Age and ageing
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Evidence-based practice, the linking of research evidence with clinical decision-making, has been a major recent development. However there are many challenges to the development of evidence-based stroke rehabilitation. Before it can become a reality we need to establish a reliable evidence-base providing information which is relevant, reliable, accessible and understandable. This article describes some steps taken to develop such information based on common questions generated by clinicians. ⋯ Stroke rehabilitation needs to establish and apply a solid evidence-base even though the challenges are formidable.
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Multicenter Study
Antithrombotic prescribing in atrial fibrillation: application of a prescribing indicator and multidisciplinary feedback to improve prescribing.
Atrial fibrillation is common in older people, and is associated with an increased risk of ischaemic stroke. Antithrombotic therapy reduces stroke-risk, but is known to be under-prescribed. ⋯ Antithrombotics were under-prescribed for older patients with atrial fibrillation. Audit and multidisciplinary feedback resulted in increased antithrombotic prescribing. The intervention had a greater impact on aspirin prescribing compared with warfarin.
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Carotid sinus hypersensitivity is a common cardiovascular cause of unexplained or recurrent falls in older adults. Effective treatment is available once carotid sinus hypersensitivity is identified. Carotid sinus massage is the only practical method for achieving a diagnosis. Carotid sinus massage is contraindicated if a carotid bruit is present. ⋯ Carotid sinus hypersensitivity is a possible attributable cause of symptoms in a third of subjects with unexplained or recurrent falls and carotid bruits. Only a small number have severe carotid artery stenosis. Ultrasound will identify high-risk subjects and facilitate accurate diagnosis with carotid sinus massage in the majority.
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syncope and falls are common symptoms in older adults. Dedicated facilities for these symptoms are emerging in the UK. To date, justification for resource allocation for these day case facilities is lacking. A dedicated syncope and falls day case facility for older adults was set up in Newcastle in 1991 (at the Royal Victoria Infirmary). The facility provided rapid access for assessment of appropriate patients from the community, the accident and emergency department, or emergency admissions. Activity and performance in 1999 were compared with peer inner-city teaching hospitals and with previous performance in 1990 at the Royal Victoria Infirmary to determine whether the facility had influenced emergency activity. ⋯ the striking variance in bed days in 1999 is due to lower emergency activity and shorter length of stay at the Royal Victoria Infirmary. This is attributed to the dedicated rapid access day-case facility. This has relevant resource implications for planning of future facilities and implementation of National Service Framework standards for falls and intermediate care.