Diagnosis and Assessment of Stroke - Annotated Bibliography Example

Diagnosis and Assessment of Stroke ANNOTATED BIBLIOGRAPHY Diagnosis and Assessment of Stroke ANNOTATED BIBLIOGRAPHY Contents. Page Marking Grid Page 2………… Annotation Assessment criteria Page 3………… Title Page 4-8……… Annotations Page 9………… Critical Analysis Page 10…………Conclusion Page 11-20……..References Marking Grid: Overall Mark: 36Annotation assessment criteria Percentage of total marks for annotated bibliography Introduction (including background to the chosen topic and the why the literature chosen is relevant) and referencing Comments: The topic of your assignment is not as clearly identified in this section. This became apparent when I read the papers you included for your annotated bibliography. The identification and diagnosis of stroke and the role of nurse as the use of telemedicine are discussed. You could make it more specific and examine the assessment and diagnosis of stroke prior to thrombolysis and other factors that should be assessed. There are grammatical and referencing errors through out and the structure is not clear at all times. 3/10 Description & analysis of each individual annotation Explanation, analysis and understanding of the main points of each selected article, e.g. purpose or hypothesis for study, the point of view/perspective from which the work was written, type and appropriateness of study methodology, comments on usefulness of the work & consideration of authority of authors. Relevant links to related sources are briefly identified (this may appear in more detail in the next two sections). Comments: You have selected a number of papers to discuss you the purpose of your study. Some of the papers linked better and some others not as well. For example, the FAST tool could be a topic on its own. The final paper could be used to support some of the arguments made in the earlier papers. You have given a description and the purpose of the studies in some papers and some others this was not as clear (i.e. first two ones). You have used a great deal of evidence in some of the papers although at times not in a coherent manner. You have also made some good comments and pointed to a number of issues that are important and you could discuss/explore further). 13/30 Analysis (from your chosen literature as a whole) Key issues/important factors appropriate to the topic are critically analysed. Connections between the selected articles, coherence (or lack of) between studies, referenced linkage to other related sources. Analysis & comparison of argument/s & opposing views appropriate to the topic area. Comments: This section follows on some of my comments above about the coherence of the papers and topics that each of them negotiate. It was a challenging topic and a very interesting one. Your comments here are clearer and you also bring most of the papers together. I would also expect here to bring some of the ideas explored in the papers. Critical analysis and evaluation was also carried out in the previous section. 12/35 Overall conclusions and recommendations Your main conclusions. Make focused recommendations for practice which demonstrate an integration of previous and new learning (synthesis). Propose recommendations for further research that can address the gaps identified through this annotated bibliography. Comments: You have made some good suggestions although some of them are not as well related to the annotated bibliography. These suggestions are the reflection of your overall clinical role with some relevant aspects to this essay. It should be more focused and tailored to the topic of this essay. You tend to discuss a number of ideas and that does not allow to explore a specific topic in depth. You have not made any recommendations for further research. 