THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Stroke: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83450-4 1. Stroke-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
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Dedication To the healthcare professionals dedicating their time and efforts to the study of stroke.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to stroke. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to stroke, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Acute Disseminated Encephalomyelitis
·
The Official Patient's Sourcebook on Agenesis of the Corpus Callosum
·
The Official Patient's Sourcebook on Agnosia
·
The Official Patient's Sourcebook on Arachnoid Cysts
·
The Official Patient's Sourcebook on Arachnoiditis
·
The Official Patient's Sourcebook on Binswanger's Disease
·
The Official Patient's Sourcebook on Brain and Spinal Cord Tumors
·
The Official Patient's Sourcebook on Central Pain Syndrome
·
The Official Patient's Sourcebook on Cerebral Atrophy
·
The Official Patient's Sourcebook on Coma
·
The Official Patient's Sourcebook on Corticobasal Degeneration
·
The Official Patient's Sourcebook on Empty Sella Syndrome
·
The Official Patient's Sourcebook on Headaches
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The Official Patient's Sourcebook on Locked in Syndrome
·
The Official Patient's Sourcebook on Occipital Neuralgia
·
The Official Patient's Sourcebook on Olivopontocerebellar Atrophy
·
The Official Patient's Sourcebook on Progressive Multifocal Leukoencephalopathy
·
The Official Patient's Sourcebook on Pseudotumor Cerebri
·
The Official Patient's Sourcebook on Seizures and Epilepsy
·
The Official Patient's Sourcebook on Syncope
·
The Official Patient's Sourcebook on Todd's Paralysis
·
The Official Patient's Sourcebook on Traumatic Brain Injury
·
The Official Patient's Sourcebook on Wallenberg's Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON STROKE: GUIDELINES ...................... 9
Overview............................................................................................................... 9 What Is Stroke? .................................................................................................. 10 Ischemic Stroke ................................................................................................... 13 Hemorrhagic Stroke ............................................................................................ 14 Transient Ischemic Attacks ................................................................................ 15 Recurrent Stroke................................................................................................. 15 How Do You Recognize Stroke?......................................................................... 16 How Is the Cause of Stroke Determined?........................................................... 16 Imaging for the Diagnosis of Acute Stroke......................................................... 16 Who Is at Risk for Stroke? .................................................................................. 18 Unmodifiable Risk Factors.................................................................................. 18 The “Stroke Belt”................................................................................................ 19 Other Risk Factors.............................................................................................. 20 Modifiable Lifestyle Risk Factors........................................................................ 24 What Stroke Therapies Are Available?............................................................... 27 What Disabilities Can Result from a Stroke?..................................................... 31 What Special Risks Do Women Face?................................................................ 33 Are Children at Risk for Stroke? ........................................................................ 34 What Research Is Being Done by the NINDS?.................................................. 35 Where Can I Find More Information? ............................................................... 39 Stroke Research Centers ..................................................................................... 41 NINDS-Sponsored Stroke Studies in Progress As of March 1999.................... 45 NINDS-Sponsored Completed Stroke Studies As of March 1999 ..................... 48 More Guideline Sources ..................................................................................... 53 Vocabulary Builder............................................................................................. 71
CHAPTER 2. SEEKING GUIDANCE ....................................................... 83
Overview............................................................................................................. 83 Associations and Stroke ...................................................................................... 83 Finding More Associations................................................................................. 92 Finding Doctors.................................................................................................. 94 Finding a Neurologist......................................................................................... 95 Selecting Your Doctor ........................................................................................ 95 Working with Your Doctor ................................................................................ 96 Broader Health-Related Resources ..................................................................... 97
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Vocabulary Builder............................................................................................. 98
CHAPTER 3. CLINICAL TRIALS AND STROKE ...................................... 99
Overview............................................................................................................. 99 Recent Trials on Stroke..................................................................................... 102 Benefits and Risks............................................................................................. 135 Keeping Current on Clinical Trials.................................................................. 138 General References............................................................................................ 139 Vocabulary Builder........................................................................................... 140
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL................................................ 143 CHAPTER 4. STUDIES ON STROKE...................................................... 145
Overview........................................................................................................... 145 The Combined Health Information Database ................................................... 145 Federally-Funded Research on Stroke .............................................................. 154 E-Journals: PubMed Central ............................................................................ 171 The National Library of Medicine: PubMed .................................................... 178 Vocabulary Builder........................................................................................... 188
CHAPTER 5. PATENTS ON STROKE .................................................... 195
Overview........................................................................................................... 195 Patents on Stroke .............................................................................................. 196 Patent Applications on Stroke .......................................................................... 197 Keeping Current ............................................................................................... 198 Vocabulary Builder........................................................................................... 199
CHAPTER 6. BOOKS ON STROKE ........................................................ 201
Overview........................................................................................................... 201 Book Summaries: Federal Agencies .................................................................. 201 The National Library of Medicine Book Index ................................................. 205 Chapters on Stroke............................................................................................ 209 Directories......................................................................................................... 215 General Home References ................................................................................. 217 Vocabulary Builder........................................................................................... 218
CHAPTER 7. MULTIMEDIA ON STROKE ............................................. 221
Overview........................................................................................................... 221 Video Recordings .............................................................................................. 221 Audio Recordings ............................................................................................. 229 Bibliography: Multimedia on Stroke ................................................................ 229 Vocabulary Builder........................................................................................... 232
CHAPTER 8. PERIODICALS AND NEWS ON STROKE .......................... 235
Overview........................................................................................................... 235 News Services & Press Releases ....................................................................... 235 Newsletters on Stroke ....................................................................................... 244 Newsletter Articles ........................................................................................... 247
Contents
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Academic Periodicals covering Stroke .............................................................. 249 Vocabulary Builder........................................................................................... 251
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 253
Overview........................................................................................................... 253 NIH Guidelines................................................................................................. 253 NIH Databases.................................................................................................. 254 Other Commercial Databases ........................................................................... 263 The Genome Project and Stroke........................................................................ 264 Specialized References....................................................................................... 268 Vocabulary Builder........................................................................................... 269
CHAPTER 10. DISSERTATIONS ON STROKE ....................................... 271
Overview........................................................................................................... 271 Dissertations on Stroke..................................................................................... 271 Keeping Current ............................................................................................... 272
PART III. APPENDICES .................................................. 273 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 275
Overview........................................................................................................... 275 Your Medications: The Basics .......................................................................... 276 Learning More about Your Medications .......................................................... 277 Commercial Databases...................................................................................... 286 Contraindications and Interactions (Hidden Dangers) ................................... 287 A Final Warning .............................................................................................. 288 General References............................................................................................ 289 Vocabulary Builder........................................................................................... 289
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 293
Overview........................................................................................................... 293 What Is CAM? ................................................................................................. 293 What Are the Domains of Alternative Medicine?............................................ 294 Can Alternatives Affect My Treatment? ......................................................... 297 Finding CAM References on Stroke ................................................................. 298 Additional Web Resources................................................................................ 309 General References............................................................................................ 323 Vocabulary Builder........................................................................................... 323
APPENDIX C. RESEARCHING NUTRITION ......................................... 327
Overview........................................................................................................... 327 Food and Nutrition: General Principles........................................................... 328 Finding Studies on Stroke ................................................................................ 332 Federal Resources on Nutrition........................................................................ 336 Additional Web Resources................................................................................ 337 Vocabulary Builder........................................................................................... 348
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 351
Overview........................................................................................................... 351
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Preparation ....................................................................................................... 351 Finding a Local Medical Library ...................................................................... 352 Medical Libraries Open to the Public............................................................... 352
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 359
Overview........................................................................................................... 359 Your Rights as a Patient................................................................................... 359 Patient Responsibilities .................................................................................... 363 Choosing an Insurance Plan............................................................................. 364 Medicare and Medicaid .................................................................................... 366 NORD’s Medication Assistance Programs ..................................................... 369 Additional Resources ........................................................................................ 370 Vocabulary Builder........................................................................................... 371
ONLINE GLOSSARIES.................................................... 373 Online Dictionary Directories.......................................................................... 389
STROKE GLOSSARY ....................................................... 391 General Dictionaries and Glossaries ................................................................ 418
INDEX................................................................................... 420
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Stroke
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Stroke has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to stroke, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on stroke. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on stroke should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate options is always up to the patient in consultation with their physician and healthcare providers.
Introduction
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Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching stroke (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to stroke. It also gives you sources of information that can help you find a doctor in your local area specializing in treating stroke. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with stroke. Part II moves on to advanced research dedicated to stroke. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on stroke. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with stroke or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with stroke. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with stroke.
Scope While this sourcebook covers stroke, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that stroke is often considered a synonym or a condition closely related to the following: ·
Cerebrovascular Accident
·
Cerebrovascular Disease
·
Little Stroke
·
Mini Stroke
·
Mini-stroke
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Stroke
·
Reversible Ischemic Neurological Accident
·
Stroke
·
Stroke - Hemorrhagic
In addition to synonyms and related conditions, physicians may refer to stroke using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for stroke:4 ·
431 intracerebral hemorrhage
·
434.11 cerebral embolism with cerebral infarction
·
435.9 transient cerebral ischemia, unspecified
·
435.9 unspecified transient cerebral ischemia
·
436 acute stroke
·
436 acute, ill-defined cerebrovascular disease (stroke)
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to stroke. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with stroke will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with stroke is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of stroke, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on stroke. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of stroke to you or even given you a pamphlet or brochure describing stroke. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON STROKE: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on stroke. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on stroke can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on stroke. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with stroke and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Neurological Disorders and Stroke (NINDS); http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
Among the above, the National Institute of Neurological Disorders and Stroke (NINDS) is particularly noteworthy. The mission of the NINDS is to reduce the burden of neurological disease—a burden borne by every age group, by every segment of society, by people all over the world.6 To support this mission, the NINDS conducts, fosters, coordinates, and guides research on the causes, prevention, diagnosis, and treatment of neurological disorders and stroke, and supports basic research in related scientific areas. The following patient guideline was recently published by the NINDS on stroke.
What Is Stroke?7 More than 2,400 years ago the father of medicine, Hippocrates, recognized and described stroke-the sudden onset of paralysis. Until recently, modern medicine has had very little power over this disease, but the world of stroke medicine is changing and new and better therapies are being developed every day. Today, some people who have a stroke can walk away from the attack with no or few disabilities if they are treated promptly. Doctors can finally offer stroke patients and their families the one thing that until now has been so hard to give: hope.
This paragraph has been adapted from the NINDS: http://www.ninds.nih.gov/about_ninds/mission.htm. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 7 Adapted from The National Institute of Neurological Disorders and Stroke (NINDS): http://www.ninds.nih.gov/health_and_medical/pubs/stroke_hope_through_research.htm 6
Guidelines 11
In ancient times stroke was called apoplexy,* a general term that physicians applied to anyone suddenly struck down with paralysis. Because many conditions can lead to sudden paralysis, the term apoplexy did not indicate a specific diagnosis or cause. Physicians knew very little about the cause of stroke and the only established therapy was to feed and care for the patient until the attack ran its course. The first person to investigate the pathological signs of apoplexy was Johann Jacob Wepfer. Born in Schaffhausen, Switzerland, in 1620, Wepfer studied medicine and was the first to identify postmortem signs of bleeding in the brains of patients who died of apoplexy. From autopsy studies he gained knowledge of the carotid and vertebral arteries that supply the brain with blood. He also was the first person to suggest that apoplexy, in addition to being caused by bleeding in the brain, could be caused by a blockage of one of the main arteries supplying blood to the brain; thus stroke became known as a cerebrovascular disease (“cerebro” refers to a part of the brain; “vascular” refers to the blood vessels and arteries). Medical science would eventually confirm Wepfer’s hypotheses, but until very recently doctors could offer little in the area of therapy. Over the last two decades basic and clinical investigators, many of them sponsored and funded in part by the National Institute of Neurological Disorders and Stroke (NINDS), have learned a great deal about stroke. They have identified major risk factors for the disease and have developed surgical techniques and drug treatments for the prevention of stroke. But perhaps the most exciting new development in the field of stroke research is the recent approval of a drug treatment that can reverse the course of stroke if given during the first few hours after the onset of symptoms. Studies with animals have shown that brain injury occurs within minutes of a stroke and can become irreversible within as little as an hour. In humans, brain damage begins from the moment the stroke starts and often continues for days afterward. Scientists now know that there is a very short window of opportunity for treatment of the most common form of stroke. Because of these and other advances in the field of cerebrovascular disease stroke patients now have a chance for survival and recovery. A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. In the same way that a person suffering a loss of blood flow to the heart is said to be having a heart attack, a person with a loss of blood flow to the brain or sudden bleeding in the brain can be said to be having a “brain attack.”
12 Stroke
Brain cells die when they no longer receive oxygen and nutrients from the blood or when they are damaged by sudden bleeding into or around the brain. Ischemia is the term used to describe the loss of oxygen and nutrients for brain cells when there is inadequate blood flow. Ischemia ultimately leads to infarction, the death of brain cells which are eventually replaced by a fluid-filled cavity (or infarct) in the injured brain. When blood flow to the brain is interrupted, some brain cells die immediately, while others remain at risk for death. These damaged cells make up the ischemic penumbra and can linger in a compromised state for several hours. With timely treatment these cells can be saved. The ischemic penumbra is discussed in more detail in the Appendix. Even though a stroke occurs in the unseen reaches of the brain, the symptoms of a stroke are easy to spot. They include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. All of the symptoms of stroke appear suddenly, and often there is more than one symptom at the same time. Therefore stroke can usually be distinguished from other causes of dizziness or headache. These symptoms may indicate that a stroke has occurred and that medical attention is needed immediately. There are two forms of stroke: ischemic - blockage of a blood vessel supplying the brain, and hemorrhagic - bleeding into or around the brain. The following sections describe these forms in detail.
Cost of Stroke to the United States ·
Total cost of stroke to the United States: estimated at about $43 billion / year
·
Direct costs for medical care and therapy: estimated at about $28 billion / year
·
Indirect costs from lost productivity and other factors: estimated at about $15 million / year
·
Average cost of care for a patient up to 90 days after a stroke: $15,000*
·
For 10% of patients, cost of care for the first 90 days after a stroke: $35,000*
Guidelines 13
·
Percentage of direct cost of care for the first 90 days8: -
Initial hospitalization = 43%
-
Rehabilitation = 16%
-
Physician costs = 14%
-
Hospital readmission = 14%
-
Medications and other expenses = 13%
Ischemic Stroke An ischemic stroke occurs when an artery supplying the brain with blood becomes blocked, suddenly decreasing or stopping blood flow and ultimately causing a brain infarction. This type of stroke accounts for approximately 80 percent of all strokes. Blood clots are the most common cause of artery blockage and brain infarction. The process of clotting is necessary and beneficial throughout the body because it stops bleeding and allows repair of damaged areas of arteries or veins. However, when blood clots develop in the wrong place within an artery they can cause devastating injury by interfering with the normal flow of blood. Problems with clotting become more frequent as people age. Blood clots can cause ischemia and infarction in two ways. A clot that forms in a part of the body other than the brain can travel through blood vessels and become wedged in a brain artery. This free-roaming clot is called an embolus and often forms in the heart. A stroke caused by an embolus is called an embolic stroke. The second kind of ischemic stroke, called a thrombotic stroke, is caused by thrombosis, the formation of a blood clot in one of the cerebral arteries that stays attached to the artery wall until it grows large enough to block blood flow. Ischemic strokes can also be caused by stenosis, or a narrowing of the artery due to the buildup of plaque (a mixture of fatty substances, including cholesterol and other lipids) and blood clots along the artery wall. Stenosis can occur in large arteries and small arteries and is therefore called large vessel disease or small vessel disease, respectively. When a stroke occurs due to small vessel disease, a very small infarction results, sometimes called a lacunar infarction, from the French word “lacune” meaning “gap” or “cavity.” From “The Stroke/Brain Attack Reporter’s Handbook,” National Stroke Association, Englewood, CO, 1997. 8
14 Stroke
The most common blood vessel disease that causes stenosis is atherosclerosis. In atherosclerosis, deposits of plaque build up along the inner walls of large and medium-sized arteries, causing thickening, hardening, and loss of elasticity of artery walls and decreased blood flow. The role of cholesterol and blood lipids with respect to stroke risk is discussed in the section on cholesterol under “Who is at Risk for Stroke?“.
Hemorrhagic Stroke In a healthy, functioning brain, neurons do not come into direct contact with blood. The vital oxygen and nutrients the neurons need from the blood come to the neurons across the thin walls of the cerebral capillaries. The glia (nervous system cells that support and protect neurons) form a blood-brain barrier, an elaborate meshwork that surrounds blood vessels and capillaries and regulates which elements of the blood can pass through to the neurons. When an artery in the brain bursts, blood spews out into the surrounding tissue and upsets not only the blood supply but the delicate chemical balance neurons require to function. This is called a hemorrhagic stroke. Such strokes account for approximately 20 percent of all strokes. Hemorrhage can occur in several ways. One common cause is a bleeding aneurysm, a weak or thin spot on an artery wall. Over time, these weak spots stretch or balloon out under high arterial pressure. The thin walls of these ballooning aneurysms can rupture and spill blood into the space surrounding brain cells. Hemorrhage also occurs when arterial walls break open. Plaque-encrusted artery walls eventually lose their elasticity and become brittle and thin, prone to cracking. Hypertension, or high blood pressure, increases the risk that a brittle artery wall will give way and release blood into the surrounding brain tissue. A person with an arteriovenous malformation (AVM) also has an increased risk of hemorrhagic stroke. AVMs are a tangle of defective blood vessels and capillaries within the brain that have thin walls and can therefore rupture. Bleeding from ruptured brain arteries can either go into the substance of the brain or into the various spaces surrounding the brain. Intracerebral hemorrhage occurs when a vessel within the brain leaks blood into the brain itself. Subarachnoid hemorrhage is bleeding under the meninges, or outer
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membranes, of the brain into the thin fluid-filled space that surrounds the brain. The subarachnoid space separates the arachnoid membrane from the underlying pia mater membrane. It contains a clear fluid (cerebrospinal fluid or CSF) as well as the small blood vessels that supply the outer surface of the brain. In a subarachnoid hemorrhage, one of the small arteries within the subarachnoid space bursts, flooding the area with blood and contaminating the cerebrospinal fluid. Since the CSF flows throughout the cranium, within the spaces of the brain, subarachnoid hemorrhage can lead to extensive damage throughout the brain. In fact, subarachnoid hemorrhage is the most deadly of all strokes.
