable and non-modifiable participant characteristics. Design: An observational study design with... more
Objective: To examine changes in leisure participation following stroke/transient ischaemic attack (TIA) and explore its relationship to modifiable and non-modifiable participant characteristics. Design: An observational study design with self-report questionnaires collected at two time points (baseline and 6-months). Setting: The study was conducted across 21 hospital sites in England, Wales, and Northern Ireland. Participants: Participants were aged 18+ and had experienced a first or recurrent stroke or TIA and had a post-stroke/TIA modified Rankin score (mRS) of ≤3. Procedure: Research practitioners at each site approached potential participants. Individuals who agreed to participate completed a baseline questionnaire whilst an inpatient or at a first post-stroke/TIA clinic appointment. A follow-up questionnaire was posted to participants with a freepost return envelope. Two questionnaires were developed that collected demographic information, pre-stroke/TIA mRS, social circumsta...
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Background Urinary incontinence affects around half of stroke survivors in the acute phase, and it often presents as a new problem after stroke or, if pre-existing, worsens significantly, adding to the disability and helplessness caused... more
Background Urinary incontinence affects around half of stroke survivors in the acute phase, and it often presents as a new problem after stroke or, if pre-existing, worsens significantly, adding to the disability and helplessness caused by neurological deficits. New management programmes after stroke are needed to address urinary incontinence early and effectively. Objective The Identifying Continence OptioNs after Stroke (ICONS)-II trial aimed to evaluate the clinical effectiveness and cost-effectiveness of a systematic voiding programme for urinary incontinence after stroke in hospital. Design This was a pragmatic, multicentre, individual-patient-randomised (1 : 1), parallel-group trial with an internal pilot. Setting Eighteen NHS stroke services with stroke units took part. Participants Participants were adult men and women with acute stroke and urinary incontinence, including those with cognitive impairment. Intervention Participants were randomised to the intervention, a system...
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ABSTRACTIntroductionLong COVID (LC), the persistent symptoms ≥12 weeks following acute COVID-19, presents major threats to individual and public health across countries, affecting over 1.5 million people in the UK alone. Evidence-based... more
ABSTRACTIntroductionLong COVID (LC), the persistent symptoms ≥12 weeks following acute COVID-19, presents major threats to individual and public health across countries, affecting over 1.5 million people in the UK alone. Evidence-based interventions are urgently required and an integrated care pathway (ICP) approach in pragmatic trials, which include investigations, treatments and rehabilitation for LC, could provide scalable and generalisable solutions at pace.Methods and analysisThis is a pragmatic, multi-centre, cluster-randomised clinical trial of two components of an ICP (Coverscan™, a multi-organ MRI, and Living with COVID Recovery™, a digitally enabled rehabilitation platform) with a nested, Phase III, open label, platform randomised drug trial in individuals with LC. Cluster randomisation is at level of primary care networks so that ICP interventions are delivered as “standard of care” in that area. The drug trial randomisation is at individual level and initial arms are riv...
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IntroductionAs mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term... more
IntroductionAs mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs.Methods and analysisThis study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the o...
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ObjectivesThis mixed-method process evaluation underpinned by normalisation process theory aims to measure fidelity to the intervention, understand the social and structural context in which the intervention is delivered and identify... more
ObjectivesThis mixed-method process evaluation underpinned by normalisation process theory aims to measure fidelity to the intervention, understand the social and structural context in which the intervention is delivered and identify barriers and facilitators to intervention implementation.SettingRETurn to work After stroKE (RETAKE) is a multicentre individual patient randomised controlled trial to determine whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care is a clinically and cost-effective therapy to facilitate return to work after stroke, compared with usual care alone. This protocol paper describes the embedded process evaluation.Participants and outcome measuresIntervention training for therapists will be observed and use of remote mentor support reviewed through documentary analysis. Fidelity will be assessed through participant questionnaires and analysis of therapy records, examining frequency, duration and content of ESSVR sessions. To unders...