8/25 Diagnosis and Assessment Annotated Bibliography C7059609 The role of the Stroke Nurse in Assessment of Stroke Survivor Stroke is used to refer to a clinical syndrome of presumed vascular origin, typified by rapidly developing signs of focal or global disturbances of cerebral functions lasting more than twenty four hours or leading to death (World Health Organisation, 1978). Stroke is the third largest cause of death in the United Kingdom (UK) according to the National audit office (2005). Ischemic stroke accounts for 70% of all strokes as researched by Wolfe (2004). Early diagnosis and treatment for stroke survivors can mean the difference between life and death or mild and severe disability for the rest of their lives (Baths and Lees, 2000). In this paper the Author will provide an annotated bibliography. This list of articles will provide the Stroke nurse with the methods and guidelines to accurately clinically assess for stroke (Long et al., 2003). These tools will lead to the correct diagnosis of stroke (NICE, 2008) through evidence based medicine (Sackett et al, 1996) and evidence based practice (Kania-Lachance et al., 2006). The Stroke nurse provides a 24 hour presence which enables continuous monitoring (RCP, 2002), high quality active care (RCP, 2000), and co-ordination of care within the Multidisciplinary Team (MDT). The author will demonstrate that with the continuous use of the FAST (Face-Arm-Speech-Time) test that the nurse will be able to observe for the signs and symptoms of stroke quickly with any deterioration detected immediately. The author will discuss the advantages of telemedicine in aiding the stroke nurse to correctly assess for stroke. Harbison J. Hossain O., Jenkinson D., Davis J., Louw S., Ford GA. (2003). Diagnostic accuracy of stroke referrals from primary care, emergency room physicians and ambulance staff using the Face-Arm-Speech test. Stroke 2003; 34:71-76. Clinical assessment is the main diagnostic method of stroke (Alder et al, 1999) and it can only be supplemented by CT or MRI (Allen., 1984). Urgent active care interventions after stroke can lead to faster access (Kwan et al, 2010) to the (ASU). Delivering high-quality acute stroke services is challenging even more so in a rural region (Derex et al 2002). The use of FAST developed in 1998 is used by front line staff including the ambulance to SPOT (2009) stroke. The study found that FAST is quick and a good assessment tool in an emergency as the person get an instant picture of the Peron and their symptoms and can get the stroke pathway commenced. The study did not include some stroke type’s e.g. haemorrhage strokes. Birns J. and Roots A. (2010). Innovations in the assessment and management of stroke: The use of Telemedicine. British Journal of Neuroscience nursing (2010). Vol 6. No 2. This paper provides an informative view of the beginning of Telemedicine (Telestroke). The authors, a stroke consultant and a nurse ,show their insight in to stroke medicine. A favourable outcome in its use is seen in the TRACTORS (Handschu et al, 2003) study. Telestroke (La Monte et al, 2003) gives the nurse remote access to a Stroke Specialist at any location and at any time. The author suggests that clinical skills cannot be replaced by Telemedicine as a natural disaster may occur at any time e.g. electrical failure or computer virus. Telemedicine as similar to stroke medicine provides a rub and spoke model of care (Demaerschalk, 2009). Telemedicine may provide education programmes (Schwann et al, 2009a; Schwann et al, 2009 b). A case study demonstrated Telemedicine to be effective and used timely. This Stroke nurse utilises telemedicine to facilitate an equitable service to all stroke patients (Kleindorfer, 2010) in her trust. Hsieh F., Lien L., Chen S., Bai C., Sun M., Tseng H., Chen Y., Chen C., Jeng J., Tsai S., Lin H., Liu C., Lo Y., Chen H., Chiu H., Lai M., Liu R., Sun M., Yip B., Chiou H., Chung Y. and the Taiwan Stroke Registry Investigators (2010). Get with the Guidelines-Stroke Performance Indicators: Surveillance of Stroke Care in the Taiwan Registry: Get With The Guidelines-Stroke in Taiwan. Journal of the American Heart Association. Circulation 