Transient Ischemic Attacks A transient ischemic attack (TIA), sometimes called a mini-stroke, starts just like a stroke but then resolves leaving no noticeable symptoms or deficits. The occurrence of a TIA is a warning that the person is at risk for a more serious and debilitating stroke. Of the approximately 50,000 Americans who have a TIA each year, about one-third will have an acute stroke sometime in the future. The addition of other risk factors compounds a person’s risk for a recurrent stroke. The average duration of a TIA is a few minutes. For almost all TIAs, the symptoms go away within an hour. There is no way to tell whether symptoms will be just a TIA or persist and lead to death or disability. The patient should assume that all stroke symptoms signal an emergency and should not wait to see if they go away.
Recurrent Stroke Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years. Recurrent stroke is a major contributor to stroke disability and death, with the risk of severe disability or death from stroke increasing with each stroke recurrence. The risk of a recurrent stroke is greatest right after a stroke, with the risk decreasing with time. About 3 percent of stroke patients will have another stroke within 30 days of their first stroke and one-third of recurrent strokes take place within 2 years of the first stroke.
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How Do You Recognize Stroke? Symptoms of stroke appear suddenly. Watch for these symptoms and be prepared to act quickly for yourself or on behalf of someone you are with: ·
Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
·
Sudden confusion, trouble talking, or understanding speech.
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Sudden trouble seeing in one or both eyes.
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Sudden trouble walking, dizziness, or loss of balance or coordination.
·
Sudden severe headache with no known cause.
If you suspect you or someone you know is experiencing any of these symptoms indicative of a stroke, do not wait. Call 911 emergency immediately. There are now effective therapies for stroke that must be administered at a hospital, but they lose their effectiveness if not given within the first 3 hours after stroke symptoms appear. Every minute counts!
How Is the Cause of Stroke Determined? Physicians have several diagnostic techniques and imaging tools to help diagnose the cause of stroke quickly and accurately. The first step in diagnosis is a short neurological examination. When a possible stroke patient arrives at a hospital, a health care professional, usually a doctor or nurse, will ask the patient or a companion what happened and when the symptoms began. Blood tests, an electrocardiogram, and CT scans will often be done. One test that helps doctors judge the severity of a stroke is the standardized NIH Stroke Scale, developed by the NINDS. Health care professionals use the NIH Stroke Scale to measure a patient’s neurological deficits by asking the patient to answer questions and to perform several physical and mental tests. Other scales include the Glasgow Coma Scale, the Hunt and Hess Scale, the Modified Rankin Scale, and the Barthel Index.
Imaging for the Diagnosis of Acute Stroke Health care professionals also use a variety of imaging devices to evaluate stroke patients. The most widely used imaging procedure is the computed tomography (CT) scan. Also known as a CAT scan or computed axial tomography, CT creates a series of cross-sectional images of the head and
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brain. Because it is readily available at all hours at most major hospitals and produces images quickly, CT is the preferred diagnostic technique for acute stroke. CT also has unique diagnostic benefits. It will quickly rule out a hemorrhage, can occasionally show a tumor that might mimic a stroke, and may even show evidence of early infarction. Infarctions generally show up on a CT scan about 6 to 8 hours after the start of stroke symptoms. If a stroke is caused by hemorrhage, a CT can show evidence of bleeding into the brain almost immediately after stroke symptoms appear. Hemorrhage is the primary reason for avoiding certain drug treatments for stroke, such as thrombolytic therapy, the only proven acute stroke therapy for ischemic stroke (see section on “What Stroke Therapies are Available?”). Thrombolytic therapy cannot be used until the doctor can confidently diagnose the patient as suffering from an ischemic stroke because this treatment might increase bleeding and could make a hemorrhagic stroke worse. Another imaging device used for stroke patients is the magnetic resonance imaging (MRI) scan. MRI uses magnetic fields to detect subtle changes in brain tissue content. One effect of stroke is an increase of water content in the cells of brain tissue, a condition called cytotoxic edema. MRI can detect edema as soon as a few hours after the onset of stroke. The benefit of MRI over CT imaging is that MRI is better able to detect small infarcts soon after stroke onset. Unfortunately, not every hospital has access to an MRI device and the procedure is time-consuming and expensive. It also is not as accurate in determining when hemorrhage is present. Finally, because MRI takes longer to perform than CT, it should not be used if it delays treatment. Other types of MRI scans, often used for the diagnosis of cerebrovascular disease and to predict the risk of stroke, are magnetic resonance angiography (MRA) and functional magnetic resonance imaging (fMRI). Neurosurgeons use MRA to detect stenosis (blockage) of the brain arteries inside the skull by mapping flowing blood. Functional MRI uses a magnet to pick up signals from oxygenated blood and can show brain activity through increases in local blood flow. Duplex Doppler ultrasound and arteriography are two diagnostic imaging techniques used to decide if an individual would benefit from a surgical procedure called carotid endarterectomy. This surgery is used to remove fatty deposits from the carotid arteries and can help prevent stroke (see information on carotid endarterectomy). Doppler ultrasound is a painless, noninvasive test in which sound waves above the range of human hearing are sent into the neck. Echoes bounce off the moving blood and the tissue in the artery and can be formed into an
18 Stroke
image. Ultrasound is fast, painless, risk-free, and relatively inexpensive compared to MRA and arteriography, but it is not considered to be as accurate as arteriography. Arteriography is an X-ray of the carotid artery taken when a special dye is injected into the artery. The procedure carries its own small risk of causing a stroke and is costly to perform. The benefits of arteriography over MR techniques and ultrasound are that it is extremely reliable and still the best way to measure stenosis of the carotid arteries. Even so, significant advances are being made every day involving noninvasive imaging techniques such as fMRI (see section on surgery in “What Stroke Therapies are Available?“).
Who Is at Risk for Stroke? Some people are at a higher risk for stroke than others. Unmodifiable risk factors include age, gender, race/ethnicity, and stroke family history. In contrast, other risk factors for stroke, like high blood pressure or cigarette smoking, can be changed or controlled by the person at risk.
Unmodifiable Risk Factors It is a myth that stroke occurs only in elderly adults. In actuality, stroke strikes all age groups, from fetuses still in the womb to centenarians. It is true, however, that older people have a higher risk for stroke than the general population and that the risk for stroke increases with age. For every decade after the age of 55, the risk of stroke doubles, and two-thirds of all strokes occur in people over 65 years old. People over 65 also have a sevenfold greater risk of dying from stroke than the general population. And the incidence of stroke is increasing proportionately with the increase in the elderly population. When the baby boomers move into the over-65 age group, stroke and other diseases will take on even greater significance in the health care field. Gender also plays a role in risk for stroke. Men have a higher risk for stroke, but more women die from stroke. The stroke risk for men is 1.25 times that for women. But men do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival than women. In other words, even though women have fewer strokes than men, women are generally older when they have their strokes and are more likely to die from them.
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Stroke seems to run in some families. Several factors might contribute to familial stroke risk. Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for hypertension or diabetes. The influence of a common lifestyle among family members could also contribute to familial stroke. The risk for stroke varies among different ethnic and racial groups. The incidence of stroke among African-Americans is almost double that of white Americans, and twice as many African-Americans who have a stroke die from the event compared to white Americans. African-Americans between the ages of 45 and 55 have four to five times the stroke death rate of whites. After age 55 the stroke mortality rate for whites increases and is equal to that of African-Americans. Compared to white Americans, African-Americans have a higher incidence of stroke risk factors, including high blood pressure and cigarette smoking. African-Americans also have a higher incidence and prevalence of some genetic diseases, such as diabetes and sickle cell anemia, that predispose them to stroke. Hispanics and Native Americans have stroke incidence and mortality rates more similar to those of white Americans. In Asian-Americans stroke incidence and mortality rates are also similar to those in white Americans, even though Asians in Japan, China, and other countries of the Far East have significantly higher stroke incidence and mortality rates than white Americans. This suggests that environment and lifestyle factors play a large role in stroke risk.
The “Stroke Belt” Several decades ago, scientists and statisticians noticed that people in the southeastern United States had the highest stroke mortality rate in the country. They named this region the stroke belt. For many years, researchers believed that the increased risk was due to the higher percentage of AfricanAmericans and an overall lower socioeconomic status (SES) in the southern states. A low SES is associated with an overall lower standard of living, leading to a lower standard of health care and therefore an increased risk of stroke. But researchers now know that the higher percentage of AfricanAmericans and the overall lower SES in the southern states does not adequately account for the higher incidence of, and mortality from, stroke in those states. This means that other factors must be contributing to the higher incidence of and mortality from stroke in this region.
20 Stroke
Recent studies have also shown that there is a stroke buckle in the stroke belt. Three southeastern states, North Carolina, South Carolina, and Georgia, have an extremely high stroke mortality rate, higher than the rate in other stroke belt states and up to two times the stroke mortality rate of the United States overall. The increased risk could be due to geographic or environmental factors or to regional differences in lifestyle, including higher rates of cigarette smoking and a regional preference for salty, high-fat foods.
Other Risk Factors The most important risk factors for stroke are hypertension, heart disease, diabetes, and cigarette smoking. Others include heavy alcohol consumption, high blood cholesterol levels, illicit drug use, and genetic or congenital conditions, particularly vascular abnormalities. People with more than one risk factor have what is called “amplification of risk.” This means that the multiple risk factors compound their destructive effects and create an overall risk greater than the simple cumulative effect of the individual risk factors.
Hypertension Of all the risk factors that contribute to stroke, the most powerful is hypertension, or high blood pressure. People with hypertension have a risk for stroke that is four to six times higher than the risk for those without hypertension. One-third of the adult U.S. population, about 50 million people (including 40-70 percent of those over age 65) have high blood pressure. Forty to 90 percent of stroke patients have high blood pressure before their stroke event. A systolic pressure of 120 mm of Hg over a diastolic pressure of 80 mm of Hg9 is generally considered normal. Persistently high blood pressure greater than 140 over 90 leads to the diagnosis of the disease called hypertension. The impact of hypertension on the total risk for stroke decreases with increasing age, therefore factors other than hypertension play a greater role mm of Hg-or millimeters of mercury-is the standard means of expressing blood pressure, which is measured using an instrument called a sphygmomanometer. Using a stethoscope and a cuff that is wrapped around the patient’s upper arm, a health professional listens to the sounds of blood rushing through an artery. The first sound registered on the instrument gauge (which measures the pressure of the blood in millimeters on a column of mercury) is called the systolic pressure. This is the maximum pressure produced as the left ventricle of the heart contracts and the blood begins to flow through the artery. The second sound is the diastolic pressure and is the lowest pressure in the artery when the left ventricle is relaxing. 9
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in the overall stroke risk in elderly adults. For people without hypertension, the absolute risk of stroke increases over time until around the age of 90, when the absolute risk becomes the same as that for people with hypertension. Like stroke, there is a gender difference in the prevalence of hypertension. In younger people, hypertension is more common among men than among women. With increasing age, however, more women than men have hypertension. This hypertension gender-age difference probably has an impact on the incidence and prevalence of stroke in these populations. Antihypertensive medication can decrease a person’s risk for stroke. Recent studies suggest that treatment can decrease the stroke incidence rate by 38 percent and decrease the stroke fatality rate by 40 percent. Common hypertensive agents include adrenergic agents, beta-blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, diuretics, and vasodilators.
Heart Disease After hypertension, the second most powerful risk factor for stroke is heart disease, especially a condition known as atrial fibrillation. Atrial fibrillation is irregular beating of the left atrium, or left upper chamber, of the heart. In people with atrial fibrillation, the left atrium beats up to four times faster than the rest of the heart. This leads to an irregular flow of blood and the occasional formation of blood clots that can leave the heart and travel to the brain, causing a stroke. Atrial fibrillation, which affects as many as 2.2 million Americans, increases an individual’s risk of stroke by 4 to 6 percent, and about 15 percent of stroke patients have atrial fibrillation before they experience a stroke. The condition is more prevalent in the upper age groups, which means that the prevalence of atrial fibrillation in the United States will increase proportionately with the growth of the elderly population. Unlike hypertension and other risk factors that have a lesser impact on the ever-rising absolute risk of stroke that comes with advancing age, the influence of atrial fibrillation on total risk for stroke increases powerfully with age. In people over 80 years old, atrial fibrillation is the direct cause of one in four strokes. Other forms of heart disease that increase stroke risk include malformations of the heart valves or the heart muscle. Some valve diseases, like mitral valve
22 Stroke
stenosis or mitral annular calcification, can double the risk for stroke, independent of other risk factors. Heart muscle malformations can also increase the risk for stroke. Patent foramen ovale (PFO) is a passage or a hole (sometimes called a “shunt”) in the heart wall separating the two atria, or upper chambers, of the heart. Clots in the blood are usually filtered out by the lungs, but PFO could allow emboli or blood clots to bypass the lungs and go directly through the arteries to the brain, potentially causing a stroke. Research is currently under way to determine how important PFO is as a cause for stroke. Atrial septal aneurysm (ASA), a congenital (present from birth) malformation of the heart tissue, is a bulging of the septum or heart wall into one of the atria of the heart. Researchers do not know why this malformation increases the risk for stroke. PFO and ASA frequently occur together and therefore amplify the risk for stroke. Two other heart malformations that seem to increase the risk for stroke for unknown reasons are left atrial enlargement and left ventricular hypertrophy. People with left atrial enlargement have a larger than normal left atrium of the heart; those with left ventricular hypertrophy have a thickening of the wall of the left ventricle. Another risk factor for stroke is cardiac surgery to correct heart malformations or reverse the effects of heart disease. Strokes occurring in this situation are usually the result of surgically dislodged plaques from the aorta that travel through the bloodstream to the arteries in the neck and head, causing stroke. Cardiac surgery increases a person’s risk of stroke by about 1 percent. Other types of surgery can also increase the risk of stroke. Diabetes Diabetes is another disease that increases a person’s risk for stroke. People with diabetes have three times the risk of stroke compared to people without diabetes. The relative risk of stroke from diabetes is highest in the fifth and sixth decades of life and decreases after that. Like hypertension, the relative risk of stroke from diabetes is highest for men at an earlier age and highest for women at an older age. People with diabetes may also have other contributing risk factors that can amplify the overall risk for stroke. For example, the prevalence of hypertension is 40 percent higher in the diabetic population compared to the general population.
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Blood Cholesterol Levels Most people know that high cholesterol levels contribute to heart disease. But many don’t realize that a high cholesterol level also contributes to stroke risk. Cholesterol, a waxy substance produced by the liver, is a vital body product. It contributes to the production of hormones and vitamin D and is an integral component of cell membranes. The liver makes enough cholesterol to fuel the body’s needs and this natural production of cholesterol alone is not a large contributing factor to atherosclerosis, heart disease, and stroke. Research has shown that the danger from cholesterol comes from a dietary intake of foods that contain high levels of cholesterol. Foods high in saturated fat and cholesterol, like meats, eggs, and dairy products, can increase the amount of total cholesterol in the body to alarming levels, contributing to the risk of atherosclerosis and thickening of the arteries. Cholesterol is classified as a lipid, meaning that it is fat-soluble rather than water-soluble. Other lipids include fatty acids, glycerides, alcohol, waxes, steroids, and fat-soluble vitamins A, D, and E. Lipids and water, like oil and water, do not mix. Blood is a water-based liquid, therefore cholesterol does not mix with blood. In order to travel through the blood without clumping together, cholesterol needs to be covered by a layer of protein. The cholesterol and protein together are called a lipoprotein. There are two kinds of cholesterol, commonly called the “good” and the “bad.” Good cholesterol is high-density lipoprotein, or HDL; bad cholesterol is low-density lipoprotein, or LDL. Together, these two forms of cholesterol make up a person’s total serum cholesterol level. Most cholesterol tests measure the level of total cholesterol in the blood and don’t distinguish between good and bad cholesterol. For these total serum cholesterol tests, a level of less than 200 mg/dL10 is considered safe, while a level of more than 240 is considered dangerous and places a person at risk for heart disease and stroke. Most cholesterol in the body is in the form of LDL. LDLs circulate through the bloodstream, picking up excess cholesterol and depositing cholesterol where it is needed (for example, for the production and maintenance of cell membranes). But when too much cholesterol starts circulating in the blood, the body cannot handle the excessive LDLs, which build up along the inside of the arterial walls. The buildup of LDL coating on the inside of the artery mg/dL describes the weight of cholesterol in milligrams in a deciliter of blood. This is the standard way of measuring blood cholesterol levels. return to “Blood Cholesterol Levels“ section
10
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walls hardens and turns into arterial plaque, leading to stenosis and atherosclerosis. This plaque blocks blood vessels and contributes to the formation of blood clots. A person’s LDL level should be less than 130 mg/dL to be safe. LDL levels between 130 and 159 put a person at a slightly higher risk for atherosclerosis, heart disease, and stroke. A score over 160 puts a person at great risk for a heart attack or stroke. The other form of cholesterol, HDL, is beneficial and contributes to stroke prevention. HDL carries a small percentage of the cholesterol in the blood, but instead of depositing its cholesterol on the inside of artery walls, HDL returns to the liver to unload its cholesterol. The liver then eliminates the excess cholesterol by passing it along to the kidneys. Currently, any HDL score higher than 35 is considered desirable. Recent studies have shown that high levels of HDL are associated with a reduced risk for heart disease and stroke and that low levels (less than 35 mg/dL), even in people with normal levels of LDL, lead to an increased risk for heart disease and stroke. A person may lower his risk for atherosclerosis and stroke by improving his cholesterol levels. A healthy diet and regular exercise are the best ways to lower total cholesterol levels. In some cases, physicians may prescribe cholesterol-lowering medication, and recent studies have shown that the newest types of these drugs, called reductase inhibitors or statin drugs, significantly reduce the risk for stroke in most patients with high cholesterol. Scientists believe that statins may work by reducing the amount of bad cholesterol the body produces and by reducing the body’s inflammatory immune reaction to cholesterol plaque associated with atherosclerosis and stroke.
