...Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: a systematic review and meta-analysis. Lip GY, Edwards SJ. Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK. g.y.h.lip@bham.ac.uk Abstract OBJECTIVE: To compare the effectiveness of aspirin, warfarin, and ximelagatran as thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF). METHODS: Systematic review of randomised controlled trials in patients with NVAF treated with adjusted-dose warfarin and aspirin, fixed low-dose (FLD) warfarin, ximelagatran or placebo. Outcome measures studied were ischaemic stroke, systemic embolism, mortality and haemorrhage. Meta-analysis was performed using a fixed effects model. RESULTS: We identified 13 trials (n=14,423 participants) of sufficient quality to be included in the analysis. Adjusted-dose warfarin significantly reduced the risk of ischaemic stroke or systemic embolism compared with aspirin (relative risk [RR] 0.59; 95% confidence interval [CI]: 0.40 to 0.86), FLD warfarin (RR 0.36; 95% CI: 0.23 to 0.58), or placebo (RR 0.33; 95% CI: 0.24 to 0.45). However, aspirin and placebo had a lower risk of major bleeding compared to warfarin (RR 0.58; 95% CI: 0.35 to 0.97 and RR 0.45; 95% CI: 0.25 to 0.82, respectively). The oral direct thrombin inhibitor, ximelagatran was as effective as adjusted-dose warfarin in the prevention of ischaemic strokes...
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...Running head: HEALTH PROMOTION Health Promotion: Reduction of Stroke Deaths Jeffrey M. Heist Indiana State University Introduction The development of health care policy in the United States has historically, been based on the fact that clinicians were responsible to treat primary illness rather than the promotion of health as it related to personal health behaviors (U.S. Preventative Services Task Force, 2011). This paper will examine the Healthy People 2020 objective HDS-3, Reducing Stroke Deaths (U. S. Department of Health and Human Services, 2011), and how the promotion of this objective has progressed since it’s Healthy People 2010, 12-7, predecessor. History The Healthy People initiative was introduced in 1979, by the Department of Health and Human Services (DHHS), in an effort to provide a systematic approach to improving health (Koh, 2010). The plans, known as HP 1990-Promoting Health/Preventing Disease (Centers for Disease Control, 2011), Healthy People 2000, Healthy People 2010 and the current Healthy People 2020 have focused on identifying health priorities and aligning the strategies to effectively implement those strategies. The goals related to each version of the initiative have changed, as have the number of objectives/measures. HP 1990 goals were to decrease mortality in infants and adults and to increase the independence among older adults while the Healthy People 2020 goals were aimed at: ...
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...Heart disease and stroke Goal Improve cardiovascular health and quality of life through detection, prevention, and treatment of risk factors for heart attack and stroke. The leading adjustable risk factors for heart disease and stroke are: High blood pressure High cholesterol Diabetes Cigarette smoking Overweight and obesity Poor diet and physical inactivity The risk of Americans dying from cardiovascular disease would be significantly reduced if major improvements were made across the U.S. population in diet, physical activity, control of cholesterol and high blood pressure, smoking and drinking cessation, and appropriate aspirin use. Cardiovascular health is very much influenced by the physical, social, and political environment, including: Maternal child health: Encompass the health of women, children, and families across the life course. This approach embraces the principles of health equity, cultural competence, community empowerment, and social determinants of health in a family-centered, intergenerational approach to maternal and child health. Promotion of healthy kids and families: Availability of healthy foods, extracurricular activities in schools and physical education can do much by improving physical strength thereby reducing overweight and increasing strength and stamina. Encourage kids to develop safe and healthy habits to prevent disease and injury. Make them aware of eating nutrients for growth. To stay healthy, be active...