122; 1116-1123. Published by American Heart Association http://circ.ahajournals.org/cgi/content/full/122/11/1116 This paper demonstrates that Quality of care (QoC) in stroke is a global priority (Schwann et al, 2010) despite economic barriers or ethnic barriers (Johnston et al, 2009). Get with the Guidelines-Stroke (GWTG-Stroke) is a tool to improve (QoC) and prevention of stroke complications administered by the American Heart and American Stroke Association. GWTG (Fonarow et al, 2010) has proven successful in the United States (U.S) in Academic hospital and community settings. GWTG-Stroke assessment of (QoC) of stroke care (Schwann et al, 2009) was based on pre-defined performance measures. This tool was compared to the Taiwan Stroke Registry (TSR). The study was carried out by 16 trained stroke neurologists, 2 epidemiologists and study nurses. These people received training in Data systems for the study. They had regular quality review meetings and this progressed to 4 steps of quality control to provide reliable and accurate data. The risk factors smoking (Shinton et al, 1989) and Deep venous thrombosis (Keenan et al, 2007) were excluded. A low dose tPA (Di Carlo, 2009) showed comparable and safety effect in Japan (Yamaguchi et al, 2006). The guidelines for thrombolysis (Taiwan Stroke Society, 2009) are associated with better outcomes for admission within two hours and receiving tPA. The country had a low uptake of tPA only 1.5 (Shultis et al, 2010,), the U.S (Reeves et al, 2005) was higher and Germany (Heuschmann et al, 2003) had the greatest uptake. The study demonstrated lower cardio-vascular events and mortality in patients receiving antithrombotics and especially favourable outcomes for the patient experiencing Atrial Fibrillation (AF). The research of the article was quite extensive, and the theme of the article was that rigorous compliance with guidelines promotes better outcomes. Moser D., Kimble L., Alberts M., Alonzo A., Croft J., Dracup K., Evenson K., Go A., Hand M., Kothari R., Mensah G., Morris D., Pancioli A., Riegel B. and Zerwic J. (2006). Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council. Circulation 114; 168-182. Published by the American Heart Association. http://circ.ahajournals.org/cgi/content/full/114/2/168. Stroke will be the number 1 cause of death by 2020 (WHO, 1996). The assessment similarities between stroke thrombolysis versus cardiac throbolysis are outlined in detail in this paper. Decision to treat myocardial infraction is based on clear electro-cardiograph (ECG); it is low risk treatment and mistakes have fewer consequences. Decision to treat for eligible stroke survivors is based on clinical assessment and radiological assessment. It is comparatively high risk and therefore mistakes can be fatal (Chao, 2010). This paper written by well known stroke specialists was based on scientific statements. It summarises evidence to show early treatments have better outcomes (AHA, 2006). (Table, 1) in their paper, identified sociodemographical, clinical social and cognitive and emotional factors that may delay access to care, like age, living condition and knowledge of symptoms. It suggested practice developments and further research (circulation, 2006) to aid the stroke survivor identify the longest phase of delay (Everson, 2001) and to try and correct this by research. All authors submitted Disclosure questionnaire. CRITICAL ANALYSIS The Stroke Nurse has an unjudgemental multi-faceted role on the clinical assessment of stroke (Fitzpatrick M et al, 2004). She provides the highest international recognised standards of quality of care (Marler J et al, 2000). She is one of the front line staff (Nedltchev et al, 2003) and continuously visually monitors the stroke survivor effectively by the aid of the internationally recognised FAST tool. The Rosier tool and the Glasgow coma scale are also good recording tools and these aid the stroke nurse to distinguish stroke mimics. Telemedicine provides 24 hour access to a