Modifiable Lifestyle Risk Factors Cigarette smoking is the most powerful modifiable stroke risk factor. Smoking almost doubles a person’s risk for ischemic stroke, independent of other risk factors, and it increases a person’s risk for subarachnoid hemorrhage by up to 3.5 percent. Smoking is directly responsible for a greater percentage of the total number of strokes in young adults than in older adults. Risk factors other than smoking - like hypertension, heart disease, and diabetes - account for more of the total number of strokes in older adults. Heavy smokers are at greater risk for stroke than light smokers. The relative risk of stroke decreases immediately after quitting smoking, with a major
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reduction of risk seen after 2 to 4 years. Unfortunately, it may take several decades for a former smoker’s risk to drop to the level of someone who never smoked. Smoking increases the risk of stroke by promoting atherosclerosis and increasing the levels of blood-clotting factors, such as fibrinogen. In addition to promoting conditions linked to stroke, smoking also increases the damage that results from stroke by weakening the endothelial wall of the cerebrovascular system. This leads to greater damage to the brain from events that occur in the secondary stage of stroke. (The secondary effects of stroke are discussed in greater detail in the Appendix.) High alcohol consumption is another modifiable risk factor for stroke. Generally, an increase in alcohol consumption leads to an increase in blood pressure. While scientists agree that heavy drinking is a risk for both hemorrhagic and ischemic stroke, in several research studies daily consumption of smaller amounts of alcohol has been found to provide a protective influence against ischemic stroke, perhaps because alcohol decreases the clotting ability of platelets in the blood. Moderate alcohol consumption may act in the same way as aspirin to decrease blood clotting and prevent ischemic stroke. Heavy alcohol consumption, though, may seriously deplete platelet numbers and compromise blood clotting and blood viscosity, leading to hemorrhage. In addition, heavy drinking or binge drinking can lead to a rebound effect after the alcohol is purged from the body. The consequences of this rebound effect are that blood viscosity (thickness) and platelet levels skyrocket after heavy drinking, increasing the risk for ischemic stroke. The use of illicit drugs, such as cocaine and crack cocaine, can cause stroke. Cocaine may act on other risk factors, such as hypertension, heart disease, and vascular disease, to trigger a stroke. It decreases relative cerebrovascular blood flow by up to 30 percent, causes vascular constriction, and inhibits vascular relaxation, leading to narrowing of the arteries. Cocaine also affects the heart, causing arrhythmias and rapid heart rate that can lead to the formation of blood clots. Marijuana smoking may also be a risk factor for stroke. Marijuana decreases blood pressure and may interact with other risk factors, such as hypertension and cigarette smoking, to cause rapidly fluctuating blood pressure levels, damaging blood vessels. Other drugs of abuse, such as amphetamines, heroin, and anabolic steroids (and even some common, legal drugs, such as caffeine and L-asparaginase
26 Stroke
and pseudoephedrine found in over-the-counter decongestants), have been suspected of increasing stroke risk. Many of these drugs are vasoconstrictors, meaning that they cause blood vessels to constrict and blood pressure to rise. Head and Neck Injuries Injuries to the head or neck may damage the cerebrovascular system and cause a small number of strokes. Head injury or traumatic brain injury may cause bleeding within the brain leading to damage akin to that caused by a hemorrhagic stroke. Neck injury, when associated with spontaneous tearing of the vertebral or carotid arteries caused by sudden and severe extension of the neck, neck rotation, or pressure on the artery, is a contributing cause of stroke, especially in young adults. This type of stroke is often called “beautyparlor syndrome,” which refers to the practice of extending the neck backwards over a sink for hair-washing in beauty parlors. Neck calisthenics, “bottoms-up” drinking, and improperly performed chiropractic manipulation of the neck can also put strain on the vertebral and carotid arteries, possibly leading to ischemic stroke.
Infections Recent viral and bacterial infections may act with other risk factors to add a small risk for stroke. The immune system responds to infection by increasing inflammation and increasing the infection-fighting properties of the blood. Unfortunately, this immune response increases the number of clotting factors in the blood, leading to an increased risk of embolic-ischemic stroke. Genetic Risk Factors Although there may not be a single genetic factor associated with stroke, genes do play a large role in the expression of stroke risk factors such as hypertension, heart disease, diabetes, and vascular malformations. It is also possible that an increased risk for stroke within a family is due to environmental factors, such as a common sedentary lifestyle or poor eating habits, rather than hereditary factors. Vascular malformations that cause stroke may have the strongest genetic link of all stroke risk factors. A vascular malformation is an abnormally formed blood vessel or group of blood vessels. One genetic vascular disease called CADASIL, which stands for cerebral autosomal dominant
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arteriopathy with subcortical infarcts and leukoencephalopathy. CADASIL is a rare, genetically inherited, congenital vascular disease of the brain that causes strokes, subcortical dementia, migraine-like headaches, and psychiatric disturbances. CADASIL is very debilitating and symptoms usually surface around the age of 45. Although CADASIL can be treated with surgery to repair the defective blood vessels, patients often die by the age of 65. The exact incidence of CADASIL in the United States is unknown.
What Stroke Therapies Are Available? Physicians have a wide range of therapies to choose from when determining a stroke patient’s best therapeutic plan. The type of stroke therapy a patient should receive depends upon the stage of disease. Generally there are three treatment stages for stroke: prevention, therapy immediately after stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual’s underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes, or preventing the widespread formation of blood clots that can cause ischemic stroke in everyone, whether or not risk factors are present. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving a blood clot causing the stroke or by stopping the bleeding of a hemorrhagic stroke. The purpose of post-stroke rehabilitation is to overcome disabilities that result from stroke damage. Therapies for stroke include medications, surgery, or rehabilitation.
Medications Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants), thrombolytics, and neuroprotective agents. Antithrombotics prevent the formation of blood clots that can become lodged in a cerebral artery and cause strokes. Antiplatelet drugs prevent clotting by decreasing the activity of platelets, blood cells that contribute to the clotting property of blood. These drugs reduce the risk of blood-clot formation, thus reducing the risk of ischemic stroke. In the context of stroke, physicians prescribe antiplatelet drugs mainly for prevention. The most widely known and used antiplatelet drug is aspirin. Other antiplatelet drugs include clopidogrel and ticlopidine. The NINDS sponsors a wide range of
28 Stroke
clinical trials to determine the effectiveness of antiplatelet drugs for stroke prevention. Anticoagulants reduce stroke risk by reducing the clotting property of the blood. The most commonly used anticoagulants include warfarin (also known as Coumadin® ) and heparin. The NINDS has sponsored several trials to test the efficacy of anticoagulants versus antiplatelet drugs. The Stroke Prevention in Atrial Fibrillation (SPAF) trial found that, although aspirin is an effective therapy for the prevention of a second stroke in most patients with atrial fibrillation, some patients with additional risk factors do better on warfarin therapy. Another study, the Trial of Org 10127 in Acute Stroke Treatment (TOAST), tested the effectiveness of low-molecular weight heparin (Org 10172) in stroke prevention. TOAST showed that heparin anticoagulants are not generally effective in preventing recurrent stroke or improving outcome. Thrombolytic agents are used to treat an ongoing, acute ischemic stroke caused by an artery blockage. These drugs halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. Recombinant tissue plasminogen activator (rt-PA) is a genetically engineered form of t-PA, a thombolytic substance made naturally by the body. It can be effective if given intravenously within 3 hours of stroke symptom onset, but it should be used only after a physician has confirmed that the patient has suffered an ischemic stroke. Thrombolytic agents can increase bleeding and therefore must be used only after careful patient screening. The NINDS rt-PA Stroke Study showed the efficacy of t-PA and in 1996 led to the first FDA-approved treatment for acute ischemic stroke. Other thrombolytics are currently being tested in clinical trials. Neuroprotectants are medications that protect the brain from secondary injury caused by stroke (see Appendix). Although only a few neuroprotectants are FDA-approved for use at this time, many are in clinical trials. There are several different classes of neuroprotectants that show promise for future therapy, including calcium antagonists, glutamate antagonists, opiate antagonists, antioxidants, apoptosis inhibitors, and many others. One of the calcium antagonists, nimodipine, also called a calcium channel blocker, has been shown to decrease the risk of the neurological damage that results from subarachnoid hemorrhage. Calcium channel blockers, such as nimodipine, act by reducing the risk of cerebral vasospasm, a dangerous side effect of subarachnoid hemorrhage in which the blood vessels in the subarachnoid space constrict erratically, cutting off blood flow.
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Surgery Surgery can be used to prevent stroke, to treat acute stroke, or to repair vascular damage or malformations in and around the brain. There are two prominent types of surgery for stroke prevention and treatment: carotid endarterectomy and extracranial/intracranial (EC/IC) bypass. Carotid endarterectomy is a surgical procedure in which a doctor removes fatty deposits (plaque) from the inside of one of the carotid arteries, which are located in the neck and are the main suppliers of blood to the brain. As mentioned earlier, the disease atherosclerosis is characterized by the buildup of plaque on the inside of large arteries, and the blockage of an artery by this fatty material is called stenosis. The NINDS has sponsored two large clinical trials to test the efficacy of carotid endarterectomy: the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Trial (ACAS). These trials showed that carotid endarterectomy is a safe and effective stroke prevention therapy for most people with greater than 50 percent stenosis of the carotid arteries when performed by a qualified and experienced neurosurgeon or vascular surgeon. Currently, the NINDS is sponsoring the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a large clinical trial designed to test the effectiveness of carotid endarterectomy versus a newer surgical procedure for carotid stenosis called stenting. The procedure involves inserting a long, thin catheter tube into an artery in the leg and threading the catheter through the vascular system into the narrow stenosis of the carotid artery in the neck. Once the catheter is in place in the carotid artery, the radiologist expands the stent with a balloon on the tip of the catheter. The CREST trial will test the effectiveness of the new surgical technique versus the established standard technique of carotid endarterectomy surgery. EC/IC bypass surgery is a procedure that restores blood flow to a blooddeprived area of brain tissue by rerouting a healthy artery in the scalp to the area of brain tissue affected by a blocked artery. The NINDS-sponsored EC/IC Bypass Study tested the ability of this surgery to prevent recurrent strokes in stroke patients with atherosclerosis. The study showed that, in the long run, EC/IC does not seem to benefit these patients. The surgery is still performed occasionally for patients with aneurysms, some types of small artery disease, and certain vascular abnormalities. One useful surgical procedure for treatment of brain aneurysms that cause subarachnoid hemorrhage is a technique called “clipping.” Clipping
30 Stroke
involves clamping off the aneurysm from the blood vessel, which reduces the chance that it will burst and bleed. A new therapy that is gaining wide attention is the detachable coil technique for the treatment of high-risk intracranial aneurysms. A small platinum coil is inserted through an artery in the thigh and threaded through the arteries to the site of the aneurysm. The coil is then released into the aneurysm, where it evokes an immune response from the body. The body produces a blood clot inside the aneurysm, strengthening the artery walls and reducing the risk of rupture. Once the aneurysm is stabilized, a neurosurgeon can clip the aneurysm with less risk of hemorrhage and death to the patient. Post-Stroke Rehabilitation Type
Goal
Physical Therapy (PT)
Relearn walking, sitting, lying down, switching from one type of movement to another Relearn eating, drinking, swallowing, dressing, bathing, cooking, reading, writing, toileting Relearn language and communications skills Alleviate some mental and emotional problems
Occupational Therapy (OT)
Speech Therapy Psychological/Psychiatric Therapy
Rehabilitation Therapy Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate post-stroke patients. For most stroke patients, physical therapy (PT) is the cornerstone of the rehabilitation process. A physical therapist uses training, exercises, and physical manipulation of the stroke patient’s body with the intent of restoring movement, balance, and coordination. The aim of PT is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another. Another type of therapy involving relearning daily activities is occupational therapy (OT). OT also involves exercise and training to help the stroke
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patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. The goal of OT is to help the patient become independent or semi-independent. Speech and language problems arise when brain damage occurs in the language centers of the brain. Due to the brain’s great ability to learn and change (called brain plasticity), other areas can adapt to take over some of the lost functions. Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no deficits in cognition or thinking, but have problems understanding speech or written words, or problems forming speech. A speech therapist helps stroke patients help themselves by working to improve language skills, develop alternative ways of communicating, and develop coping skills to deal with the frustration of not being able to communicate fully. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities. Many stroke patients require psychological or psychiatric help after a stroke. Psychological problems, such as depression, anxiety, frustration, and anger, are common post-stroke disabilities. Talk therapy, along with appropriate medication, can help alleviate some of the mental and emotional problems that result from stroke. Sometimes it is also beneficial for family members of the stroke patient to seek psychological help as well. For more information on rehabilitation, contact the National Rehabilitation Information Center, a service of the National Institute on Disability and Rehabilitation Research (see Information Resources).
What Disabilities Can Result from a Stroke? Although stroke is a disease of the brain, it can affect the entire body. Some of the disabilities that can result from a stroke include paralysis, cognitive deficits, speech problems, emotional difficulties, daily living problems, and pain.
Paralysis A common disability that results from stroke is paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis. The paralysis or weakness may affect only the face, an arm, or a leg or may affect one entire side of the
32 Stroke
body and face. A person who suffers a stroke in the left hemisphere of the brain will show right-sided paralysis or paresis. Conversely, a person with a stroke in the right hemisphere of the brain will show deficits on the left side of the body. A stroke patient may have problems with the simplest of daily activities, such as walking, dressing, eating, and using the bathroom. Motor deficits can result from damage to the motor cortex in the frontal lobes of the brain or from damage to the lower parts of the brain, such as the cerebellum, which controls balance and coordination. Some stroke patients also have trouble eating and swallowing, called dysphagia.
Cognitive Deficits Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. If the cognitive problems are severe, the stroke patient may be said to have apraxia, agnosia, or “neglect.” In the context of stroke, neglect means that a stroke patient has no knowledge of one side of his or her body, or one side of the visual field, and is unaware of the deficit. A stroke patient may be unaware of his or her surroundings, or may be unaware of the mental deficits that resulted from the stroke.
Language Deficits Stroke victims often have problems understanding or forming speech. A deficit in understanding speech is called aphasia. Trouble speaking or forming words is called dysarthria. Language problems usually result from damage to the left temporal and parietal lobes of the brain.
Emotional Deficits A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions in certain situations. One common disability that occurs with many stroke patients is depression. Post-stroke depression may be more than a general sadness resulting from the stroke incident. It is a clinical behavioral problem that can hamper recovery and rehabilitation and may even lead to suicide. Poststroke depression is treated as any depression is treated, with antidepressant medications and therapy.
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Pain Stroke patients may experience pain, uncomfortable numbness, or strange sensations after a stroke. These sensations may be due to many factors including damage to the sensory regions of the brain, stiff joints, or a disabled limb. An uncommon type of pain resulting from stroke is called central stroke pain or central pain syndrome (CPS). CPS results from damage to an area in the mid-brain called the thalamus. The pain is a mixture of sensations, including heat and cold, burning, tingling, numbness, and sharp stabbing and underlying aching pain. The pain is often worse in the extremities - the hands and feet - and is made worse by movement and temperature changes, especially cold temperatures. Unfortunately, since most pain medications provide little relief from these sensations, very few treatments or therapies exist to combat CPS.
What Special Risks Do Women Face? Some risk factors for stroke apply only to women. Primary among these are pregnancy, childbirth, and menopause. These risk factors are tied to hormonal fluctuations and changes that affect a woman in different stages of life. Research in the past few decades has shown that high-dose oral contraceptives, the kind used in the 1960s and 1970s, can increase the risk of stroke in women. Fortunately, oral contraceptives with high doses of estrogen are no longer used and have been replaced with safer and more effective oral contraceptives with lower doses of estrogen. Some studies have shown the newer low-dose oral contraceptives may not significantly increase the risk of stroke in women. Other studies have demonstrated that pregnancy and childbirth can put a woman at an increased risk for stroke. Pregnancy increases the risk of stroke as much as three to 13 times. Of course, the risk of stroke in young women of childbearing years is very small to begin with, so a moderate increase in risk during pregnancy is still a relatively small risk. Pregnancy and childbirth cause strokes in approximately eight in 100,000 women. Unfortunately, 25 percent of strokes during pregnancy end in death, and hemorrhagic strokes, although rare, are still the leading cause of maternal death in the United States. Subarachnoid hemorrhage, in particular, causes one to five maternal deaths per 10,000 pregnancies. A study sponsored by the NINDS showed that the risk of stroke during pregnancy is greatest in the post-partum period - the 6 weeks following childbirth. The risk of ischemic stroke after pregnancy is about nine times
34 Stroke
higher and the risk of hemorrhagic stroke is more than 28 times higher for post-partum women than for women who are not pregnant or post-partum. The cause is unknown. In the same way that the hormonal changes during pregnancy and childbirth are associated with increased risk of stroke, hormonal changes at the end of the childbearing years can increase the risk of stroke. Several studies have shown that menopause, the end of a woman’s reproductive ability marked by the termination of her menstrual cycle, can increase a woman’s risk of stroke. Fortunately, some studies have suggested that hormone replacement therapy can reduce some of the effects of menopause and decrease stroke risk. Currently, the NINDS is sponsoring the Women’s Estrogen for Stroke Trial (WEST), a randomized, placebo-controlled, double-blind trial, to determine whether estrogen therapy can reduce the risk of death or recurrent stroke in postmenopausal women who have a history of a recent TIA or non-disabling stroke. The mechanism by which estrogen can prove beneficial to postmenopausal women could include its role in cholesterol control. Studies have shown that estrogen acts to increase levels of HDL while decreasing LDL levels.
Are Children at Risk for Stroke? The young have several risk factors unique to them. Young people seem to suffer from hemorrhagic strokes more than ischemic strokes, a significant difference from older age groups where ischemic strokes make up the majority of stroke cases. Hemorrhagic strokes represent 20 percent of all strokes in the United States and young people account for many of these. Clinicians often separate the “young” into two categories: those younger than 15 years of age, and those 15 to 44 years of age. People 15 to 44 years of age are generally considered young adults and have many of the risk factors mentioned above, such as drug use, alcohol abuse, pregnancy, head and neck injuries, heart disease or heart malformations, and infections. Some other causes of stroke in the young are linked to genetic diseases. Medical complications that can lead to stroke in children include intracranial infection, brain injury, vascular malformations such as moyamoya syndrome, occlusive vascular disease, and genetic disorders such as sickle cell anemia, tuberous sclerosis, and Marfan’s syndrome.
