A systematic analysis of the differences in process of care and outcomes between patients admitted and not admitted to hospital after a stroke

Includes bibliographical references (p. 245-252).The population of this study is a subset of the Tees Stroke Register population. The patients were all residents of the area, had their first ever in their lifetime stroke and were not inpatients in hospital at the time or stroke onset. I have written the protocols and documented all the t1owcharts. These underwent numerous drafts with reviews and input by all the study team members and supervisors. I have personally seen, consented and clinically assessed over 1200 patients out of the total of the 1898 recorded and confirmed stroke events. In addition, 1 have reviewed almost all the over 9000 suspected stroke notifications to the stroke register (this usually involved reviewing the patients medical records and / or assessing them). I have reviewed death certificate data, and where needed patients records, of all participants in the study. 1 managed and supervised the day-to-day activities of the research team, helped prepare regular feedback pamphlets detailing the progress of the study, presented progress reports to the study supervisors and presented interim findings at national and international meetings. I have undertaken the basic analyses (odds ratios etc) myself. I have required extensive assistance from the study database supervisor (who also checked my results) for the other and more complex analyses (multivariate regression etc). Dr Nick Steen, statistician for the Centre for Health Services Research, University of Newcastle assisted and guided the performance and interpretation of the basic and logistical regression analyses. My supervisor has reviewed this script and advised modifications and amendments

A prospective study of MRI biomarkers in the brain and lower limb muscles for prediction of lower limb motor recovery following stroke

The aim of this prospective observational longitudinal study was to explore and decipher the predictive value of prospective MRI biomarkers in the brain and lower limb muscles for 3-month lower limb motor recovery following stroke. In the brain, we measured the integrity of the corticospinal tract (fractional anisotropy/"FA"). In the muscles, we measured volume, fatty replacement (fat fraction analysis and proton spectroscopy) and oedema. Measurements were taken at two time points: (1) within 4 weeks of stroke (baseline measurement, clinical and imaging) and (2) 3 months following stroke (follow up measurement, clinical only). Clinical measurements consisted of assessments of functional ability and strength (Fugl-Meyer score, motor NIHSS, Functional Ambulation Category/"FAC", and muscle dynamometry). Twenty-three patients completed imaging and clinical assessments at baseline and follow-up; five patients had partial imaging assessment. The results provided some evidence that damage to the corticospinal tract would result in less motor recovery: recovery of the Fugl-Meyer score and dynamometric ankle plantarflexion, ankle dorsiflexion, and knee extension correlated positively and significantly with fractional anisotropy (0.406-0.457; p = 0.034-p = 0.016). However, fractional anisotropy demonstrated a negative correlation with recovery of the Functional Ambulation Category (-0.359, p = 0.046). For the muscle imaging, significant inverse correlation was observed between vastus lateralis fat fraction vs. NIHSS recovery (-0.401, p = 0.04), and a strong positive correlation was observed between ratio of intra- to extra-myocellular lipid concentrations and the recovery of knee flexion (0.709, p = 0.007). This study supports previous literature indicating a positive correlation between the integrity of the corticospinal tract and motor recovery post-stroke, expanding the limited available literature describing this relationship specifically for the lower limb. However, recovery of functional ambulation behaved differently to other clinical recovery markers by demonstrating an inverse relationship with corticospinal tract integrity. The study also introduces some muscle imaging biomarkers as potentially valuable in the prediction of 3-month lower limb motor recovery following stroke

Are patients who are not admitted to hospital following acute stroke disadvantaged?

Includes bibliographical references.The aims of the study were to compare the structure, process and outcomes of care of patients with acute stroke (first ever stroke) who were and who were not admitted to hospital; to compare the demographic and clinical features of patients who were and who were not admitted to hospital; to identify demographic and clinical features associated with hospital admission following acute stroke