stroke consultant and this aids the nurse (Birns et al, 2010) in providing fast access for the eligible stroke survivor for thrombolysis (Carty et al,2006) and it can bring every discipline into the MDT when required. She develops evidence based protocols for fast assessment (Kwan et al, 2010) and tries to access patient centred factors that may have contributed to this stroke (AHA, 2006) This will provide better outcomes for the stroke survivor. She is a constant point of contact as she assists her stroke survivors to the imaging suites to assist in the diagnosing and developing treatment plans for the full spectrum of strokes. Stroke is a disease specific (Schneider et al., 2003) which has a potential for delays. One has to rule out stroke mimics and this may cause delays in dialling 999. All the papers show the need to recognise stroke symptoms quickly (Kwan et al, 2010). The stroke nurse has a role to play as an educator in stroke and fibrinolytic therapy. The stroke nurse is also in a position to obtain information from consenting stroke survivors to be involved in further stroke trials. CONCLUSION. The author has discussed throughout the papers the importance of a structured organised direct “blue light” transfer by ambulance staff to the ASU. The stroke nurse tries to measures the stroke units outcome performance by comparing it to the best international standards and aims to continually improve its delivery of safe nursing care. The aid of clinical skills and the FAST (Harbison et al, 2003) test have facilitated the application of science in to practice. This tool is a constant observational tool for the stroke nurse (Whiteley, 2010). The advances in technology such as continuous cardiac monitors offer unbiased consistent assessment and interval reassessment as well as monitoring for potential unintended consequences. The stroke nurse can maintain up to date with new technologies by visiting the Stroke forums and seeing these devices working and can decide if they would aid the ASU in the assessment of stroke. The stroke nurse should have access to 24 stroke specialist by the consultant present on site or by the use of telemedicine to aid with the clinical diagnosis of stroke (DOH, 2006). The stroke unit should have access to 24 hour brain scanning and expertise in reading the scans (Liu and Wardlaw, 2004). The ASPECTS tool (Demchuk AM et al, 2010) is currently been reviewed by the stroke nurses in the acute stroke unit. The stroke nurse is continuously educating herself by pursuing specialised education courses in stroke like the masters course in Leeds Metropolitan University, UK which aids the stroke nurse to become a stroke practitioner. The experienced stroke nurse has to rule out stroke mimics at all times by using a rapid stroke screening tool, such as FAST, continuous observation of such observation indicators is part of a continuous learning package undertaken by all ASU staff. The nurse should automatically access the legs and observe eye movements. Since the introduction of the direct phone access for the Para medics to the stroke specialist the outcome of direct and faster treatment is offered to the stroke survivor. Hierarchy of empirical evidence need to be formulated by the MDT and the involvement of the ethics team and up-dated as new best practices emerge. The author suggests that Brain attack education standards should be brought in line with Heart attack (SIGN, 108) standards and should receive the financial support from the government for this to improve the holistic care for the potential stroke survivor and their families. The Elderly and the stroke survivor living alone need a system to establish the time of onset of symptoms and to direct fast access to hospital perhaps with an emergency push button system (Moser, 2006). Access to patients to the MDT has been enhanced. Ongoing stakeholder consultation and a unique rolling out audit ensure that efficiencies and deficiencies are monitored and that service evolves and adapts to ensure quality care in to the further (NHS, 2003). References: AHA (2006) Guideline for the primary prevention of ischemic stroke. Stroke. 