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The symptoms of stroke in children are different from those in adults and young adults. A child experiencing a stroke may have seizures, a sudden loss of speech, a loss of expressive language (including body language and gestures), hemiparesis (weakness on one side of the body), hemiplegia (paralysis on one side of the body), dysarthria (impairment of speech), convulsions, headache, or fever. It is a medical emergency when a child shows any of these symptoms. In children with stroke the underlying conditions that led to the stroke should be determined and managed to prevent future strokes. For example, a recent clinical study sponsored by the National Heart, Lung, and Blood Institute found that giving blood transfusions to young children with sickle cell anemia greatly reduces the risk of stroke. The Institute even suggests attempting to prevent stroke in high-risk children by giving them blood transfusions before they experience a stroke. Most children who experience a stroke will do better than most adults after treatment and rehabilitation. This is due in part to the immature brain’s great plasticity, the ability to adapt to deficits and injury. Children who experience seizures along with stroke do not recover as well as children who do not have seizures. Some children may experience residual hemiplegia, though most will eventually learn how to walk.
What Research Is Being Done by the NINDS? The NINDS is the leading supporter of stroke research in the United States and sponsors a wide range of experimental research studies, from investigations of basic biological mechanisms to studies with animal models and clinical trials. Currently, NINDS researchers are studying the mechanisms of stroke risk factors and the process of brain damage that results from stroke. Some of this brain damage may be secondary to the initial death of brain cells caused by the lack of blood flow to the brain tissue. This secondary wave of brain injury is a result of a toxic reaction to the primary damage and mainly involves the excitatory neurochemical, glutamate. Glutamate in the normal brain functions as a chemical messenger between brain cells, allowing them to communicate. But an excess amount of glutamate in the brain causes too much activity and brain cells quickly “burn out” from too much excitement, releasing more toxic chemicals, such as caspases, cytokines, monocytes, and oxygen-free radicals. These substances poison the chemical environment of
36 Stroke
surrounding cells, initiating a cascade of degeneration and programmed cell death, called apoptosis. NINDS researchers are studying the mechanisms underlying this secondary insult, which consists mainly of inflammation, toxicity, and a breakdown of the blood vessels that provide blood to the brain. Researchers are also looking for ways to prevent secondary injury to the brain by providing different types of neuroprotection for salvagable cells that prevent inflammation and block some of the toxic chemicals created by dying brain cells. From this research, scientists hope to develop neuroprotective agents to prevent secondary damage. For more information on excitotoxicity, neuroprotection, and the ischemic cascade, please refer to the Appendix. Another area of research involves experiments with vasodilators, medications that expand or dilate blood vessels and thus increase blood flow to the brain. Vasodilators have long been used to treat many disorders, including heart disease. Researchers hope that vasodilators may aid in the rehabilitation of stroke victims by increasing blood flow to the brain. So far, unfortunately, they have shown limited success, possibly because they have not been given soon enough after the onset of stroke. Basic research has also focused on the genetics of stroke and stroke risk factors. One area of research involving genetics is gene therapy. Gene therapy involves putting a gene for a desired protein in certain cells of the body. The inserted gene will then “program” the cell to produce the desired protein. If enough cells in the right areas produce enough protein, then the protein could be therapeutic. Scientists must find ways to deliver the therapeutic DNA to the appropriate cells and must learn how to deliver enough DNA to enough cells so that the tissues produce a therapeutic amount of protein. Gene therapy is in the very early stages of development and there are many problems to overcome, including learning how to penetrate the highly impermeable blood-brain barrier and how to halt the host’s immune reaction to the virus that carries the gene to the cells. Some of the proteins used for stroke therapy could include neuroprotective proteins, anti-inflammatory proteins, and DNA/cellular repair proteins, among others. The NINDS supports and conducts a wide variety of studies in animals, from genetics research on zebrafish to rehabilitation research on primates. Much of the Institute’s animal research involves rodents, specifically mice and rats. For example, one study of hypertension and stroke uses rats that have been bred to be hypertensive and therefore stroke-prone. By studying stroke in rats, scientists hope to get a better picture of what might be happening in human stroke patients. Scientists can also use animal models to
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test promising therapeutic interventions for stroke. If a therapy proves to be beneficial to animals, then scientists can consider testing the therapy in human subjects. One promising area of stroke animal research involves hibernation. The dramatic decrease of blood flow to the brain in hibernating animals is extensive - extensive enough that it would kill a non-hibernating animal. During hibernation, an animal’s metabolism slows down, body temperature drops, and energy and oxygen requirements of brain cells decrease. If scientists can discover how animals hibernate without experiencing brain damage, then maybe they can discover ways to stop the brain damage associated with decreased blood flow in stroke patients. Other studies are looking at the role of hypothermia, or decreased body temperature, on metabolism and neuroprotection. Both hibernation and hypothermia have a relationship to hypoxia and edema. Hypoxia, or anoxia, occurs when there is not enough oxygen available for brain cells to function properly. Since brain cells require large amounts of oxygen for energy requirements, they are especially vulnerable to hypoxia. Edema occurs when the chemical balance of brain tissue is disturbed and water or fluids flow into the brain cells, making them swell and burst, releasing their toxic contents into the surrounding tissues. Edema is one cause of general brain tissue swelling and contributes to the secondary injury associated with stroke. The basic and animal studies discussed above do not involve people and fall under the category of preclinical research; clinical research involves people. One area of investigation that has made the transition from animal models to clinical research is the study of the mechanisms underlying brain plasticity and the neuronal rewiring that occurs after a stroke. New advances in imaging and rehabilitation have shown that the brain can compensate for function lost as a result of stroke. When cells in an area of the brain responsible for a particular function die after a stroke, the patient becomes unable to perform that function. For example, a stroke patient with an infarct in the area of the brain responsible for facial recognition becomes unable to recognize faces, a syndrome called facial agnosia. But, in time, the person may come to recognize faces again, even though the area of the brain originally programmed to perform that function remains dead. The plasticity of the brain and the rewiring of the neural connections make it possible for one part of the brain to change functions and take up the more important functions of a disabled part. This rewiring of the brain and restoration of function, which the brain tries to do automatically, can be helped with
38 Stroke
therapy. Scientists are working to develop new and better ways to help the brain repair itself to restore important functions to the stroke patient. One example of a therapy resulting from this research is the use of transcranial magnetic stimulation (TMS) in stroke rehabilitation. Some evidence suggests that TMS, in which a small magnetic current is delivered to an area of the brain, may possibly increase brain plasticity and speed up recovery of function after a stroke. The TMS device is a small coil which is held outside of the head, over the part of the brain needing stimulation. Currently, several studies at the NINDS are testing whether TMS has any value in increasing motor function and improving functional recovery. Clinical Trials Clinical research is usually conducted in a series of trials that become progressively larger. A phase I clinical trial is directly built upon the lessons learned from basic and animal research and is used to test the safety of therapy for a particular disease and to estimate possible efficacy in a few human subjects. A phase II clinical trial usually involves many subjects at several different centers and is used to test safety and possible efficacy on a broader scale, to test different dosing for medications or to perfect techniques for surgery, and to determine the best methodology and outcome measures for the bigger phase III clinical trial to come. A phase III clinical trial is the largest endeavor in clinical research. This type of trial often involves many centers and many subjects. The trial usually has two patient groups who receive different treatments, but all other standard care is the same and represents the best care available. The trial may compare two treatments, or, if there is only one treatment to test, patients who do not receive the test therapy receive instead a placebo. The patients are told that the additional treatment they are receiving may be either the active treatment or a placebo. Many phase III trials are called double-blind, randomized clinical trials. Double-blind means that neither the subjects nor the doctors and nurses who are treating the subjects and determining the response to the therapy know which treatment a subject receives. Randomization refers to the placing of subjects into one of the treatment groups in a way that can’t be predicted by the patients or investigators. These clinical trials usually involve many investigators and take many years to complete. The hypothesis and methods of the trial are very precise and well thought out. Clinical trial designs, as well as the concepts of blinding and randomization, have developed over years of experimentation, trial, and
Guidelines 39
error. At the present time, researchers are developing new designs to maximize the opportunity for all subjects to receive therapy. Most treatments for general use come out of phase III clinical trials. After one or more phase III trials are finished, and if the results are positive for the treatment, the investigators can petition the FDA for government approval to use the drug or procedure to treat patients. Once the treatment is approved by the FDA, it can be used by qualified doctors throughout the country. The back packet of this brochure contains cards with information on some of the many stroke clinical trials the NINDS supports or has completed.
Where Can I Find More Information? The NINDS is the Federal government’s leading supporter of biomedical research on brain and nervous system disorders, including stroke. The NINDS conducts research on stroke in its own laboratories at the National Institutes of Health in Bethesda, Maryland, and supports research at institutions worldwide. The Institute also sponsors an active public information program. The address for the Institute, as well as information on other organizations that offer various services to those affected by stroke, is provided in the Information Resources section. Information on the NINDS and its research programs is also available at http://www.ninds.nih.gov/. Information Resources The National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health, is the leading federal supporter of research on brain and nervous system disorders. The Institute also sponsors an active public information program and can answer questions about diagnosis, treatment, and research related to stroke. For information on stroke or other neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at: BRAIN P.O. Box 5801 Bethesda, Maryland 20824 (800) 352-9424 www.ninds.nih.gov
40 Stroke
In addition, a number of private organizations offer a variety of services and information that can help those affected by stroke. They include: American Heart Association/American Stroke Association 7272 Greenville Avenue Dallas, TX 75231-4596 (800)-AHA-USA1 (242-8721) http://www.americanheart.org/ Serves as a clearinghouse that publishes a wide variety of newsletters, brochures, journals, videos, and other information. Provides many resources on stroke. Supports nationwide affiliates and offices. Brain Aneurysm Foundation, Inc. 295 Cambridge Street Old Forge Realty Bldng. Boston, MA 02114 (617) 723-3870 http://neurosurgery.mgh.harvard.edu/baf/ Serves as an information and support organization for brain aneurysm patients, their families, and the medical community. National Heart, Lung, and Blood Institute Information Center P.O. Box 30105 Bethesda, MD 20824-0105 592-8573 or (800) 575-WELL (575-9355) www.nhlbi.nih.gov Provides public and patient educational materials, including cholesterol, high blood pressure, exercise, and stroke. Treatment guidelines for health professionals are available on high blood cholesterol and high blood pressure. Catalogues of publications and materials are available for professionals and the general public. National High Blood Pressure Education Program NHLBI Information Center P.O. Box 30105 Bethesda, MD 20824-0105 592-8573 or (800) 575-WELL (575-9355) www.nhlbi.nih.gov/about/nhbpep/ Publishes clinical practice guidelines and other expert reports on the treatment and prevention of high blood pressure in the general population, as well as among special populations, such as pregnant women and people with diabetes. Identifies agencies who can help implement population strategies for disease prevention, improve blood
Guidelines 41
pressure control among special populations, such as older women and minorities, and reduce deaths from stroke in targeted populations. National Rehabilitation Information Center 1010 Wayne Avenue, Suite 800 Silver Spring, MD 20910-5633 (800) 346-2742 http://www.naric.com Publishes a series of issue briefs. Funds research and maintains on-line information databases. National Stroke Association 9707 East Easter Lane Englewood, CO 80112-3747 (303)-649-9299 or (800) STROKES (787-6537) www.stroke.org Provides education, research, information, and referrals. Sponsors a speakers bureau, workshops, and conferences. Publishes pamphlets, brochures, booklets, a newsletter, and a professional journal. Sponsors nationwide chapters and support groups. Stroke Clubs International 805 12th Street Galveston, TX 77550 (409) 762-1022 Operates as a nationwide network of support groups. Publishes a newsletter. Children’s Hemiplegia and Stroke Assocn. (CHASA) 4101 West Green Oaks Blvd. #149 Arlington, TX 76016 Tel: 817-492-4325 www.hemikids.org Non-profit 501(c)(3) corporation that offers support and information for families of children who have hemiplegia due to stroke or other causes. Also provides information regarding research and causes of any type of pediatric stroke.
Stroke Research Centers To find better ways to prevent, diagnose, and treat stroke, the NINDS research program supports a broad spectrum of studies by investigators at
42 Stroke
leading biomedical research institutions across the country. Key components of this program are Stroke Research Centers. Information on research activities at these centers, possible clinical trials, and patient eligibility may be obtained from the principal investigators listed below: Justin A. Zivin, M.D., Ph.D. Department of Neurosciences School of Medicine University of California, San Diego 9500 Gilman Drive La Jolla, California 92093-0624 (619) 534-3525 William Pardridge, M.D. Professor Department of Medicine School of Medicine University of California Los Angeles Los Angeles, California 90024-1682 (213) 825-8858 Mark J. Fisher, M.D. Department of Neurology University of Southern California School of Medicine 1540 San Pablo Street, DEI-5416| Los Angeles, California 90033 (213) 342-2731 Frank R. Sharp, M.D. Department of Neurology Veterans Affairs Medical Center 415 Clement Street, Mail Code V127 San Francisco, California 94121 (415) 750-2011 Gary Steinberg, M.D., Ph.D. Department of Neurosurgery Stanford University School of Medicine 300 Pasteur Drive, Room S-006 Stanford, California 94305-5327 (650) 723-5575
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Myron D. Ginsberg, M.D. Department of Neurology University of Miami School of Medicine P.O. Box 016960Miami, Florida 33101 (305) 547-6449 Frank M. Faraci, M.D. University of Iowa College of Medicine E 318-1 GH Iowa City, Iowa 52242 (319) 356-8250 Richard J. Traystman, Ph.D. Department of Anesthesiology The Johns Hopkins University 600 North Wolfe Street Baltimore, Maryland 21205 955-8157 Steven J. Kittner, M.D., M.P.H. Professsor of Neurology Epidemiology and Preventive Medicine University of Maryland Medical Center 22 South Green Street, N4W46 Baltimore, Maryland 21201-1595 (410) 706-7673 Mark Moss, Ph.D. Department of Anatomy and Neurology Boston University School of Medicine 80 East Concord Street Boston, Massachusetts 02118 (617) 638-4063 Michael A. Moskowitz, M.D. Departments of Neurology & Neurosurgery Massachusetts General Hospital Fruit Street Boston, Massachusetts 02114 (617) 726-8442 Michael Chopp, Ph.D. Department of Neurology
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Henry Ford Health Science Center 2799 West Grand Boulevard Detroit, Michigan 48202 (313) 876-3936 Jack P. Whisnant, M.D. Department of Health Sciences Research Mayo Clinic and Foundation Rochester, Minnesota 55901 (507) 284-1101 Dennis W. Choi, M.D, Ph.D. Department of Neurology, Box 8111 School of Medicine Washington University 660 South Euclid Avenue St. Louis, Missouri 63110 (314) 362-7175 Marcus E. Raichle, M.D. Washington University School of Medicine 510 South Kingshighway St. Louis, Missouri 63110 (314) 362-6907 William J. Powers, M.D. Department of Neurology Washington University School of Medicine 660 South Euclid Avenue, Box 8111 St. Louis, Missouri 63110 (314) 362-7116 B. Todd Troost, M.D. Department of Neurology Bowman Gray School of Medicine Medical Center Boulevard Winston-Salem, North Carolina 27157-1078 (336) 716-4101
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Martin Reivich, M.D. Department of Neurology Hospital of the University of Pennsylvania Johnson Pavilion (G1), Room 429 36th and Hamilton Walk Philadelphia, Pennsylvania 19104 (215) 662-2632 Roger P. Simon, M.D. Department of Neurology University of Pittsburgh School of Medicine Liliane S. Kaufmann Building 3471 Fifth Avenue, Suite 811 Pittsburgh, Pennsylvania 15213 (412) 692-4622 Kenneth K. Wu, M.D. Division of Hematology/Oncology University of Texas Health Science Center 6431 Fannin Street Houston, Texas 77030 (713) 792-5450
NINDS-Sponsored Stroke Studies in Progress As of March 1999 African-American Antiplatelet Stroke Prevention Study (AAASPS) AAASPS will examine the effectiveness of ticlopidine versus aspirin in the prevention of a second stroke in African-Americans. Preliminary data suggest that ticlopidine may be more effective than aspirin in preventing a second stroke in this group of patients.
Antiphospholipid Antibodies and Stroke Study (APASS) APASS will examine the role of antiphospholipid antibodies (aPL), proteins that circulate in the blood, as a marker for an increased risk for ischemic stroke. Every year in the United States, about 40,000 people with blood tests that show high levels of aPL experience a stroke, and approximately 20% of first-time ischemic stroke patients have this potentially treatable autoimmune-mediated syndrome. The investigators hypothesize that aPL is a risk factor for ischemic stroke and that a group of subjects with aPL will
46 Stroke
experience more ischemic strokes than a group of subjects without aPL. The information obtained from the APASS trial could lead to a more comprehensive clinical trial involving the subset of patients who have had an ischemic stroke and also have aPL. If the presence of aPL does predict that a person has a higher risk of stroke, then the individual will know that he or she needs to make special efforts to prevent future strokes.
Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) CREST is the first multicenter, randomized trial to test the efficacy of stenting, a relatively new surgical procedure for the treatment of carotid atherosclerosis. It will be compared to carotid endarterectomy (CEA), the established standard treatment for carotid stenosis, to determine the efficacy of each in preventing stroke, myocardial infarction, or death within 30 days of treatment, and in preventing stroke within a 4-year followup period. Stenting, also called stent-assisted carotid percutaneous transluminal angioplasty (SACPTA), requires only heavy sedation instead of general anesthesia, which is commonly used in CEA. The trial is scheduled to enroll more than 2,000 patients with high-grade ( 70%) stenosis and a history of previous TIA or stroke starting in 1999.