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Supplemental material, sj-pdf-1-wso-10.1177_17474930211027834 for Stroke in India: A systematic review of the incidence, prevalence, and case fatality by Stephanie P Jones, Kamran Baqai, Andrew Clegg, Rachel Georgiou, Harris Cath,... more
Supplemental material, sj-pdf-1-wso-10.1177_17474930211027834 for Stroke in India: A systematic review of the incidence, prevalence, and case fatality by Stephanie P Jones, Kamran Baqai, Andrew Clegg, Rachel Georgiou, Harris Cath, Emma-Joy Holland, Yogeshwar Kalkonde, Catherine E Lightbody, Pallab BK Maulik, Padma MV Srivastava, Pandian J Durai, Patel Kulsum, PN Sylaja, Caroline L Watkins, Hackett Maree L and on behalf of the NIHR Global Health Research Group on IMPROVIng Stroke carE in India (IMPROVISE) Collaboration in International Journal of Stroke
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Corrigendum to: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (E...more
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ObjectivesThe aim of this national survey was to explore the impact of COVID‐19 public health measures on access to social support services and the effects of closures of services on the mental well‐being of older people and those... more
ObjectivesThe aim of this national survey was to explore the impact of COVID‐19 public health measures on access to social support services and the effects of closures of services on the mental well‐being of older people and those affected by dementia.MethodsA UK‐wide online and telephone survey was conducted with older adults, people with dementia, and carers between April and May 2020. The survey captured demographic and postcode data, social support service usage before and after COVID‐19 public health measures, current quality of life, depression, and anxiety. Multiple linear regression analysis was used to explore the relationship between social support service variations and anxiety and well‐being.ResultsFive hundred and sixty‐nine participants completed the survey (61 people with dementia, 285 unpaid carers, and 223 older adults). Paired samples t‐tests and X2‐tests showed that the mean hour of weekly social support service usage and the number of people having accessed vario...
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Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone.Methods: A prospective observational... more
Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone.Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals.Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58...
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Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive... more
Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e., usual NHS rehabilitation) is more clinically and cost effective for supporting post-stroke RTW, than UC alone.Methods: 760 stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants’ ho...
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BackgroundDespite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are... more
BackgroundDespite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs).ObjectiveWe investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence.MethodsIn UK primary care EHR (The Health Information Network 2011–2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed.ResultsAmong 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA2DS2VASc[Congestive heart failure, Hyp...
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PurposeThere appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia – a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge... more
PurposeThere appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia – a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice.MethodsA narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities. Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care.DiscussionOral health after a stroke is important from a social as well as physical health perspective...
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Gender differences in the prevalence of various manifestations of obstructive sleep apnea syndrome (OSAS) is not as great as previously believed. The aim of the present study was to clarify the clinical patient characteristics of Japanese... more
Gender differences in the prevalence of various manifestations of obstructive sleep apnea syndrome (OSAS) is not as great as previously believed. The aim of the present study was to clarify the clinical patient characteristics of Japanese women and men with OSAS. A cross-sectional case-match control study was performed on patients from two sleep disorder centers. Two hundred forty-five women with OSAS were classified into premenopausal (n = 70) and postmenopausal (n = 175) groups. As well, 245 men matched for both age and apnea-hypopnea index (AHI) and another 245 men matched for age and body mass index (BMI) were established. We compared descriptive variables between genders in both the premenopausal and the postmenopausal female patient groups. As a whole, female patients had significantly higher BMI than AHI-matched male patients (p < 0.05) and a significantly lower value of AHI than BMI-matched male patients (p < 0.001). Female patients had lower Epworth Sleepiness Scale scores than BMI-matched male patients (p < 0.05). On logistic regression analysis, presence of hypertension was significantly associated with BMI (>or=25 kg/m(2)), AHI (>or= 15 to < 30 events/h; >or= 30 to < 60 events/h; >or= 60 events/h), and presence of both hyperlipidemia and diabetes mellitus. However, gender differences were not associated with the occurrence of hypertension. Female patients had significantly lower optimal levels of continuous positive airway pressure than male patients. Our results suggest that both the OSAS severity and the strength of pharyngeal closure is less in Japanese female patients than in male patients. Moreover, Japanese female patients are thought to have less daytime sleepiness than male patients but a similar rate of hypertension as male patients.