37(6):1583-1634 American Heart Association. Heart Disease and Stroke Statistics-2005 Update. Dallas, Texas: American Heart Association;2005. Albers G., Bates V., Clark W., Bell R., Verro P.,Hamilton S (2000): Intravenous tissue-type plasminogen activator for treatment of acute stroke :the standard Treatment with Alteplase to reverse stroke (STARS) study. JAMA 2000 March 1; 283.(9):1145-1150. 285:1145-1150. Allen C.(1984).Differential diagnosis of acute stroke: a review. Journal of the Royal Society of Medicine 77:878-881. Alleder S.,Moody A.,Martel A.,Morgan P.,Delay G.,Gladman J., Fentem P., Lennox G. (1999).Limitations of clinical diagnosis in acute stroke. Lancet 354:1523. Barber PA, Demchuk AM, Zhang J, Buchan AM. Validitiy and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolysis therapy: ASPECTS Study Group. Alberto Programme early CT Score. Lancet 2000; 355;1670-1674. Bath P.,Lees K.(2000). ABC of arterial and venous disease.Acute Stroke.BMJ 320:920-923. Birns J., Roots A. (2010). Innovations in the assessment and management of stroke. The use of Telemedicine. British Journal of Neuroscience nursing Vol 16, No 2. Carty R., Mooraby R., Paterson J. (2006). Evolution of a Model for the thrombolysis of acute stroke patients. British Journal of Nursing, Vol 15. No 8. Circulation. (2006); 114:168-182. Chambers B,Donnan G,Bladin P(1983) Patterns of stroke.an analysis of the first 700 consecutive admissions to the Austin Hospital stroke unit. Australian and New Zealand Journal of Medicine 13:57-64. Committee on Health Research Relating to Future Invention Options. Investing in Health Research and Development. Geneva, Switzerland: World Health Organisation;1996. Demchuk AM, Hill MD, Barber PA, Silver B, Patel SC, Levine SR, NINDS rtPA Stroke Study Group, NIH. Importance of early ischaemic computed tomography changes using ASPECTS in NINDS rtPA S tudy. Stroke 2005; 36(10); 2110-2115. Demerschelk B, Miley M., Kiernan T.(2009). Stroke telemedicine. Mayo clinic project 84(1):53-64. Department of Health (2005) The National Service Framework for the long-term conditions. London: Department of Health. Department of Health (2006) Mending hearts and brains: a clinical case for change. Department of Health (2006). Quality and Outcome Framework. London. Derex L.,Adeleine P.,Nighoghossian N.,Honnorat J.,Trouillas P.(2002) Factors influcing early admission in a french Stroke Unit. Stroke 33: 153-159. Dinah A.(2003) Reduction of waiting times in A/E following introduction of “Fast-Track” scheme for elderly patients with hip fractures. Injury 34:839-841. Di Carlo A.(2009) Human and economic burden of stroke. Age Ageing 38: 4-5. Everson K., Rosamond W., Morris D.(2001). Prehospital and in-hospital delays in acute stroke care. Neuroepidemiology.20:65-76. Fawcett S. (2010). The establishment of a network of Stroke Champions throughout the care homes in an urban conurbation in the North West of England. The Stroke Association,North West Region,UK. Fitzpatrick M. and Birns J. (2004). Thrombolysis for Acute Ischemic Stroke and the role of the nurse. British Journal of Nursing Vol 13, No. 20. Fonarow G., Reeves M., Smith E., Saver J., Zhao X., Olson D., Hernandez A., Peterson E., Schwamm L., (2010). Characteristics per-formance measures , and in-hospital outcome of the first one million stroke abd transient ischemic attack admissions in Get With The Guidelines-Stroke. Circulation Cardiovascul Qual Outcomes. 3:291-302. Foster A., Farrin A., Bhakta B., Hewison J., House A.,Mellish K., Murray J., Young J.,Been R., Patch A., Knapp M., Brady T. (2009) LoTS Care long –Term Stroke Care. Stroke research programme project 1, 2, 3, and 4. a.forster@leeds.ac.uk. Garside MJ.,Price CIM.