The Family Intervention in Recovery from Stroke Trial (FIRST) FIRST is a randomized clinical trial using epidemiological methods to test the effects of psychosocial intervention to improve functional ability in elderly stroke patients. The trial will determine if emotional and daily-living support from family members and close friends can increase self-confidence and functional ability in stroke patients. The study will enroll approximately 300 stroke subjects, who will meet with investigators 15 times over a 6month period.
Genes in Stroke Study (GENESIS) GENESIS will use blood samples from patients enrolled in the WARSS trial (see below) to find genes that are associated with high risk for stroke in families and individuals. Genes are plans for the structure of proteins in the body. If a gene that predicts a high risk of stroke is found, the protein from that gene can be identified. Once the protein is identified scientists can determine how it is different from the same protein in patients with a low
Guidelines 47
risk of stroke. Once the mechanism for the increased risk of stroke is understood, new drugs to prevent stroke in all patients can be developed.
Hemostatic System Activation Study (HAS) HAS will examine the level of activity of the hemostatic system in stroke patients enrolled in the WARSS trial (described below) by measuring the blood plasma level of the protein named prothrombin activation fragment F1+2. The purpose of the HAS study is to determine if patients with previous embolic strokes have a higher level of F1+2 than patients with other types of ischemic stroke. If this is so, patients with the embolic subtype of stroke may have to be treated differently from those with other subtypes of ischemic stroke. HAS will also study the effectiveness of warfarin versus aspirin in lowering the levels of F1+2 in patients with embolic-ischemic stroke versus patients in other stroke groups. This will help us understand how aspirin and warfarin lower the risk of stroke and perhaps lead to the development of drugs that are more effective, easier to take, and have fewer side effects.
Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS) PICSS, another study being done with the patients in the WARSS trial (see below), will examine the role of patent foramen ovale (PFO) in ischemic stroke. PFO, a heart defect consisting of a hole or shunt between the two atria, is found in 40% of patients with acute ischemic stroke with no known cause (referred to as a cryptogenic stroke). The purpose of the study is to determine the rate of recurrent stroke in PFO stroke patients treated with either warfarin or aspirin. The investigators hypothesize that PFO is an important stroke risk factor and will double the 2-year rate of recurrent stroke in medically treated cryptogenic stroke patients. The investigators hope to enroll about 470 subjects by the conclusion of the WARSS trial in 1998. If their findings suggest that PFO does increase the risk of stroke, then further trials may be proposed to test whether simple procedures to close the hole in the heart wall (the PFO) will be worthwhile for patients with this common condition.
Vitamin Intervention for Stroke Prevention (VISP) VISP is a multicenter, double-blind, randomized, controlled clinical trial testing whether a multivitamin with high levels of folate and two B vitamins (B6 and B12) will effectively prevent stroke. Homocysteine is a protein
48 Stroke
breakdown product commonly found at high levels in the blood of patients who have recently had a stroke. Some investigators hypothesize that homocysteine may be one of the factors that leads to a stroke. The VISP trial will test the ability of this dietary supplement containing standard multivitamins, high-dose folic acid, pyridoxine, and cyanocobalamin plus best medical management and risk factor modification to prevent a second stroke or heart attack in patients who have had a previous stroke and who have elevated homocysteine levels. The investigators hope to enroll more than 3,000 patients and will follow each patient for 2 years.
Warfarin Antiplatelet Recurrent Stroke Study (WARSS) More than 30 clinical centers are participating in the WARSS clinical trial, which has already enrolled all of the approximately 1,900 subjects required to complete the trial. The trial will test the effectiveness of the anticoagulant, warfarin, compared to the antiplatelet, aspirin, in preventing the reoccurrence of stroke. The size of the WARSS trial gives the investigators a valuable opportunity to study specific subtypes of stroke to see if one drug or the other may work better after one subtype of stroke or the other. Several smaller clinical studies involving certain subsets of WARSS subjects will test other strategies and treatments to treat or prevent stroke.
Women’s Estrogen for Stroke Trial (WEST) WEST will test the effectiveness of estrogen therapy plus best medical care in preventing a second stroke in postmenopausal women with prior TIA or stroke. The investigators hope to enroll more than 650 women in the 4 ½year study. After this study period, the women will continue taking estrogen for a year or more while they are observed to see if the benefits of estrogen treatment outweigh its risks.
NINDS-Sponsored Completed Stroke Studies As of March 1999 The Aspirin and Carotid Endarterectomy (ACE) Trial The purpose of the ACE trial was to determine if aspirin can reduce the risk of carotid endarterectomy. Different doses of aspirin were given to patients with the hope that one of the doses would provide protective benefit against surgical complications. Surgeons asked patients scheduled for carotid endarterectomy to receive one of four daily doses of aspirin-80, 325, 650, or
Guidelines 49
1,300 mg-for 90 days. The patients were evaluated for 3 months after the surgery to record all strokes, deaths, and any disability. The results of the study showed that the higher doses of aspirin did not improve on the results of the surgery.
Asymptomatic Carotid Atherosclerosis Study (ACAS) This multicenter NINDS clinical trial showed the benefit of surgery (carotid endarterectomy) for patients with no symptoms of stroke but with severe stenosis of one of the carotid arteries. The trial enrolled 1,662 patients from December 1987 through December 1993 and involved more than 39 centers across the U.S. and Canada. The patients were between the ages of 40 and 79 years old, had greater than or equal to 60% stenosis of one of the carotid arteries, and showed no stroke symptoms due to the stenotic artery prior to enrollment in the trial. All patients received best medical care, which consisted of a daily adult aspirin tablet and management of modifiable risk factors, such as high blood pressure, high cholesterol, and diabetes. In addition to best medical care, 828 patients also underwent surgery by a preapproved, well-qualified neurosurgeon or vascular surgeon. The NINDS halted the trial in 1994 when there was convincing evidence that the surgery was beneficial for this group of patients. Physicians participating in the study were immediately notified and advised to reevaluate patients who did not receive surgery. The surgery reduced the 5-year risk of stroke by about one-half, from more than 1 in 10 to fewer than 1 in 20. The risk of stroke was 4.8% for those patients receiving the surgery compared to 10.6% for those who did not receive the surgery, with a relative risk reduction of 55% overall. Men had a relative risk reduction of 69% and women had a 16% relative risk reduction.
Extracranial/Intracranial Bypass Stroke Study (EC/IC Bypass) This NINDS-sponsored study was the first large, multicenter clinical trial to test the efficacy of a surgical procedure in stroke prevention. The 8-year trial, which began in 1977 and was concluded in 1985, involved 1,377 patients at 71 centers around the world. At the time of the study, EC/IC bypass was a new procedure used by neurosurgeons to prevent stroke caused by narrowing of the carotid arteries. Surprisingly, instead of showing that EC/IC bypass prevented future strokes, the study showed that the procedure actually contributed to more and earlier recurrent strokes. The study showed that the operation was unnecessary and possibly dangerous,
50 Stroke
causing a paradigm shift in the way neurosurgeons approached stroke prevention. Even though the results were negative, the study itself was a success and a breakthrough clinical trial. The EC/IC bypass study showed that controlled and randomized clinical trials are possible in the field of neurosurgery. It also showed that large clinical trials are cost-effective because they guide the medical community to the most beneficial treatments. This trial set the groundwork for future successful surgical trials, such as the NASCET and ACAS trials.
NINDS rt-PA Stroke Study Probably the greatest achievement in the history of NINDS stroke research was the success of the NINDS rt-PA Stroke Study. Two clinical trials involving 624 patients at nine centers across the country showed that carefully selected ischemic stroke patients who received t-PA treatment within 3 hours of their initial stroke symptoms were at least 30% more likely than untreated patients to recover from their stroke with little or no disability after 3 months. The results of this study were announced in December 1995, and in June 1996, t-PA became the first interventional treatment for acute ischemic stroke approved by the FDA. In the two-part NINDS trial, patients received either intravenous t-PA or a placebo within 3 hours of the initial symptoms of a stroke. A CT scan, blood tests, and informed consent were obtained prior to t-PA administration to rule out hemorrhagic stroke and to exclude patients who did not meet the inclusion criteria. Part 1 of the trial was designed to look for marked improvement in the patients’ condition 24 hours after treatment and, secondarily, to examine efficacy of the treatment at 3 months. Part 2 was designed to confirm the long-term benefit of the drug. In both parts of the study, there was a dramatic improvement at 3 months in those patients who received t-PA. The investigators demonstrated that the number of patients with complete or almost complete recovery was increased by 30% or more as measured by four different medical outcome scales. For every 100 patients receiving t-PA, at least 11 more had an excellent recovery compared to the group that did not receive t-PA. The overall odds in favor of the t-PA-treated group were 1.7 times greater than the placebo group. A subsequent t-PA study showed a greater than 90% probability that treating acute ischemic stroke patients with t-PA could result in a substantial net cost savings to the health care system. t-PA-treated stroke patients leave
Guidelines 51
the hospital sooner and require less rehabilitation and nursing care after discharge than do patients who do not receive t-PA. The study also showed that t-PA-treated stroke patients, because of their decreased disability, can expect to have an improved quality of life. The Need for Speed: In response to the results of the t-PA trial, indicating that treatment must begin within 3 hours of the start of stroke symptoms, the NINDS hosted the National Symposium on Rapid Identification and Treatment of Acute Stroke, a gathering of 400 people from more than 50 organizations involved in the diagnosis, care, and treatment of acute stroke patients. The purpose of the symposium was to lay the foundation for a national plan for rapid stroke treatment. The NINDS Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke: Setting New Directions for Stroke Care provides a working blueprint for health care professionals involved in prehospital emergency medical care systems, emergency department and acute hospital care, and public education.
North American (NASCET)
Symptomatic
Carotid
Endarterectomy
Trial
This 12-year NINDS-supported trial showed the benefit of the surgical procedure carotid endarterectomy (CE) for patients with symptoms of stroke and moderate to severe stenosis of one of the carotid arteries. Interim results for the first part of the study, which looked at patients with severe stenosis (70-99%), showed that for these patients, surgery plus best medical treatment was highly effective in reducing strokes compared to best medical treatment alone. A total of 595 patients were enrolled at 50 centers in the U.S. and Canada; about half of the patients received surgery and best medical treatment and about half received best medical treatment only. After 18 months, 24% of the best medical treatment patients suffered a stroke, compared to only 7% of the surgical patients. The surgery reduced the chances of having a stroke from about 1 in 4 to about 1 in 10, with a 65% relative risk reduction and a 17% absolute risk reduction of death or stroke over the 2 years following the surgery. The interim results were so positive that in February 1991, the NINDS stopped the severe stenosis phase of the trial and scheduled all of the patients in the non-surgical arm of the trial for surgery. The NINDS then issued a clinical alert to announce the findings, recommending to the medical community that all qualified symptomatic stroke patients with severe stenosis of the carotid artery receive CE by a qualified neurosurgeon or vascular surgeon. Followup of the patients 8 years after the surgery showed that the benefit of CE surgery was maintained.
52 Stroke
The second part of the NASCET study looked at the effect of CE for symptomatic patients with moderate stenosis (30-69%) and involved a total of 2,885 patients at more than 100 centers worldwide. The results of the study, reported in 1998, showed that CE was beneficial for symptomatic patients with 50-69% stenosis, with a statistically significant 29% relative risk reduction and a 6.5% absolute risk reduction of stroke or death at 5 years following the surgery. For those patients with less than 50% stenosis, the risk of surgical complications (inherent with any surgical procedure) outweighed the benefits of the surgery. The study also showed that there are some additional risk factors that can increase the risk of surgical (peri-operative) complications or decrease the effectiveness of the surgery for those patients with moderate stenosis. These additional risk factors included female gender, the presence of diabetes, blockage of the carotid artery not subjected to surgery, and not taking aspirin prior to the time of the surgery.
Stroke Prevention in Atrial Fibrillation (SPAF) SPAF was designed by the NINDS to test the effectiveness of aspirin versus warfarin in preventing a second stroke in patients with atrial fibrillation (AF) who had already suffered a stroke. AF affects 2.2 million Americans and increases stroke risk 5- to 10-fold. About 15% of stroke patients have AF, a condition in which the two upper chambers of the heart (the atria) do not have a rhythmic, forceful beat, and the pulse is irregular. This can slow blood flow, allowing clots to form and increasing the risk of an embolicischemic stroke. The three-part SPAF trial involved more than a decade of research, more than 20 clinical centers, and more than 3,800 patient volunteers with AF. In 1990, results from SPAF I showed an 80% reduction in stroke risk for persons with AF who received treatment with aspirin or warfarin compared to those who received no treatment. Both drugs help prevent the formation of blood clots, but warfarin is a more effective blood thinner than aspirin. In 1994, the SPAF II study identified the 60% of people with AF for whom a daily adult aspirin provides adequate protection against stroke with minimal complications. This group consists of individuals with AF who are younger than 75 and those older than 75 with no additional stroke risk factors (other than old age) such as high blood pressure or heart disease. In SPAF III, investigators studied the remaining 40% of AF patients with additional risk factors for stroke and for whom warfarin had been shown effective. The trial tested whether a combination of a fixed, low dose of warfarin plus aspirin would work as well as standard warfarin therapy. The
Guidelines 53
benefit of standard warfarin therapy over the combination therapy became apparent to the investigators early in the trial, prompting them to stop the trial in 1996 and recommend standard warfarin therapy, administered under strict medical supervision, for all patients over 75 with AF and additional stroke risk factors.
Trial of Org 10172 in Acute Stroke Treatment (TOAST) TOAST was a 7-year phase III clinical trial involving 1,281 subjects at 36 centers across the country. The goal of the NINDS-sponsored study was to discover the effectiveness of low-molecular-weight (LMW) heparinoid (danaparoid/Org 10172) combined with conventional care in improving outcomes of stroke patients at 7 days and at 3 months after ischemic stroke compared to conventional therapy alone. The study found that the anticlotting drug Org 10172 started within 24 hours after a stroke has little effect in producing a good outcome or in preventing a second stroke in most patients. TOAST was the largest trial ever of an intravenously administered anticoagulant drug for the treatment of acute ischemic stroke. The findings, published in 1998, are important in that they may bring about a change in the way the medical community treats ischemic stroke. For many years it has been common practice to administer anticoagulants to patients after a stroke in an effort to limit brain injury and prevent recurrent strokes. However, the results of this study showed that, for most patients, this therapy may not work and physicians and investigators should focus on other types of acute stroke therapies, such as thrombolytic agents.
More Guideline Sources The guideline above on stroke is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to stroke. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with stroke. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
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Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on stroke and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
About Dementia Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1994. 15 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733; FAX (413) 665-2671. Price: $1.00 each for up to 24 copies. Shipping and handling determined by amount of purchase. ORDER NUMBER: 38174. Summary: This booklet offers supportive advice on living with an older person with the symptoms of dementia. It discusses treatments and suggests ways to help patients cope with daily life. It explains the
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irreversible causes of dementia including stroke, Parkinson's disease, and Acquired Immunodeficiency Syndrome (AIDS); and the reversible causes including thyroid problems and poor nutrition. It stresses that some forms of dementia are treatable; urges early diagnosis; and lists sources of assistance. ·
Los Angeles Caregiver Resource Center: Part of a Statewide System of Regional Resource Centers Serving Families and Care Givers of Brain Impaired Adults Source: Los Angeles, CA: Los Angeles Caregiver Resource Center. 1991. [6 p.]. Contact: Available from Los Angeles Caregiver Resource Center. 3715 McClintock Avenue, Los Angeles, CA 90089-0191. (213) 740-8711 or (800) 540-4442. Price: Free. Summary: This brochure describes the Los Angeles Caregiver Resource Center, a program of the Andrus Older Adult Center at the University of California. The Center is part of a statewide system of regional resource centers serving families and caregivers of adults with permanent brain impairment due to Alzheimer's disease and other dementing illnesses, stroke and other cerebrovascular accidents, traumatic brain injury, brain tumors, and other conditions. The Center assists these caregivers directly by providing the following services: information and community resources, support groups, family consultations, respite care, legal and financial consultations, and workshops on issues related to caregiving. Families who reside in Los Angeles County are eligible for some or all of the services. The brochure describes these services and provides contact information for further inquiries.
·
Un Compendio Sobre La Enfermedad De Alzheimer. [Summary on Alzheimer's Disease] Source: Chicago, IL: Alzheimer's Association. 1988. 12 p. Contact: Alzheimer's Association. 919 North Michigan Avenue, Suite 1000, Chicago, IL 60611-1676. (800) 272-3900; (312) 335-8700; (312) 3358882 (TDD); FAX (312) 335-1110. Price: $9.00/set of 100. Summary: This brochure, written in Spanish, provides basic information on the various aspects of Alzheimer's disease. It describes the symptoms of the disease and how it differs from other disorders affecting the brain such as atherosclerosis, dementia and minor stroke. Alzheimer's disease progresses gradually, presenting symptoms that include impaired memory and intellectual functioning and generally affects people over 65 years old. As the disease progresses, patients experience confusion and
56 Stroke
disorientation and are unable to perform daily activities. There is no specific test to detect Alzheimer's disease; diagnosis must be made through a series of physical, psychological and neurological tests. There is no known cure or treatment for Alzheimer's disease, but recent research shows progress in this area. The brochure concludes with a list of suggested readings and a glossary of commonly used terms. ·
Del Oro Caregiver Resource Center for Caregivers of Brain Impaired Adults Source: Carmichael, CA: Del Oro Caregiver Resource Center. 6 p. Contact: Available from Del Oro Caregiver Resource Center. 5713A Marconi Avenue, Suite 300, Carmichael, CA 95608. (800) 635-0220 or (916) 971-0893. Price: Free. Summary: This brochure describes the goals, services, and eligibility requirements of a program provided by a California Regional Resource Center to aid adults who suffer from brain impairment due to various causes (Alzheimer's, Parkinson's, Huntington's and other degenerative diseases of the brain; stroke; traumatic brain injury; brain tumors). The Center was founded in 1984 to establish a coordinated resource system to meet the needs of brain impaired adults through assistance to their families, professionals, and other caregivers. The Center supplies information and referral services to caregivers of brain impaired adults, and provides contractual services for legal and financial advice, family counseling, respite care, and diagnostic assessment.