Research Interests: Japan, Medicine, Humans, Internal Medicine, Diabetes mellitus, and 15 moreFemale, Male, Gender Difference, Confidence intervals, Medical Physiology, Body Mass Index, Clinical Sciences, Aged, Chest, Chi Square Distribution, Cross Sectional Studies, Logistic Models, Case Control Studies, Epworth sleepiness scale, and Cardiovascular medicine and haematology
Research Interests: Medicine, Event Detection, Humans, Automation, Female, and 15 moreFeasibility Studies, Male, Statistical Significance, Cerebrovascular diseases, Randomised Controlled Trial, Clinical Sciences, Aged, Middle Aged, Randomized Controlled Trial, Cerebrovascular, Pilot Projects, Neurosciences, Severity of Illness Index, Recovery of Function, and hospital units
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AIMS AND OBJECTIVES To explore healthcare staff's experiences of how dehydration is identified and managed in hospitalised patients after acute stroke, and facilitators and challenges to optimising hydration. BACKGROUND Optimal... more
AIMS AND OBJECTIVES To explore healthcare staff's experiences of how dehydration is identified and managed in hospitalised patients after acute stroke, and facilitators and challenges to optimising hydration. BACKGROUND Optimal hydration post-stroke reduces the risk of neurological deterioration and other complications. Patients are at risk of dehydration in acute stroke, particularly those with dysphagia. DESIGN A descriptive qualitative study reported following the COREQ guidelines. METHODS Semi-structured interviews, utilising patient vignettes, were conducted in 2018 (Apr-Oct) with a purposive sample of 30 multidisciplinary staff members from two UK stroke units. Interviews were digitally recorded and transcribed verbatim. Content analysis identified common themes which were mapped to the Theoretical Domains Framework and the Behaviour Change Wheel. RESULTS The themes were mapped to twelve of the fourteen domains in the Theoretical Domains Framework. Participants believed that inadequate hydration management had potentially serious consequences, and described complex knowledge, skills and cognitive elements to effective hydration care. Participants felt that maintaining hydration was a multidisciplinary responsibility requiring good communication. Although the performance of initial dysphagia screening was reinforced by external audit, other areas of post-stroke hydration management were not; notably, there was no established method of assessing hydration. Barriers to maintaining good hydration included lack of staff, out-of-hours working patterns, low priority given to hydration, patients' comorbidities and complex post-stroke disabilities such as dysphagia, aphasia, inattention and hemiparesis. CONCLUSION Findings highlighted the importance of assessing and maintaining hydration but identified barriers to, and variation in, clinical practice. To provide optimal care, barriers to the prevention and treatment of dehydration after stroke must be further understood and addressed. RELEVANCE TO CLINICAL PRACTICE Multidisciplinary teamwork is important in hydration care after stroke, but clarity is required about the specific contributions of each team member. Without this, hydration care becomes 'everybody's and nobody's job'.
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Research Interests: Emergency Medicine, Health Informatics, Medicine, England, Emergency Medical Services, and 15 moreLibrary and Information Studies, Stroke, Humans, Triage, Female, Male, Confidence intervals, Two Stroke Engine, Aged, Medical Emergency, Public health systems and services research, Odds ratio, Interrupted time series, Inservice training, and Interrupted Time Series Analysis
Prompt recognition of suspected stroke symptoms and immediate activation of Emergency Medical Services (EMS) are crucial to effective pre-hospital stroke care, early access to stroke specialist services and successful management
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BackgroundPatients with Type 2 Diabetes Mellitus (T2DM) are at a relatively higher risk of severe stroke. Glucagon like peptide-1 receptor agonists (GLP-1RAs) are licensed for the management of T2DM. Cardio- vascular outcome trials... more
BackgroundPatients with Type 2 Diabetes Mellitus (T2DM) are at a relatively higher risk of severe stroke. Glucagon like peptide-1 receptor agonists (GLP-1RAs) are licensed for the management of T2DM. Cardio- vascular outcome trials (CVOTs) have demonstrated that GLP-1RAs can be safely administered to T2DM patients but have also indicated a trend towards a reduction in non-fatal stroke incidence compared to placebo.MethodsWe searched the literature to identify all GLP-1RA CVOTs. We performed a meta-analysis of the incidence of non-fatal stroke and presented the outcomes by Odds Ratio (OR) with 95% confidence intervals (CI).ResultsWe identified 7 GLP-1RA studies. SUSTAIN-6 and REWIND reported statistically significant reductions in non-fatal stroke incidence, whilst LEADER demonstrated a similar, non-significant trend. ELIXA, EXSCEL, HARMONY and PIONEER-6 did not report a reduction in stroke incidence. Meta-analysis of 7 studies, totalling 56,004 participants yielded a significant reduction in non-fatal stroke incidence in patients receiving GLP-1RAs when compared with placebo (OR 0.85, 95% CI 0.76 – 0.94).ConclusionsThis data supports the value of GLP-1RAs in reducing stroke incidence in patients with T2DM. There is potential value in prospective, randomised controlled trials adequately powered to establish the value of GLP-1RAs in stroke prevention in T2DM patients.mark.maskery@doctors.org.uk|ABN Bursary