(2010). STAT (stroke and TIA assessment training)- A simulation-based training programme to improve the emergency response. Six-month survival in 20,891 patients with acute myocardial infraction randomised between Alteplase and streptokinase with or without heparin(1992). GISSI-2 and International study group. Gruppo Italiano per lo Studio della Sopravvienza nell’Infarto. European Heart Journal 13:1692-1697. Grotta J., Burgin W., EL-Mitwalli A. 1996-2000 Intravenous tissue-type plasminogen activator therpy for Ischemic stroke. Houston experience Nerol 2001 December;58(12):2009-13. 58:2009-2013 Guidelines for IV tPA treatment.Taiwan Stroke Society. http://www.stroke.org.tw/guideline/guideline-3.asp.Accessed December 15, 2009. Hacke W.,Donnan G.,Fieschi C.(2004). Association of outcome with early stroke treatment:pooled analysis of ATLANTIS,ECASS and NINDS rt-PA stroke trials.Lancet 363:768-774. Handschu R.,Littermann R., Reulbach U.(2003). Telemedicine in the emergency evaluation of acute stroke: interrater agreement in remote video examination with novel multimedia system. Stroke 34(12): 2842-6. Hankey GJ. Thrombolysis for acute ischemic stroke. Journal of Clinical Neuroscience 2001;(8) :103-105. Harbison J., Hossain O., Jenkinson D., Davis J., Louws S., Ford GA. (2003). Diagnosis accuracy of stroke referrals from primary care, emergency room, physicians and ambulance staff using the Face – Arm – Speech – Test. Stroke 2003;34: 71-76. Heuschmann P., Berger K., Misselwitz B., Hermanek P., Leffmann C., Adelmann M., Buecker-Nott H., Rother J., Neundoerfer B., Kolominsky-Rabas P., (2003). Frequency of thrombolysis therpy in patients with acute ischemic stroke and the risk of in-hospital mortality: the German Stroke Registers Study Group. Stroke;34:1106-1113. Hsieh F., Lien L., Chen S., Bai C., Sun M., Tseng H., Chen Y., Chen C., Jeng J., Tsai S., Lin H., Liu C., Lo Y., Chen H., Chiu H., Lai M., Liu R., Sun M., Yip B., Chiou H., Chung Y. and the Taiwan Stroke Registry Investigators (2010). Get with the Guidelines-Stroke Performance Indicators: Surveillance of Stroke Care in the Taiwan Registry: Get With The Guidelines-Stroke in Taiwan. Journal of the American Heart Association. Circulation 122; 1116-1123. Published by American Heart Association http://circ.ahajournals.org/cgi/content/full/122/11/1116 Inns K.(2003) International Stroke Trial (IST-3) Stroke Nurse Collaborative Group.Thrombolysis for acute ischaemic stroke:core nursing requirement. British journal of Nursing 12:416-24. SITS-ISTR: www.acutestroke.org International Stroke Trial (2010-2011) 3rd, trial. B.M.C. Trial. Open –access publications http://www.trialsjournal.com/content/9/1/37. Johnston S., Mendis S., Mathers C.(2009). Global variations in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 8:345-354. Keenan C., White R.(2007).The effects of race/ethnicity and sex on the risk of venous thromboembolism. Curr Opin Pulmonary Medicine 13:377-383. Kwan J.,Marigold R., South A.,Hennessy N. (2010).Pre-hospital screening of stroke patients for thrombolysis reduces delay to CT scanning and treatment. Kania-Lachance, DM, Best, PJM, McDonah, MR, Ghosh, AK (2006) Evidence-Based Practice and the Nurse Practitioner The Nurse Practitioner 2006; 31(10): 46-54 Kidwell C., Starkmann S.,Eckstem M.,Weemsk,Saver J.(2000).Identifing stroke in the field:prospective validation of the Los Angeles Pre hospital Stroke Screen.Stroke;31:71-76. Kleindorfer O D., Khoury J., Moomaw C., Alwell K., Woo D., Flaherty M., Khatri P., Adeoye O., Ferioli S., Broderick J., Kissela B. (2010). A population-based Estimate of Temporal Trends in Stroke Incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke 2010,41:1326. Kothari R.,Pancioli A.,Liu T.,Brott T.,Broderick J.(1999).Prehospital Stroke scale:reproductability and validity.Ann Emergency Med.33:373-378. Kwon YD.,Yoon S.,Chang H.(2007).Impact of an early hospital arrival on treatment outcomes in acute ischemic stroke patients. Journal preview MED. PUB. Health 40:130-136. LaMonte M., Bahouth M., Hu P. (2003). Telemedicine for acute stroke: triumphs and pitfalls. Stroke 34(4): 725-8. LeesKR,Bluhmki E,von Kummer R.