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Help for Apraxia Source: Oceanside, CA: Academic Communication Associates. 1995. 5 p. Contact: Available from Academic Communication Associates. P.O. Box 586248, Oceanside, CA 92058-6249. (619) 758-9593; Fax (619) 758-1604; Email:
[email protected]; http://www.acadcom.com. Price: Single copy free; $13.00 for package of 10 booklets. Item Number 49912-T6. Summary: This brochure familiarizes readers with apraxia, a neurological communication disorder that is often observed following a stroke or a traumatic brain injury. Individuals with apraxia exhibit speech difficulties in situations where they make conscious, voluntary efforts to produce speech. The author outlines behaviors commonly observed in apraxia and lists guidelines for remediation. The author stresses that words commonly used in the classroom or in the work environment should be emphasized to help the individual communicate effectively in these situations. The brochure concludes with a brief section emphasizing the importance of a team approach in any apraxia treatment program.
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·
Adult Aphasia: Understanding the Disability Source: Cambridge, MA: Department of Communication Disorders, Youville Hospital and Rehabilitation Center. 1994. 12 p. Contact: Available from Youville Hospital and Rehabilitation Center. Department of Communication Disorders, 1575 Cambridge Street, Cambridge, MA 02138-4398. (617) 876-4344. Price: $4.00 each. Summary: This manual helps family members and caregivers understand adult aphasia, a language disability that is often the result of a stroke (cerebrovascular accident or CVA). The manual reminds readers that each individual's recovery will vary, depending on the severity of the stroke and other factors. The manual provides definitions of related terms and then discusses aphasia and its impact on expression and understanding. The authors then discuss complications, including factors that may affect the communication interaction, sensation loss, and visual field cuts. A lengthy section provides suggestions for helping the patient to remain a person and stay involved in his or her own health care. Additional sections address loss of independence, automatic (nonpropositional) speech, emotional lability, the time commitments required for effective communication, perseveration, interpersonal relationships, and medical follow ups. The manual concludes with a question and answer section. Comments from patients and caregivers are included throughout the text. 3 figures. 2 references. (AA-M).
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Three Precious Things in Life. [Tres Cosas Lindas Hay en la Vida] Source: Tucson, AZ: National Center for Neurogenic Communication Disorders, University of Arizona. 199x. 24 p. Contact: Available from National Center for Neurogenic Communication Disorders, University of Arizona. P.O. Box 210071, Tuscon, AZ 857210071. (502) 621-1472. E-mail:
[email protected]. Website: cnet.shs.arizona.edu. Price: Single copy free. Summary: This photo novella, available in English or Spanish, tells the story of a woman who has had a stroke. The woman's adult daughters help her to understand how important it is to see a physician when symptoms of a stroke are present. The story, told through photographs and dialog, covers the chronological events from stroke symptoms through recovery and rehabilitation. The story presents post-stroke language and speech issues, explains the connection between stroke and aphasia, and emphasizes the importance of seeking immediate medical care. The language used in the story is colloquial and easy to read.
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·
Discussion of Facial Nerve Problems Source: Los Angeles, CA: House Ear Institute. 199x. 19 p. Contact: Available from House Ear Institute. 2100 West Third Street, Fifth Floor, Los Angeles, CA 90057. Voice (213) 483-4431; TTY (213) 484-2642; Fax (213) 483-8789; http://www.hei.org. Price: $1.00 per booklet. Summary: This brochure provides basic information about facial nerve disorders. The author describes the function of the facial nerve and several diagnostic tests for facial nerve disorders. Conditions resulting in facial nerve weakness such as Bell's Palsy and Herpes Zoster, their medical and surgical treatments, and the risks and complications of each are described. Other topics include myringoplasty, tympanoplasty, the modified radical mastoidectomy, the mastoid obliteration operation, acoustic tumors, facial nerve neuroma, hypoglossal-facial nerve anastomosis, mastoid infection, postoperative facial nerve weakness, hemifacial spasm, and brain disease (i.e., stroke). The brochure notes that facial nerve disorders are accompanied at times by a hearing impairment; this impairment may or may not be related to the facial nerve problem. An ear specialist is often called upon to manage facial nerve problems because of the close association of this nerve with the ear structures. 2 figures. 2 tables. (AA-M).
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Effective Communication with the Aphasic Person Source: Englewood, CO: National Stroke Association. 199x. 8 p. Contact: National Stroke Association. 8480 East Orchard Road, Englewood, CO 80111-5015. (303) 771-1700. Price: Single copy free. Summary: This pamphlet describes aphasia, which is an impairment in language and communication ability due to brain injury. The publication educates caregivers and family about how to communicate with people who have aphasia. The pamphlet discusses the communication difficulties that individuals with aphasia have in listening and understanding language, gesturing, reading, and speaking. The document lists additional materials concerning stroke and recovering from a stroke.
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Augmentative Communication: Consumers Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 199x. 36 p. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888)
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498-6699. TTY (301) 897-0157. Website: www.asha.org. Price: $1.50 per booklet. Item Number 0210251. Summary: This consumer information booklet describes the use of augmentative communication for people who can hear but have little or no usable speech. Such severe communication disabilities can result from severe language delay, cerebral palsy, mental retardation, autism, traumatic brain injury (TBI), or stroke. In addition, a variety of specific neuromuscular disorders, such as amyotrophic lateral sclerosis (ALS), dystonia, Huntington's disease, multiple sclerosis, and muscular dystrophy can also cause severe speech problems. Augmentative communication is defined as any method other than speech, to send a message from one person to another. Techniques of augmentative communication range from specialized gestures and sign language to communication aids such as sign boards to highly specialized computerbased techniques. The booklet emphasizes the implementation of an effective augmentative communication system, regardless of level of sophistication, requires a detailed multidisciplinary assessment, training for the user(s), and regular re-evaluation. The booklet outlines the roles of members of the patient care team, including the speech language pathologist, the occupational therapist, the physical therapist, physicians, the educator, social worker, psychologist, rehabilitation engineer, computer programmer, vocational counselor, audiologist, orthotist, and manufacturers or distributors of communication devices. The author encourages readers to become active partners in their own care or the care of their children with communication disorders. The booklet includes a resource list of professional and consumer groups concerned with augmentative communication. An appendix provides a glossary of some of the terms used in augmentative communication. The booklet is illustrated with black and white photographs. ·
American Speech-Language-Hearing Association Answers Questions About Adult Aphasia Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 199x. (2 p.). Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 897-0157. Website: www.asha.org. Price: Single copy free; bulk orders available. Item Number 0210114. Summary: This brochure provides basic information about adult aphasia. Aphasia is defined as a condition in which an individual has difficulty expressing thoughts and understanding what is said or written by others. The brochure, written in question and answer format, covers some of the
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language problems associated with aphasia, why it takes a person with aphasia so long to respond, swearing in individuals with aphasia, related communication problems caused by stroke or head injury, some of the physical problems connected with brain damage, spontaneous recovery, and support available for the person with aphasia. The brochure stresses both the importance of seeking therapy from a speech-language pathologist and the vital role that family and friends can play in rehabilitation. The brochure includes the toll-free telephone number of the American Speech-Language-Hearing Association (800-638-8255). ·
TLC Makes a Difference Source: Rockville, MD: Treatment and Learning Centers (TLC). 199x. [4 p.]. Contact: Available from Treatment and Learning Centers (TLC). 9975 Medical Center Drive, Rockville, MD 20850. Voice (301) 424-5200; TTY (301) 424-5203; Fax (301) 424-8063. Price: Single copy free. Summary: This brochure describes the Treatment and Learning Centers (TLC), a nonprofit agency providing services to help individuals achieve independence. Their services are particularly designed for children and adults with speech, motor, sensory integrative, and hearing problems; children with learning and language disabilities; typically-developing children with early childhood education needs; and adults who have disabilities and neurological impairments, including brain injury and stroke. The brochure lists the diverse programs of TLC, including the Katherine Thomas School (for children preschool through sixth grade with learning and language disabilities), the Shady Grove Early Learning Center, the Family Hearing Center, the Outcomes Neuro Rehab Center, and Camp Littlefoot. TLC also offers outpatient therapy services, psychoeducational testing and tutoring, and community education programs. The brochure provides quotes from TLC clients, a list of accreditations and licenses, and a list of telephone numbers for accessing TLC services. A map and directions to the facility are also provided.
·
Augmentative Communication for General Public Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 1987. 20 p. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 897-0157. Website: www.asha.org. Price: $1.50 each; $6.00 for set of four.
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Summary: This booklet introduces augmentative communication, a method of communication that uses a variety of techniques, from simple headshaking, gestures and pointing, to sign language, communication boards, and computers. The booklet describes how augmentative communication can promote social interaction, personal growth and independence; facilitate speech and language development; help students with severe speech and language impairments participate in the classroom; and enhance vocational opportunities. The booklet then describes how augmentative communication is taught and utilized. The next section describes how readers can help facilitate augmentative communication by locating resources, getting an evaluation, obtaining funds to purchase a communication aid, and becoming a communication partner. The booklet concludes with a list of communication tips and a directory of resource organizations and manufacturers. Throughout the booklet, the stories of two people with communication disorders (a child with cerebral palsy, and a 47-year-old woman who had a stroke) are presented, including how they learned to use augmentative communication and its impact on their lives. 4 figures. ·
One Sip at a Time: Making the Best of Swallowing Problems Source: Atlanta, GA: Pritchett and Hull Associates, Inc. 1995. 32 p. Contact: Available from Pritchett and Hull Associates. 3440 Oakcliff Road, Northeast, Suite 110, Atlanta, GA 30340-3079. (800) 241-4925. Fax (800) 752-0510. Price: $3.15 each. Summary: This booklet helps caregivers understand swallowing problems and the steps that can be taken to help overcome them. The booklet notes that dysphagia (trouble with swallowing) is often caused by a traumatic brain injury (TBI) or stroke. While in the hospital, the patient gets therapy to learn how to swallow and eat again. When the patient is ready to go home, the role of the caregiver becomes very important. The booklet outlines recommendations for before the loved one comes home, including arranging for a relief person, making sure instructions are clear and understood, and knowing the goals the health team has set for the patient; strategies for soon after the patient returns home, including ways to help the patient feel more in control of his or her own progress; what to eat and drink, including soft foods, chopped foods, and a soft diet, and the differences between extra thick, thick, and thin liquids; utilizing the services of a dietitian and a speech language pathologist (SLP); the different types of swallowing problems; techniques to improve swallowing; adaptive equipment, including special utensils, plates and cups; preventing the problem of silent aspiration; and when to call the doctor or SLP. The booklet concludes with a review of safety
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problems and what to do, as well as with a reminder that caregivers also need a support system. The booklet includes a number of charts and forms for recordkeeping and listing resources. Simple, cartoonlike line drawings illustrate each of the concepts presented. ·
Prevent Diabetes Problems: Keep Your Heart and Blood Vessels Healthy. Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2000. 17 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 907-8906. E-mail:
[email protected]. Price: Single copy free. Summary: This illustrated booklet, written in nontechnical language, uses a question and answer format to provide people who have diabetes with information on preventing heart and blood vessel problems caused by diabetes. The heart and blood vessels can be damaged by having high blood sugar, high blood pressure, and high blood cholesterol; smoking; eating foods that contain saturated fat and cholesterol; and being overweight and physically inactive. Diabetes is a risk factor for high blood cholesterol. When cholesterol is too high, the insides of large blood vessels become clogged and narrowed. This makes it harder for blood to get to all parts of the body. Heart problems caused by clogged and narrowed arteries include chest pain, heart attack, and cardiomyopathy. The booklet explains how a person can prevent heart and blood vessel problems and peripheral vascular disease, how heart disease causes high blood pressure, and how clogged blood vessels can damage the legs and feet. Other topics include the warning signs of a stroke and the medical tests that will help keep track of heart and blood vessel problems. The booklet also provides general tips for staying healthy. In addition, the booklet includes sources of information about diabetes and describes the activities of the National Diabetes Information Clearinghouse. Also available in Spanish.
·
Strategies for Communication Source: Ann Arbor, MI: University of Michigan Communicative Disorders Clinic. 1998. 10 p. Contact: Available from University of Michigan Communicative Disorders Clinic. 1111 East Catherine Street, Ann Arbor, MI 48109-2054. (734) 764-8440. Price: Single copy free.
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Summary: This group of fact sheets offers concrete strategies for improving communication with people who have communication disorders, including those due to brain trauma or stroke. The first sheet reviews general tips for things to remember in all communication strategies. Tips are offered in two complementary lists: one for the communication partner and one for the survivor (person with the communication disorder). Additional sheets offer suggestions for auditory comprehension, for reading comprehension, for the survivor who uses jargon, for the survivor who swears or curses, for diffusing anger, for the survivor who is vague or who gives up, for writing, and for drawing. Throughout, the suggestions focus on being patient, trying alternative methods of communication (such as gesture, drawing pictures, or writing), trying again another time, and being as clear as possible. ·
Sources of Health Materials for African Americans, American IndianAlaska Natives, Asians, Hispanics, Pacific Islanders Source: Washington, DC: Office of Minority Health Resource Center. October 1997. 56 p. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. Price: Single copy free. Summary: This bibliography lists sources of health materials that are written specifically for the needs of certain ethnic groups. This bibliography includes five sections: African Americans, American Indians (including Alaska Natives), Asians, Hispanics, and Pacific Islanders. The first section concentrates on health materials identified by the Office of Minority Health Resource Center (OMH-RC) as specifically targeting African Americans and includes resources on nutrition, exercise, and AIDS educational materials. This section also includes cancer, chemical dependency, diabetes, heart disease and stroke, infant mortality, and the associated risk factors. The second section lists culturally sensitive printed health materials identified for American Indians and includes sources of information for AIDS, cancer, child development, diabetes, high blood pressure, nutrition, and substance abuse. The third section includes culturally sensitive health materials identified in various Asian languages and lists resources on nutrition, exercise, and AIDS education. The fourth section covers health materials specifically targeting different Hispanic populations, noting that culturally sensitive and universally appropriate Spanish language materials for this diverse population are difficult to obtain and some do not take culture, linguistics and other factors that may influence health
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behaviors into consideration. The final section lists sources that produce or distribute health promotion materials for Pacific Islander populations. The listing includes sources of information for AIDS, diabetes, hepatitis, sexually transmitted diseases, and thalassemia, as well as other health areas. Each of the five sections offers a brief introduction, a listing of subject topics covered, and the organizations or publishers that serve as sources for the health materials. Representative publications (including audiovisual materials) are listed and briefly annotated under each organization. ·
Hispanic: Sources of Spanish Language Health Materials Source: Washington, DC: Office of Minority Health Resource Center. October 1997. [15 p.]. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. Price: Single copy free. Summary: This chapter is from a bibliography that lists sources of health materials that are written specifically for the needs of certain ethnic groups. The bibliography includes five sections: African Americans, American Indians (including Alaska Natives), Asians, Hispanics, and Pacific Islanders. This chapter lists health materials specifically targeting different Hispanic populations, noting that culturally sensitive and universally appropriate Spanish language materials for this diverse population are difficult to obtain and some do not take culture, linguistics and other factors that may influence health behaviors into consideration. The listing includes sources of information for cancer, chemical dependency, diabetes, heart disease and stroke, infant mortality, kidney disease, high blood pressure, women's health, and health-associated risk factors. The chapter includes a brief introduction, a listing of subject topics covered, and the organizations or publishers that serve as sources for the health materials. Representative publications (including audiovisual materials) are listed and briefly annotated under each organization. Organizations included in the listing should be contacted directly to determine the cost and availability of bulk quantities and for permission to photocopy.
·
African American: Sources of Health Materials Source: Washington, DC: Office of Minority Health Resource Center. October 1997. [12 p.].
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Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. Price: Single copy free. Summary: This chapter is from a bibliography that lists sources of health materials that are written specifically for the needs of certain ethnic groups. The bibliography includes five sections: African Americans, American Indians (including Alaska Natives), Asians, Hispanics, and Pacific Islanders. This chapter concentrates on health materials identified by the Office of Minority Health Resource Center (OMH-RC) as specifically targeting African Americans and includes resources on nutrition, exercise, and AIDS educational materials. This section also includes cancer, chemical dependency, diabetes (including diabetesrelated kidney disease), heart disease and stroke, infant mortality, and the associated risk factors. The chapter includes a brief introduction, a listing of subject topics covered, and the organizations or publishers that serve as sources for the health materials. Representative publications (including audiovisual materials) are listed and briefly annotated under each organization. Organizations included in the listing should be contacted directly to determine the cost and availability of bulk quantities and for permission to photocopy. ·
FitForce, Kit 3: Shooting Down Cholesterol Source: Champaign, IL, Human Kinetics, 10-minute VHS videotape, poster, 19-page instructor's manual, 1995. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825-5076. (800) 747-4457; (217) 351-5076. Summary: FitForce, Kit 3: Shooting Down Cholesterol, an information package, is part of a program called FitForce, which is intended to improve the fitness level of law enforcement officers. Program goals include building strength, eating properly, preventing back pain, controlling cholesterol, and coping with stress. A VHS videotape begins with an officer describing the fear he experienced when he learned that he faced heart surgery. Heart disease is the cause of half of the disability retirements among law enforcement officers. In addition, a police officer is 15 to 20 times more likely to die from a heart attack than from being killed in the line of duty. Factors that increase the risk for heart attack include a high-fat diet, lack of exercise, stress, and a family history of heart disease. Methods of reducing one's risk for heart attack include lowering blood pressure, losing weight, and not smoking. In the videotape, a health professional at a rehabilitation facility explains that the fewer predisposing factors a person has, the faster the recovery from stroke and the greater the likelihood that a stroke can be prevented. The
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degree of artery blockage can even be reversed by eating well, exercising, and not smoking. Other materials in the information package include instructions and a timeline for a 2-month program; a sample program announcement; optional program ideas, such as publications and seminars; tips for lowering cholesterol; a low-fat shopping list; a fact sheet on the effects of cholesterol on the body; a fact sheet listing risk factors for high cholesterol; a lesson plan with objectives and content; text for transparencies; a poster to publicize the program; and an evaluation form. ·
FitForce, Kit 6: Eating for Performance and Health Source: Champaign, IL, Human Kinetics, 7-minute VHS videotape, poster, 19-page instructor's manual, 1995. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825-5076. (800) 747-4457; (217) 351-5076. Summary: FitForce, Kit 6: Eating for Performance and Health, an information package, is part of a program called FitForce, which is intended to improve the fitness level of law enforcement officers. Program goals include building strength, eating properly, preventing back pain, controlling cholesterol, and coping with stress. A VHS videotape begins with an officer talking about the few restaurants that are open during night shifts. Fast food and its effects on health are discussed, including obesity, which is a factor in heart disease. Poor eating habits can lead to heart disease, stroke, increased blood pressure, and cancer. Police officers discuss problems caused by being overweight, including not being able to run fast enough to assist fellow officers in an arrest. Making wise food choices involves eating more salads, vegetables, fruit, bread, rice, and pasta, and fewer foods that contain fat, cholesterol, and sodium. Abstaining from alcohol and drinking more water and fewer caffeine products is recommended. A dietitian advises choosing lower-fat selections, such as grilled chicken sandwiches, in fast food restaurants. She stresses the importance of balance, moderation, and variety in one's diet. The videotape concludes by emphasizing the benefits of making dietary changes. The information package also contains instructions and a timeline for use during a 2-month program; a sample announcement; optional program activities; the telephone number of a nutrition hotline; a fact sheet outlining the dietary guidelines from the Department of Agriculture; information about the new food label developed by the Food and Drug Administration; a lesson plan with objectives and content; text for transparencies; a poster to publicize the program; and an evaluation form.