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...in the arteries within the heart which blocks the blood flow and can lead to a heart attack. In the United States about one in every three adults or seventy million people has high blood pressure. Only about half of these have this under control by either diet and exercise or medication. Blood Pressure is a very common condition but if not under control it increases the patients risk for heart disease and stroke significantly. High blood pressure is known as the silent killer as it has no warning signs or symptoms so often patients do not even know that they have it and this is very dangerous (CDC, 2015). In the United States and most other societies, there is a strong tendency for Blood Pressure to rise progressively with increasing age; however, epidemiologic studies indicate that age-related increases in BP and the occurrence of hypertension are uncommon in societies whose members live in isolated settings. These findings indicate that high BP is not an inevitable consequence of aging and that prevention of hypertension is a realistic goal (Epidemiology and the Prevention of Hypertension. (n.d.). Epidemiological Rational I live in the Crater District in Southside Virginia and the stats show, Virginia Department of Heath for the Crater District 2010, that Heart Disease hospitalizations age adjusted rate (per 10, 000) are 187.4 for the Crater area vs 98.1 for the State of VA. Heart Disease Deaths are (per 10,000) 135.7 for the Crater area vs 101.7 for the State of VA. Heart...
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...NURSING MANAGEMENT OF A STROKE PATIENT INTRODUCTION Stroke is the only largest cause of adult disability which leaves a devastating and lasting effect on people and their families (DoH, 2007a). The government of the United Kingdom had recognized stroke as a health care priority. Several government agencies developed clinical guidelines which are being implemented today in local health care settings (Williams et al, 2010a). This essay will focus on stroke as the cause of impaired mobility and will tackle on the patient-centered rehabilitation care plan along with its evidence-based rationales. Health and social care policies and its effect on the patient’s chosen journey will also be discussed. PATIENT PROFILE This is a case of a 68 year-old, married female who lives in the south of England. Mrs. G was admitted on 12 October 2010 with a presenting complaint of left-sided weakness. Prior to admission, she experienced persistent pain on the back of the head for 2 days, which was unrelieved by Paracetamol intake. On the morning of admission, she collapsed in the bathroom and was found by the husband after 3 hours. She was brought to the hospital via ambulance and upon initial assessment, no shortness of breath, slurred speech, dizziness, palpitation and chest pain were noted. Her vital signs were as follows: blood pressure of 169/59 mmHg, pulse rate of 80 bpm, respiratory rate of 18 breaths per minute, body temperature of 37.5 degrees...
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...resource and not the objective of living (WHO, 2012). This paper will review the purpose of health promotion as related to nursing practice, and how nursing roles and responsibilities have evolved in regards to health promotion and implementation on the prevention, management and long term maintenance and rehabilitation on Stroke patients, including preventing education to the public and communities, on a primary, secondary, and tertiary prevention level (Edelman & Mandle, 2010). A stroke is caused by the disruption of the blood supply to the brain, usually related to a blood vessel ruptures or blocked by a clot, as define by World Health Organization. The blockage of oxygen and nutrients to the brain’s tissues can cause permanent damage to the brain tissue. Warning signs of stroke are, sudden weakness or numbness of the face, arm or leg, most often on one side of the body. Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness. The effects of a stroke depend on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death (WHO 2012). Scientists outline health promotion as the course of action taken to enable individuals to have control over their health physically and mentally on ongoing bases and the awareness and knowledge to make changes and...
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...Strokes I. August 29th 2009. I will never forget that day. It was a life changing day for me, my family, and most of all, my grandma. II. My grandma experienced a massive stroke on that day. A. My grandma was helping her neighbor move into their new house and over worked herself. She became very tired and decided to rest. She then lost all feeling in her left side and my grandpa called 911 right away. B. This time was very life changing for me and my family. III Today I am going to inform you on the different types of strokes, the effects that a stroke can have on a person, and the signs of a stroke and how you can prevent it from happening. Body I. The two types of strokes that I will be talking about today are Hemorrhagic stroke and Ischemic stroke. A. A Hemorrhagic stroke is the rarer of the two types of strokes and accounts for about 13 percent of stroke cases which is what my grandma experienced. 1. It results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. 2. The two types of hemorrhagic strokes are intracerebral hemorrhage or subarachnoid hemorrhage. B. Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels that usually cause hemorrhagic stroke are aneurysms and arteriovenous malformations or AVMs. 1. An aneurysm is a ballooning of a weakened region of a blood vessel. If left...