(2010).Time to treatment with intravenous alteplase and outcome in stroke:an updated pooled analysis of ECASS,ATLANTIS,NINDS,and EPITHET Trials. Lancet 2010;375(9727):1695-703. Liu ,M. Wardlaw J.(2004). Thrombolysis for acute ischemic stroke (Cochrane review). In the Cochrane liabrary, Issue 1, 2004. Chichester,U.K: John Wiley and 4.sons. Long F., Kneafsey R., Ryan J. (2003) International Journal of Nursing studies (40) 603-673. www.sciencedirect.com Luepker R., Raczynski J., Osganian S., Goldgerg R., Finnegan J., Hedges J., Goff D., Eisenberg M., Zapka J., Feldman H., Labarthe D., McGovern P., Cornell C., Proschan M., Simoms-Morton D. (2000). Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: the Rapid Early Action for Coronary Treatment (REACT) Trial. JAMA 284:60-67. Mant,J., Wade.,D. Winner,S.(2004). Health care needs assessment in stroke. In Stevens A, Raftery J, Mant j, Simpson S (eds) (2004). Health care needs assessment; the epidemiologically based needs assessment reviews. Second edition. Oxford: Radcliffe Medical Press. Marler JR, Tilley BC, Lu M..Early stroke treatment associated with better outcome: the NINDS rt-PA Stroke Study. Neurology 2000; 55:1649-55. Martin J., Donnell P., Dennis.,Xavier,. Lisheng L., Hongye.,Zhang S., Punima M., Sumathy R. (2010) Interstroke study. Lancet, Volumn 376, Issue 9735, Pages 112-123. Mazor K.,Billings-Gagliardio S.(2003) Does reading about stroke increase stroke knowledge? The impact of different print materials. Patient education council, 51:207-215. Moser D., Kimble L., Alberts M., Alonzo A., Croft J., Dracup K., Evenson K., Go A., Hand M., Kothari R., Mensah G., Morris D., Pancioli A., Riegel B. and Zerwic J. (2006)Reducing Delay in Seeking Treatment by Patients With AcuteCoronarySyndrome and Stroke: A scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council. Circulation 114; 168-182. Published by the American Heart Association. http://circ.ahajournals.org/cgi/content/full/114/2/168. National Audit Office (2005). Reducing Brain Damage: Faster Access to better Stroke Care (HC 452 SESSION 2005-2006). NAO, London. National Collaboration Centre for Chronic Conditions (2008) Stroke: National clinical guideline for the diagnosis and initial management of acute stroke and transient ischemic attack (TIA). London: Royal college of Physicians. National Health Service (NHS) (2003). Responsiveness and equity consultation website. Gov.uk/www.dh/DH-4075292. National Institute for Health and Clinical Excellence (NICE 68, 2008). Diagnosis and initial management of acute stroke and Transient ischemic attack (TIA). Nedeltchev K., Arnold M., Breken C., Isenegger J., Remonda L., Schroth G., Mattel H.(2003). Pre- and in-hospital delays from stroke onset to intra-arteral thrombolysis. Stroke 34:1230-1234. NINDS(2000). National Institute of neurological Disorders and Stroke.Stroke information compiled by NINDS. Reeves M., Arora S., Broderick J., Frankel M., Heinrich J., Hicken-bottom S., Karp H., LaBresh K., Malarcher A., Mensah G., Moomaw C., Schwamm L., Weiss P. (2005). Acute stroke care in the US: result from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke. 36: 1232-1240. Royal College of Physicians (2004) . Intercollegiate Stroke Working Party ; National clinical guidelines for stroke. Second edition. Royal College of Physicians of Edinburgh (2000). Consensus conference on stroke treatment and service delivery. Edinburgh Rudd. A, Pearson, M. and Georgion, A. (2000) Measuring Clinical outcome in stroke. London: Royal College of Physicians. Rudd,A (2008). Speaking at the Irish Heart Association 11th Annual Stroke Day. Sacco R.,Adam R.,Albers G.(2006).Guidelines for Prevention of Stroke in Patients with Ischaemic Stroke or Transient ischaemic Attack.A statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke. Stroke;37:577-617. Sen A., Butler K., Brodbin E.,Pace J., Charles-Jones H., Chatterjee K.