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·
Healthy Achievers: Achieving Lean Living. Kit 5 Source: Champaign, IL, Human Kinetics Publishers, 8-minute VHS videotape, 1 display poster, and several handouts, 1994. Contact: Human Kinetics Publishers, 1607 North Market Street, P.O. Box 5076, Champaign, IL 61825. (217) 351-5076. (800) 747-4457. Summary: The Healthy Achievers: Achieving Lean Living, is the fifth kit in a 6-part worksite wellness program entitled Healthy Achievers. Each kit contains everything needed to present informational and educational health promotion topics to employees: (1) A 5- to 10-minute video on a specific health topic, (2) kit instructions, (3) an activity timeline, (4) an announcement memorandum for employees, (5) a 22 X 17 inch program poster and 2 or 3 smaller display posters, (6) a health article for the company newsletter, (7) two reproducible table tents, (8) various reproducible handouts and quizzes to spark employee interest, (9) a list of additional resources, (10) participant and facilitator evaluation forms, and (11) ideas and forms for activities that can be used to expand the program. The Achieving Lean Living kit discusses reasons why diets don't work and outlines ways to maintain a trim and healthy body. Eighty percent of Americans feel that they need to lose some weight, and Americans spend $92 million dollars annually on diet products and services. Research has shown that 95 percent of those who lose weight from diets gain the weight back within 5 years. Most diets do not work for the following reasons: (1) They decrease metabolism; (2) they increase girth; (3) they induce overeating patterns; (4) they fail to provide permanent lifestyle changes; (5) they destroy self-esteem; and (6) for many people, hereditary predetermines their body size and appearance. Permanent changes in lean living habits can be attained by increasing activity levels, eating nutritiously and sensibly, and maintaining positive self-esteem. Obesity can increase risk for (1) hypertension, (2) diabetes, (3) gall bladder disease, (4) a variety of cancers, (5) heart attacks, and (6) stroke. The videotape asserts that health goals should center not around weight loss but rather the implementation of lean living habits. The individual should attempt to burn 300 calories daily, an amount that can be burned by a 60-minute moderate workout or a 30-minute vigorous workout.
·
HeartCare Program Source: Minneapolis, MN, Hall-Foushee Productions, Inc., 44-page leader manual, 15-page consumer booklet, four VHS videotapes, staff audiotape, 14 reproducible handouts, four class posters, shopping guide card, 1994.
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Contact: Hall-Foushee Productions, Inc., 1313 5th Street SE., Suite 214-B, Minneapolis, MN 55414. (800) 478-3829; (612) 379-3829. Summary: The HeartCare Program is intended for people interested in healthier eating for weight loss and reduced risk of cancer, diabetes, heart disease, and stroke. It emphasizes high blood cholesterol and includes a kit with sections on (1) how to use the HeartCare Program; (2) worksite, hospital, public screening program, and medical clinic implementation and suggested uses; (3) options for viewing the HeartCare videotapes; (4) a profile for a successful clinic program; (5) common questions and answers; and (6) facts about high blood cholesterol and coronary heart disease. It also contains a 4-class curriculum for teaching the HeartCare class series with leader's scripts for each class and tips for teaching the HeartCare class series. Class topics are (1) Eating to Live, Living to Eat; (2) Up With Fiber! Down With Fat!; (3) Low-fat Eating in a High-fat World; and (4) Tomorrow's Kitchen. The kit also contains videotapes related to the class topics; handouts such as a fat-finding test, a promise of no-nag support, a fiber and fat IQ test, and label lingo information; and an audiocassette containing advice for staff using the program. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “stroke” or synonyms. The following was recently posted: ·
ACR Appropriateness Criteria™ for cerebrovascular disease. Source: American College of Radiology.; 1996 (revised 2000); 21 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1663&sSearch_string=Stroke
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Antithrombotic and thrombolytic therapy for ischemic stroke. In: Sixth ACCP Consensus Conference on Antithrombotic Therapy. Source: American College of Chest Physicians.; 2001 January; 21 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1959&sSearch_string=Stroke
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·
Management of patients with stroke. I: assessment, investigation, immediate management and secondary prevention. A national clinical guideline. Source: Scottish Intercollegiate Guidelines Network.; 1997 May; 27 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2122&sSearch_string=Stroke
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Management of patients with stroke. II: management of carotid stenosis and carotid endarterectomy. A national clinical guideline. Source: Scottish Intercollegiate Guidelines Network.; 1997 May; 37 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2123&sSearch_string=Stroke
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Management of patients with stroke. IV: rehabilitation, prevention and management of complications, and discharge planning. A national clinical guideline. Source: Scottish Intercollegiate Guidelines Network.; 1998 April; 26 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2126&sSearch_string=Stroke
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Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke. Source: Canadian Task Force on Preventive Health Care.; 1999; 8 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1931&sSearch_string=Stroke
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Preventive health care, 2000 update. Use of ambulatory electrocardiography for the detection of paroxysmal atrial fibrillation in patients with stroke. Source: Canadian Task Force on Preventive Health Care.; 2000; 7 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1929&sSearch_string=Stroke
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Recommendations for the establishment of primary stroke centers. Source: Brain Attack Coalition.; 2000 June; 8 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1784&sSearch_string=Stroke
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Tissue plasminogen activator (t-PA) for acute ischemic stroke. Source: Daniel Freeman Hospitals, Inc.; 1997 June http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0472&sSearch_string=Stroke
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to stroke. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Agnosia: Loss of the ability to comprehend the meaning or recognize the importance of various forms of stimulation that cannot be attributed to impairment of a primary sensory modality. Tactile agnosia is characterized by an inability to perceive the shape and nature of an object by touch alone, despite unimpaired sensation to light touch, position, and other primary sensory modalities. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH]
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Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anoxia: A total lack of oxygen; often used interchangeably with hypoxia to mean a reduced supply of oxygen to the tissues. [EU] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aphasia: Defect or loss of the power of expression by speech, writing, or signs, or of comprehending spoken or written language, due to injury or disease of the brain centres. [EU] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH]
Guidelines 73
Arteriography: Roentgenography of arteries after injection of radiopacque material into the blood stream. [EU] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Asparaginase: A hydrolase enzyme that converts L-asparagine and water to L-aspartate and NH3. EC 3.5.1.1. [NIH] Aspiration: The act of inhaling. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atrial: Pertaining to an atrium. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autopsy: Postmortem examination of the body. [NIH] Beauty: Characteristics or attributes of persons or things which elicit pleasurable feelings. [NIH] Calcification: The process by which organic tissue becomes hardened by a deposit of calcium salts within its substance. [EU] Cardiac: Pertaining to the heart. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Caspases: A family of intracellular cysteine endopeptidases. They play a key role in inflammation and mammalian apoptosis. They are specific for aspartic acid at the P1 position. They are divided into two classes based on the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10 have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-. [NIH]
Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Cholesterol: The principal sterol of all higher animals, distributed in body
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tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constriction: The act of constricting. [NIH] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Diastolic: Of or pertaining to the diastole. [EU]
Guidelines 75
Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Dysphagia: Difficulty in swallowing. [EU] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Electrocardiography: The making of graphic records of the variations in electrical potential caused by electrical activity of the heart muscle and detected at the body surface, as a method for studying the action of the heart muscle. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Facial: Of or pertaining to the face. [EU] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Gestures: Movement of a part of the body for the purpose of communication. [NIH]
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Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemiplegia: Paralysis of one side of the body. [EU] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hibernation: The dormant state in which some animal species pass the winter. It is characterized by narcosis and by sharp reduction in body temperature and metabolic activity and by a depression of vital signs. It is a natural physiological process in many warm-blooded animals. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU]
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Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kinetic: Pertaining to or producing motion. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or
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somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Nimodipine: A calcium channel blockader with preferential cerebrovascular activity. It has marked cerebrovascular dilating effects and lowers blood pressure. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parietal: 1. of or pertaining to the walls of a cavity. 2. pertaining to or located near the parietal bone, as the parietal lobe. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Postmenopausal: Occurring after the menopause. [EU]
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Postoperative: Occurring after a surgical operation. [EU] Preclinical: Before a disease becomes clinically recognizable. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Prothrombin: Factor II. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Shunt: 1. to turn to one side; to divert; to bypass. 2. a passage or anastomosis between two natural channels, especially between blood vessels. Such structures may be formed physiologically (e.g. to bypass a thrombosis) or they may be structural anomalies. 3. a surgically created anastomosis; also, the operation of forming a shunt. [EU]
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Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Thalamus: Either of two large, ovoid masses, consisting chiefly of grey substance, situated one on each side of and forming part of the lateral wall of the third ventricle. It is divided into two major parts : dorsal and ventral, each of which contains many nuclei. [EU] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Thrombolytic: 1. dissolving or splitting up a thrombus. 2. a thrombolytic agent. [EU] Thrombosis: The formation, development, or presence of a thrombus. [EU] Ticlopidine: Ticlopidine is an effective inhibitor of platelet aggregation. The drug has been found to significantly reduce infarction size in acute myocardial infarcts and is an effective antithrombotic agent in arteriovenous fistulas, aorto-coronary bypass grafts, ischemic heart disease, venous thrombosis, and arteriosclerosis. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Toxicity: The quality of being poisonous, especially the degree of virulence
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of a toxic microbe or of a poison. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebral: Of or pertaining to a vertebra. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH]
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CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with stroke. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.11 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with stroke. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Stroke As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.12 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 12 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 11
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influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Health Assistance Foundation Address: American Health Assistance Foundation 15825 Shady Grove Road, Suite 140, Rockville, MD 20850 Telephone: (301) 948- 3244 Toll-free: (800) 437-2423 Fax: (301) 258-9454 Web Site: http://www.ahaf.org Background: The American Health Assistance Foundation (AHAF) is a national nonprofit health organization dedicated to raising funds for scientific research on age-related and degenerative diseases, educating the public about these diseases, and providing financial assistance to Alzheimer's disease patients and their caregivers. Some of the age-related and degenerative diseases with which AHAF is concerned include Alzheimer's disease, macular degeneration, glaucoma, heart disease, and stroke. AHAF is an umbrella organization comprised of five separate and distinct programs: Alzheimer's Disease Research, National Glaucoma Research, Macular Degeneration Research, National Heart Foundation, and the Alzheimer's Family Relief Program. Currently AHAF supports 22 investigations focusing on the causes of and potential cures for Alzheimer's disease, 16 research projects studying glaucoma, and nine studies of heart disease and stroke. Since its inception in 1973, AHAF has awarded more than $42 million in research grants. The Alzheimer's Family Relief Program has provided more than $1.4 million in emergency assistance grants since it began in 1988. The Foundation produces educational materials including brochures, pamphlets, booklets, and a regular newsletter. AHAF also maintains a web site on the Internet at http://www.ahaf.org. Relevant area(s) of interest: Stroke
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·
American Heart Association Address: American Heart Association National Center, 7272 Greenville Avenue, Dallas, TX 75231-4596 Telephone: (214) 373-6300 Toll-free: (800) 242-8721 Fax: (214) 373-0268 Email:
[email protected] Web Site: http://www.americanheart.org Background: The American Heart Association (AHA), a national not-forprofit voluntary health agency funded by private contributions, is dedicated to the reduction of death and disability from cardiovascular diseases including heart diseases and stroke. The Association consists of approximately 2,000 community organizations in all states, the District of Columbia, and Puerto Rico. More than 4 million people volunteer with the Association to fight cardiovascular diseases, the nation's number one cause of death and leading cause of disability. Preventing heart disease and stroke is the first priority of the American Heart Association. In support of this goal, the Association has contributed more than one billion dollars to cardiovascular research since 1949. The Association also distributes a variety of educational materials and sponsors continuing medical education (CME) seminars and meetings. Relevant area(s) of interest: Stroke
·
Dana Alliance for Brain Initiatives Address: Dana Alliance for Brain Initiatives 745 Fifth Avenue, Suite 700, New York, NY 10151 Telephone: (212) 223-4040 Toll-free: (800) 445-8106 Fax: (212) 593-7623 Email:
[email protected] Web Site: http://www.dana.org Background: The Dana Alliance for Brain Initiatives, a nonprofit organization supported by the Charles A. Dana Foundation, was established as an alliance of neuroscientists dedicated to providing information and promoting understanding concerning the personal and public benefits of brain research. (The Charles A. Dana Foundation is a private philanthropic foundation with grant programs in health and education.) Established in 1993, the Dana Alliance for Brain Initiatives currently consists of more than 175 neuroscientists. Alliance members have set 10 main objectives in brain research that are considered obtainable by the Year 2000. These objectives include the identification of
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the genes that are defective in familial Alzheimer's and Huntington's diseases; identification of genes responsible for hereditary forms of manic- depressive illness; and development of new drugs and other measures to alleviate the effects of multiple sclerosis, Alzheimer's disease, Parkinson's disease, motor neuron disease such as Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease), and epilepsy. Many of the 10 objectives have been met, and significant progress is being made on all 10 objectives. According to the Alliance, approximately one in five Americans is affected by a brain disease or disorder, ranging from learning disabilities to Parkinson's Disease from epilepsy to spinal cord injuries. The Dana Alliance for Brain Initiatives is dedicated to answering questions concerning brain-related research and providing information concerning new developments. The Alliance offers a variety of periodicals, newsletters, reports, reference works, and books. The Dana Alliance and the Dana Foundation also have a web site on the Internet that provides information on current activities and services, describes the Dana Alliance's objectives, offers information concerning available publications, and provides comprehensive dynamic linkage through the Dana BrainWeb. The Dana BrainWeb recommends several Internet sites as helpful resources for individuals concerned about brain diseases and disorders. The Dana Foundation and Alliance web site is located at http://www.dana.org. Relevant area(s) of interest: Headaches, Stroke ·
Disabled Sports USA Address: Disabled Sports USA 451 Hungerford Drive, Suite 100, Rockville, MD 20850 Telephone: (301) 217-0960 Toll-free: (800) 437-2423 Fax: (301) 217-0968 Email:
[email protected] Web Site: http://www.dsusa.org/~dsusa/dsusa.html Background: Disabled Sports USA (DS/USA) is a not-for-profit organization dedicated to ensuring that disabled people have access to sports, recreation, and physical education programs from preschool through college to elite sports levels. Established in 1967 by disabled Vietnam veterans, DS/USA serves people with physical disabilities that restrict mobility, including amputations, weakness or paralysis of both legs (paraplegia), paralysis of all four limbs (quadriplegia), cerebral palsy, head injury, multiple sclerosis, muscular dystrophy, spina bifida, stroke, and visual impairment. DS/USA consists of more than 60,000 members and 80 chapters around the United States. Educational
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materials include a general information packet, a newsletter entitled 'Disabled Sports USA Update,' and a sports magazine entitled 'Challenge.' Program activities include sporting activities and events, patient education (e.g., workshops), and patient networking. DS/USA maintains a web site at http://www.dsusa.org/~dsusa/dsusa.html. ·
Factor V Leiden, Activated Protein C and Activated Protein SSupport Page and Mailing List Address: Factor V Leiden, Activated Protein C and Activated Protein S Support Page and Mailing List Telephone: (301) 217-0960 Toll-free: (800) 437-2423 Email:
[email protected] Web Site: http://www.fvleiden.org Background: The Factor V Leiden, Activated Protein C and Activated Protein S Support Page and Mailing List is primarily an online mailing list (or 'listserv') dedicated to enabling affected individuals and family members to exchange information, resources, and mutual support. There are several genetic disorders that may result in associated blood clotting (coagulation) abnormalities. Such disorders include Protein S deficiency, Antithrombin III deficiency, and Protein C deficiency, which is often due to a particular mutation known as the factor V Leiden genetic mutation. Of such disorders, the factor V Leiden mutation is considered the most common. The factor V Leiden mutation may result in the abnormal development of blood clots in certain veins (venous thrombosis); unexplained miscarriages in affected females; preeclampsia or eclampsia during pregnancy in affected females; stroke and/or heart attack; and/or other abnormalities. The group's web site provides instructions on how to join the mailing list, a description of the factor V Leiden mutation, and dynamic linkage to additional sources of information on such hereditary blood coagulation disorders. Interested individuals may subscribe to either of two lists: Fvleiden-Support or Fvleiden-Support-Digest. The digest (collection) of each day's messages is sent out at midnight. Those who are interested in subscribing to either list may visit the Factor V Leiden, Activated Protein C and Activated Protein S Support Page and Mailing List's web site for more information.