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...Running Head: Physical Activity and Stroke Physical Activity in the Prevention and Treatment of Stroke His/her Name University Name Abstract Researchers and scientists have always favored preventive measures to avoid the conditions which result in undergoing a rigorous treatment. In this view physical activity or fitness training programs have been found having significant effects in the prevention of strokes as well as at post care stage as treatment and a measure of rehabilitation in survivors of cardiac arrests. Further, it has been noted in recently conducted studies that quite a remarkable evidences are discovered in favor of physical activity as therapeutic as well as rehabilitative in nature. Organized physical activity in the form of exercise, tailor made programs according to the needs of the patients at post care stage and fitness training exercise therapy have been found considerably helpful in rehabilitation in the survivors of stroke. In addition, further research is proposed to explore the different types of organized exercise programs according to the physical and mental conditions of survivors and as preventive measures among them. Physical Activity in the Prevention and Treatment of Stroke Cardiac arrest is a one of the growing and leading causes of death around the globe. According to available data, more than 130,000...
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...Causes and Effects of Stroke Thesis: To gain better knowledge and understanding of the disease called stroke, one must be familiar with how it is caused, its forms, symptoms, facilitators, how it is diagnosed, treated, and prevented. I. Introduction II. Stroke A. Definition B. Types C. Causes III. Demographics IV. Symptoms V. Diagnosis, Treatment, and Prevention VI. Conclusion Causes and Effects of Stroke Many individuals know or have friends, relatives, loved ones, or someone close to them who have either experienced firsthand or have seen the effects of a stroke, in addition to the toll it takes on the victim and the victim’s life. However, what remains unclear to most families is exactly what the condition is and what causes it. To gain better knowledge and understanding of the disease called stroke, one must be familiar with how it is caused, its forms, symptoms, facilitators, how it is diagnosed, treated, and prevented. By definition, a stroke is a condition where a blood clot or ruptured artery or blood vessel blocks the flow of blood to a specific area of the brain. It is a lack of flowing oxygen and glucose to the brain that leads to the deterioration of brain cells and the start of brain damage, thus resulting in the person developing speech impairment, memory, and movement. There are two main categories in which strokes are classified, ischemic stroke and hemorrhagic stroke. The ischemic stroke is what accounts for...
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...10.1 STROKE This concept was taken from module 10 “Assessment of nervous system”, Sub-topic 3 “common abnormalities and assessment findings of nervous system”. Stroke is a condition of both the nervous and cardio-vascular system. Stroke is a condition of brain damage which results due to shortage of blood supply. The blood supply to the arteries of the brain is reduced leading to brain damage. This result from shortage of blood supply and glucose supply to the brain. In the US it is the fourth leading cause of death. Stroke is also known as cerebro-vascular accident and it is a medical emergency. TYPES OF STROKE There are two main types of stroke namely ischemic stroke and hemorrhagic stroke, though some authors belief that transient...
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...Coronary Artery Disease. Coronary artery disease is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries. These plaques can restrict blood flow to the heart muscle by physically clogging the artery or by causing abnormal artery tone and function. Without an adequate blood supply, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. If blood supply to a portion of the heart muscle is cut off entirely, or if the energy demands of the heart become much greater than its blood supply, a heart attack (injury to the heart muscle) may occur. Your coronary arteries are shaped like hollow tubes through which blood can flow freely. The muscular walls of the coronary arteries are normally smooth and elastic and are lined with a layer of cells called the endothelium. The endothelium provides a physical barrier between the blood stream and the coronary artery walls, while regulating the function of the artery by releasing chemical signals in response to various stimuli. Coronary artery disease starts when you are very young. Before your teen years, the blood vessel walls begin to show streaks of fat. As you get older, the fat builds up, causing slight injury to your blood vessel walls. Other substances traveling...
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...A stroke comes about when there is a sudden blood supply interruption to a brain part. A stroke can also occur when a blood vessel bursts in the brain spattering blood into the spaces around the brain cells. When brain cells do not receive oxygen and nutrients or get damaged by an abrupt bleeding, they die. The loss of oxygen and nutrients for brain cells is known as ischemia. Ultimately ischemia results to infarction. Infarct is a fluid-filled cavity that eventually replaces the dead brain cells. The national institute of neurological disorder has been conducting clinical trials in stroke. Here are some of the findings from freshly accomplished trials. The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) Carotid endarterectomy has been considered as the typical treatment for stroke prevention. Stenting on the other hand is a new and less aggressive procedure. The procedure involves inserting an expandable metal stent (tube) into the carotid artery, keeping it wide with balloon dilation. The safety and effectiveness of the two procedures was basically the same according to the study. The study also showed that both men and women benefitted equally as well as those persons who had stroke before as well as those who did not. Extremity Constraint-Induced Therapy Evaluation (EXCITE) One of the major consequences of stroke is impaired movement in the arms and legs Constant induced movement therapy (CIMT) has revealed capabilities for movement rehabilitation...