(2009).SPOT stroke,a project to develop a pre-hospital stroke pathway for primary care. Shultis W., Graff R., Chamie C., Hart C., Lonangketh P., MS McNamare, Okon DO N and Tirschwell D. (2010). Outcome of the rural twenty four hour thrombolysis service. Striking Rural-Urban Disparities observe red in Acute Stroke Care capacity and services in the Pacific North West. Implications and Recommdations. Stroke 2010. 0 STROKEAHA. 110 – 594374vL. Scottish Intercollegiate Guidelines Network (2008). SIGN 108. Management of patients with stroke or TIA. Assessment, Investigations, immediate management and secondary prevention. Stroke Unit Triallist Collaboration (2001). How do stroke units improve patient outcomes? A collaborative systematic review of the randomised trials. Stroke 1997; 28: 2139-2144. Tanne D., Turgeman D. and Aldery (2001). Management of Acute Ischemic Stroke in the Elderly. Tolerability of Thrombolytics. Therpy in Practice. Drugs 2001: 61 (10) 1439- 1453. A., Pancioli A., Khour J., Rademacher E., Tuchfaber A., Miller R., Woo D., Kissela B., Broderick J.(2003). Trends in community knowledge of the warning signs and risk factors for stroke. JAMA.289 Schneider:343-346. Schwann L., Audebert H., Amarenco P. (2009 b). Recommendations for the implementation of telemedicine within Stroke systems of care: a policy statement from the American Heart Association . Stroke 40(7):2635-60. Schwamm L., Fonarow G., Reeves M., Pan W., Frankel M., Smith E., Ellrodt G., Cannon C., Liang L., Peterson E., Labresh K. (2009). Get with the Guidelines-Stroke is associated with sustained improvements in care for patients hospitalised with acute stroke or triansient ischemic attack. Circulation. 2009;119:107-115. Schwamm L., Reeves M., Pan W., Smith E., Frankel M., Olson D., Zhao X., Peterson E., Fanarow G. (2010). Race/ethnicity, quality of care and outcomes in ischemic stroke. Circulation.121:1492-1501. Shinton R., Beevers G., (1989). Meta-analysis of relation between cigarette smoking and stroke. British Medical Journal 298:789-794. Schwann L., Holloway R., Amarenco P. (2009 a). A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke 40(7): 2616-34 The ATLANTIS, ECASS and NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS and NINDS rt-PA stroke trials. Lancet 2004;363: 768-74. The National Institute of Neurological Disorders and Stroke r-tpa Stroke Study group (1995). Tissue plasminogen activator for acute ischemic stroke.North England Journal medicine 333: 2581-1587 Venables, G. (2002). Prognosis, outcomes and recurrence of stroke. The British Journal of Cardiology, Volume 9, Issue 2. Wardlaw JM.,Murray V.,Berge E.(2009).Thrombolysis for acute ischaemic stroke.Cochrane Database of systernatic Reveiws 2009,Issue 4.Art. no.:CD000213.DOI:10.1002/14651858.CD000213.pub2. Wardlaw JM and Mielde O.. Early signs of Brain infaraction at CT: Observer reliability and Outcome after Thrombolytic Treatment-Systematic review. Radiology 2005; 235:444-453. Wahlgren N., Ahmed N., Davalos A., Ford G., Grand M., Hacke W., Hennerici M., Kaste Markkus., Kuelkens S., Larrne V., Lees K., roine R.,Soinne L., Toni D., Vanhooren G. for the SITS-MOST I nvestigations. Thrombolysis with Alteplase for acute ischemic stroke in the safe implementation of thrombolysis in Stroke-Monitoring Study. (SITS-MOST): an observational study. Lancet (2007): 369: 275-82. Wolfe, C., Mckevitt,C. and Rudd, A. (eds) (2002) Stroke Services. Policy and Practice across Europe. Abingdon, UK: Radcliffe Medical Press. Whiteley W., Sander P., Lindley R., Wardlau J. (2007) CT appearance at baseline in MRC Third international Stroke Trial: relationship with time from stroke onset to scan and stroke severty. Stroke; 38 (2): 488. (abst.P.10) Whiteley W., Wardlaw J., Thomas R., Dennis M., Sandercock P..(2010). A comparison of stroke screening tools with the clinical diagnosis of emergency department staff: a prospective study. Yamaguchi T.,Mori E., Minematsu K., Nakagaware J., Hashi K., Saito I., Shinohara Y. (2006). Alteplase at 0.6mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke 37:1810-1815. Read More