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...Stroke Definition: A stroke is the sudden death of the cells in a specific area of the brain caused by inadequate blood flow. Another name for it is cerebral vascular accident (CVA). A stroke is also called a brain attack. Description: A stroke occurs when an artery bursts or becomes closed when a blood clot lodges in it and blood flow is interrupted to that part of the brain. Blood circulating to that area of the brain served by the artery stops at the point of rupture, and the brain tissue in that area dies or is damaged. The effects of a stroke are determined by which portion of the brain is affected and how much damage occurs. A stroke can cause memory loss, speech impairment, reasoning ability, loss of vision, paralysis, coma, and death, depending on what region of the brain is affected. Strokes are considered to be medical emergencies that require immediate treatment. About one third of strokes can be followed by transient ischemic attacks (mini-strokes). These strokes temporarily interrupt blood flow to the brain and cause similar symptoms like sudden vision loss or temporary weakness in a limb. Quick treatment can improve the chances of survival and increase the degree of recovery. A person who may have suffered a stroke should be seen in a hospital emergency room immediately. To be most effective, blood clot prevention treatment should begin within three hours of a stroke. More than half a million people in the United States experience a new or recurrent stroke...
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...Vascular dementia occurs when the blood flow to the brain is reduced and usually happens from strokes, it also can be caused by a variety of diseases and damages that affects the brain. One of the most common type of vascular dementia is the Multi-infarct dementia which is caused by minor strokes or (which sometimes are called “mini strokes” or silent strokes”) that at times could go unnoticed. Unlike Alzheimer's disease, there are no licensed treatments for vascular dementia (O’Brien and Thomas, 2015) Multi-infarct dementia is more common in older men than women around the ages of 60 to 75 years old. Vascular dementia is really rare in anyone younger than 65. Global, 48.5 million people have dementia, about 70% of that is Alzheimer’s and around 10% are vascular dementia, there are 7.7 million new cases every year. This case study looks further into Vascular Dementia and the people who have them and shows how a great care system and collaboration can help the patient. A case study will be conducted for the patient while using a long term nursing home. Case Description Tania Joseph, female, age 78, was recently checked into a long term nursing home. Tania was healthy until a year ago, which was when Tania was involved in a terrible car accident and had a concussion but after a couple of days was told that she would recover nicely. A couple of days later she had a serious of strokes...
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...Community Interest Company: a Social Enterprise Organisation Project Report Health Needs Assessment: Stroke in South West and South East London Author: Version: Date: Client: Ref No: Dr John Hayward, Sarah Martin, Dr Michael Soljak Final Version 16.03.09 South West and South East London Cardiac and Stroke Network Boards P132 A Social Enterprise organisation and Community Interest Company Registered office: PO Box 1295, 20 Station Road, Gerrards Cross, Buckinghamshire, SL9 8EL English Company Number: 06480440 VAT Registration: 926 9466 78 www.phast.org.uk E&OE Final Project Report P132 Health Needs Assessment: Stroke in South West and South East London Public Health Action Support Team (PHAST) The Public Health Action Support Team (PHAST) is a Community Interest Company. This is a type of social enterprise that is committed to using its surpluses and assets for the public good. Social enterprises are social mission driven organisations which trade in goods or services for a social purpose.1 PHAST is based at Imperial College, London. It has over 60 experienced and expert public health professionals whose aim is to improve the health of the population and reduce inequalities. Many have worked at high level in the NHS, the Department of Health or in academia. Quality assurance and due diligence processes are in place to ensure all associates work to the highest standard. PHAST also has associates with economic, ethical and legal expertise. For further details see www.phast...
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