·
Family Caregiver Alliance Address: Family Caregiver Alliance 425 Bush Street, Suite 500, San Francisco, CA 94108 Telephone: (415) 434-3388 Toll-free: (800) 445-8106
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Fax: (415) 434-3508 Email:
[email protected] Web Site: http://www.caregiver.org Background: The Family Caregiver Alliance, formerly called the Family Survival Project, is a not-for-profit, self-help, advocacy organization dedicated to assisting and supporting caregivers of brain-impaired adults through education, research, services and advocacy. Brain-impaired individuals include those who may have experienced a traumatic brain injury or stroke or been diagnosed with a brain tumor, Alzheimer's Disease, Parkinson's Disease, or other disorders affecting brain function. Established in 1977, The Family Caregiver Alliance provides several services to caregivers in the State of California. For example, the Alliance gives appropriate referrals, including support groups; promotes patient and family advocacy and legislation that is beneficial to affected individuals and families; and supports and promotes research. The Alliance also offers a variety of educational and support materials to caregivers both in California and throughout the United States; such information is provided through its database, directory, quarterly newsletter, reports, brochures, and audio- visual aids. ·
Heart and Stroke Foundation of Canada Address: Heart and Stroke Foundation of Canada 222 Queen Street, Suite 1402, Ottawa, Ontario, K1P 5VP, Canada Telephone: (613) 569-4361 Toll-free: (800) 437-2423 Fax: (613) 569-3278 Email:
[email protected] Web Site: http://www.hsf.ca Background: The Heart and Stroke Foundation of Canada (HSFC) is a national voluntary organization dedicated to furthering the study, prevention, and reduction of disability and death from heart disease and stroke through research, education, and the promotion of healthy lifestyles. The Foundation consists of 10 provincial divisions and a network of community-based volunteers across Canada. To fulfill its mission and objectives, the Foundation offers a variety of programs and services including sponsoring conferences and scientific meetings; offering scientific awards to recognize the merits of medical researchers' contributions; providing advocacy and representation for its provincial divisions; engaging in lobbying efforts; and providing position statements. The Heart and Stroke Foundation of Canada also regularly sponsors campaigns to promote public awareness, including 'Heart
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Month' and 'Health Check,' a food information program to help consumers make wise food choices when shopping for groceries. In addition, the Foundation is committed to providing and maintaining a cardiovascular database that enables Canadian researchers, clinicians, and policymakers to track progress in fighting heart disease. The Foundation also provides regular news releases, health news and statistics, fact sheets on all aspects of stroke and heart disease, 'heart smart' cook books, a video course in cardiopulmonary resuscitation (CPR), and the 'Canadian Family Guide to Stroke.' The Heart and Stroke Foundation of Canada also has a web site on the Internet that discusses its mission, goals, and services; provides information on its provincial divisions; posts news releases, fact sheets, the 'President's Newsletter,' and the Foundation's annual report; and offers a special area entitled the 'Health Smart Family Fun Centre.'. Relevant area(s) of interest: Stroke ·
Kent Waldrep National Paralysis Foundation Address: Kent Waldrep National Paralysis Foundation 16415 Addison Road, Suite 550, Dallas, TX 75248 Telephone: (972) 248-7100 Toll-free: (800) 925-2873 Fax: (972) 248-7313 Email:
[email protected] Web Site: http://www.kwnpf.org Background: The Kent Waldrep National Paralysis Foundation (NPF) is a not-for- profit organization dedicated to raising funds for research to find a cure for paralysis caused by brain injury, spinal cord injury, or stroke. Established in 1985, NPF provides funding to support a comprehensive paralysis research center at UT-Southwestern in Dallas; the Research Scholars Program to attract and train new scientists; Research Grant Programs to support leading edge research; the Medical Symposium Fund to support national and international medical education and information sharing programs; and community service activities for affected individuals to promote a better quality of life through education, employment, and recreational sports opportunities. The Foundation's educational materials include brochures and a regular newsletter. NPF also maintains a web site at http://www.kwnpf.org. Relevant area(s) of interest: Stroke
·
Moving Forward Address: Moving Forward 2934 Glenmore Avenue, Kettering, OH 45409
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Telephone: (937) 293-0409 Toll-free: (800) 445-8106 Email:
[email protected] Web Site: http://www.acor.org/diseases/hematology/mpd Background: Moving Forward is a voluntary not-for-profit self-help organization dedicated to disseminating informational resources concerning Myoclonus to affected individuals and their families. Myoclonus, a syndrome with more than 75 classifications, is a neurological movement disorder characterized by sudden, shock-like, involuntary contractions of muscles. The disorder may interfere with walking, speech, and/or manual activities. Myoclonus may be caused by a chemical imbalance, a brain or spinal cord injury, a stroke, epilepsy, or another underlying disorder. Established in 1995, Moving Forward is a networking group that promotes awareness of Myoclonus and its many different forms; engages in patient and professional education; and promotes and supports research. The organization offers brochures as well as a resource list of books, articles, and videos. Moving Forward also provides a listing of movement disorder clinics throughout the country as well as several organizations that can offer further information, assistance, networking services, and additional support. ·
National Hospice and Palliative Care Organization Address: Telephone: (703) 243-5900 Toll-free: (800) 658-8898 Fax: (703) 525-5762 Email:
[email protected] Web Site: http://www.nhpco.org Background: The National Hospice Organization (NHO) is a national nonprofit membership organization dedicated to promoting and maintaining quality care for terminally ill individuals and their families and making hospice an integral part of the U.S. health care system. Hospice is a comprehensive, medically directed, team-oriented program of care that seeks to treat and comfort terminally ill patients and their families in a home or home-like setting. Established in 1978, the NHO is committed to educating about and advocating for the fundamental philosophy and principles of hospice care to meet the unique needs of each terminally ill person and his or her family. Consisting of approximately 2,200 hospices and 5,000 individual professional members, the NHO engages in patient advocacy and lobbying, promotes research, engages in patient and professional education, and provides referrals. The NHO offers a variety of materials including pamphlets, brochures,
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educational booklets, a resource directory listing hospices throughout the United States by city and state, a journal, and a regular newsletter. The National Hospice Organization also has a web site on the Internet at http://www.nho.org that provides a searchable online directory of hospices in the United States, links to other hospice sites on the web, links to discussion groups, conference information for hospice professionals, and more. Relevant area(s) of interest: Coma, Stroke ·
National Stroke Association Address: National Stroke Association 96 Inverness Drive East, Suite I, Englewood, CO 80112-5112 Telephone: (303) 649-9299 Toll-free: (800) 787-6537 Fax: (303) 649-9486 Email:
[email protected] Web Site: http://www.stroke.org Background: The National Stroke Association (NSA) is a national not-forprofit voluntary health organization dedicated to reducing the incidence and impact of stroke by changing the way it is viewed and treated. During a stroke, interruption of oxygenated blood supply to the brain or leakage of blood outside of blood vessel walls may cause damage to a portion of the brain. Depending upon the exact location and duration of lack of oxygenated blood supply to brain tissue (ischemia), affected individuals may experience a variety of symptoms such as weakness, paralysis, speech impairment, sensory abnormalities, and/or lifethreatening complications. Established in 1984, the National Stroke Association promotes patient, physician, and public education; engages in patient advocacy efforts; and promotes research into improved stroke prevention, treatment, and rehabilitation. The organization, which currently has 14 chapters and approximately 7,000 members, offers networking services that enable affected individuals and family members to exchange information, assistance, and support; maintains a registry; offers support groups; and makes appropriate referrals. In addition, the NSA offers a stroke information hotline and provides a variety of materials including reports, brochures, pamphlets, videos, audiovisual aids, and a quarterly newsletter. Relevant area(s) of interest: Stroke
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·
Smell and Taste Center Address: Smell and Taste Center University of Pennsylvania, 5 Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104 Telephone: (215) 662-6580 Fax: (215) 349-5266 Background: The Smell and Taste Center at the University of Pennsylvania was established in 1980 as the result of funding received from the National Institute of Neurological Disorders and Stroke, the Hoffman Fund, and other sources. It is the first clinical research center in the United States devoted to the senses of taste and smell and has achieved world-wide prominence for its research and clinical activities. In addition, the Center has plans to expand its facilities, clinical service, research programs, and staff. The Center is focused on three primary goals: to provide clinical evaluation, treatment, and counseling for patients ex affected individuals experiencing taste and smell disorders; to provide the facilities and an intellectual focus for research in both basic and applied aspects of chemoreception; and to provide training for students and doctoral level scientists and other interested medical personnel in both basic and applied aspects of chemoreception science. Foreign language translators are available from other departments at the University to speak with callers in most languages.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about stroke. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
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DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “stroke” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “stroke”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “stroke” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with stroke. You should check back periodically with this database since it is updated every 3 months.
The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “stroke” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site:
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http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with stroke must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:13 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at
13
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 95
http://www.abms.org/newsearch.asp.14 You can also contact the ABMS by phone at 1-866-ASK-ABMS. ·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding a Neurologist The American Academy of Neurology allows you to search for member neurologists by name or location. To use this service, go to http://www.aan.com/, select “Find a Neurologist” from the toolbar. Enter your search criteria, and click “Search.” To find out more information on a particular neurologist, click on the physician’s name. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor15 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about stroke?
·
Really listen to my questions?
·
Answer in terms I understood?
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 15 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 14
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·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for stroke?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor16 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
16
Seeking Guidance 97
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:17 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
17
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Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Hospices: Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family. [NIH] Manic: Affected with mania. [EU] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Paraplegia: Paralysis of the legs and lower part of the body. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending cortico-spinal and cortico-bulbar tracts. Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]
Clinical Trials 99
CHAPTER 3. CLINICAL TRIALS AND STROKE Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning stroke.
What Is a Clinical Trial?18 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for stroke is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
18
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What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on stroke.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for stroke compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on stroke carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on stroke. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This treatment, like a placebo, has no effect on stroke and does not harm patients.
Clinical Trials 101
Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how stroke develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for stroke. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help
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find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Stroke The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to stroke.19 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
A study to evaluate the effects of YM872 on brain function and disability when administered in combination with alteplase (tissue plasminogen activator) Condition(s): Acute ischemic stroke Study Status: This study is currently recruiting patients. Sponsor(s): Yamanouchi Pharma America Purpose - Excerpt: The purpose of this study is to determine if YM872 in combination with t-PA can reduce disability and brain damage from stroke. YM872 or placebo will be given as a continuous intravenous (iv) infusion for 24 hours. It is important that the study medication, YM872 or placebo, is administered prior to the completion of the t-PA administration. The clinical effects of YM872 in addition to t-PA will be determined by assessing neurological function and disability scores at follow up visits through Day 90 of the study. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below
19
These are listed at www.ClinicalTrials.gov.
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00044057;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
A study to evaluate the effects of YM872 on stroke lesion volume in acute stroke patients Condition(s): Acute ischemic stroke Study Status: This study is currently recruiting patients. Sponsor(s): Yamanouchi Pharma America Purpose - Excerpt: This study will investigate the effects of a potential neuroprotectant compound, YM872, in the treatment of acute ischemic stroke. The study will determine if a 24-hour infusion of YM872, given within 6 hours of stroke onset, reduces the ischemic lesion volume as measured by MRI at 28 days after the infusion is given. The clinical effects of YM872 will also be determined by neurological function and disability scores at follow up visits through Day 90 of the study. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00044070;jsessionid=850715E 24189833F850C2F9F1F0833A2
·
Aspirin or warfarin to prevent stroke Condition(s): Stroke; Cerebral Infarction; Atherosclerosis; Constriction, Pathologic Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to determine whether aspirin or warfarin is more effective in preventing stroke in patients with intracranial stenosis. Phase(s): Phase III Study Type: Interventional Contact(s): Harriet Howlett Smith, RN 1-404-778-3153
[email protected]; Georgia; Emory University, Atlanta, Georgia, 30322, United States; Recruiting. Study chairs or principal investigators: Marc Chimowitz, Principal Investigator; Emory University
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004728;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Assisted Movement Neuro-Rehabilitation: VA Multi-Site Clinical Trials Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Rehabilitation Research and Development Service Purpose - Excerpt: To justify their use, new neuro-rehabilitation methods must be validated with rigorous clinical trials. Using a prospective, controlled, blinded protocol, our previous study; " Mechanically assisted upper limb movement for assessment and therapy", demonstrated a greater, more rapid movement in upper limb motor recovery when therapy was delivered with robot assistance, compared to traditional training of equal intensity and duration in subjects with chronic hemiplegia. Although the effectiveness of robot-assisted therapy has now been independently demonstrated significant differences exist in the methods used and populations studied. This study will test the following hypotheses: (1) Subjects using the novel, upper limb robotic system developed by the VA and Stanford University (MIME system) experience greater functional gains than a control group receiving conventional therapy of equal intensity and duration during the initial phase of recovery from stroke. (2) Robot assisted therapy results in a dosedependent response. (3) Robot-assisted therapy promotes greater control of movement, greater recovery of strength, and greater reduction of cocontraction than the control intervention. The above hypotheses will be tested through a multi-site clinical trial conducted at the VA Rehabilitation Centers in Houston, Los Angeles,and Palo Alto. Palo Alto Center will serve as the coordinating site and will provide training and technical assistance. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00038324;jsessionid=850715E 24189833F850C2F9F1F0833A2
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·
Automated Constrained-induced Therapy for Restoring Movement after Stroke Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Rehabilitation Research and Development Service Purpose - Excerpt: We propose to develop and evaluate a workstation that significantly enhances the application of Constrained-Induced (CI) Therapy by automating and instrumenting several of the tasks currently used in the shaping training. The motivation for development of such a device is as follows: 1) Patients could receive CI therapy at home without the need for constant supervision from a therapist. Many veterans do not have the resources to travel to their local VAMC for the two or three week period required for the treatment. A home-based device would expand the pool of veterans who could receive CI therapy. 2) For subjects who were able to receive CI therapy in the clinic, this device would facilitate an effective post-treatment home-practice program. 3) Currently, patients are treated on a one-on-one basis in the clinic. This device could allow one therapist to treat 3 or 4 patients at one time, thereby substantially reducing the cost of the therapy. 4) This workstation would provide clear and comprehensive quantification of the progress of the treatment. This could indicate on which tasks the patient was progressing most and least rapidly, and would therefore enable effective modifications of the treatment plan while treatment was in progress. The hypothesis is that the positive outcomes of CI therapy can be achieved, and possibly enhanced, if the shaping training component is performed in a workstation that guides, motivates and records exercise of the more-affected limb. In the first 18 months, the workstation will be designed and fabricated. To expedite the design, we will rely on simple modifications to "off the shelf" components. In the last 18 months, a controlled, randomized, clinical trial will compare the effectiveness of automated CI therapy programs with standard CI therapy. The standard CI therapy group would receive shaping training in a clinical setting, one-on-one with a therapist. The clinic-based automated CI therapy group would perform the shaping training in the workstation, in a clinical setting and with minimal supervision. The home-based automated CI therapy group would perform the shaping training at home in the workstation, and with no direct supervision. All other aspects of the three treatment programs will be identical. At the end of this 3-year project, a device will have been designed, built and evaluated that could significantly enhance the application of CI therapy for chronic stroke patients.
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Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037960;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Carotid Occlusion Surgery Study Condition(s): Stroke; transient ischemic attack (TIA) Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: To determine if extracranial-intracranial bypass surgery when added to best medical therapy can reduce the subsequent risk of ipsilateral stroke in high-risk patients with recently symptomatic carotid occlusion and increased cerebral oxygen extraction fraction measured by PET. Phase(s): Phase III Study Type: Interventional Contact(s): William J. Powers, M.D. 314-362-3317
[email protected]; Missouri; Washington University School of Medicine, Box 8225, 4525 Scott Avenue, St. Louis, Missouri, 63110, United States; Recruiting; William J. Powers, M.D., Principal Investigator. Study chairs or principal investigators: William J. Powers, M.D., Principal Investigator; Washington University School of Medicine Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00029146;jsessionid=850715E 24189833F850C2F9F1F0833A2
·
Compare the effects of amiodarone, sotalol, and placebo in maintaining sinus rhythm in patients with atrial fibrillation converted to sinus rhythm Condition(s): Atrial Fibrillation; Cerebrovascular Accident; Death, Sudden Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program
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Purpose - Excerpt: Atrial fibrillation is the most frequently occurring cardiac arrhythmia, with 1.0-1.5 million cases annually. It is a risk factor for congestive heart failure, and stroke, 75,000 cases of the latter occurring annually in patients with atrial fibrillation. The safety of the most widely used antiarrhythmic agent for this group of patients, quinidine, has been called into question. This study seeks to determine whether two other agents, amiodarone and sotalol, are safe and effective treatments for patients with atrial fibrillation. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00007605;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Coordination of Rehabilitation
Hemiparetic
Movement
After
Post-Stroke
Condition(s): Stroke Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Purpose - Excerpt: This study will determine whether a therapeutic exercise program for improving motor coordination in locomotor tasks in post-stroke, hemiparesis patients will result in CNS recovery. The study will develop relationships between the improved motor performance and motor coordination during the locomotor task and the functional effects of the exercise program(e.g., gait variables.) Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00013481;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Effects of Exercise on patients with Hemiparetic Stroke Condition(s): Stroke; Hemiplegia; Cardiovascular Disease Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Medical Research Service
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Purpose - Excerpt: This randomized trial investigates the hypothesis that regular aerobic exercise training using a task specific gait training modality will improve cardiovascular fitness, functional mobility, and reduce risk factors for recurrent cardiovascular events in chronic hemiparetic stroke patients, when compared to matched controls performing just stretching. Study Type: Interventional Contact(s): Maryland; VA Maryland Health Care System, Baltimore, Maryland, 21201, United States; Recruiting; Richard F. Macko, M.D. 410605-7063
[email protected]; Richard Macko, Principal Investigator Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00018421;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Effects of Strength Training on Upper-Limb Function in Post-Stroke Hemiparesis Condition(s): Cerebrovascular Accident; Hemiparesis Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Rehabilitation Research and Development Service Purpose - Excerpt: Our overall goal is to develop therapeutic interventions to improve upper-limb motor function in hemiparetic persons based on an improved understanding of the mechanisms responsible for its loss and recovery. We intend to rigorously evaluate the efficacy of these interventions with clinical trials, and to study the mechanisms by which these interventions affect motor recovery. In this proposal, we will use a controlled, randomized, double blind clinical trial to study the effects of shoulder and elbow strength training in subjects in the subacute phase of recovery following stroke. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037908;jsessionid=850715E 24189833F850C2F9F1F0833A2
·
Efficacy of a Family Telephone Intervention for Stroke Condition(s): Stroke
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Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this trial is to determine if a family intervention administered by telephone to stroke patients and their caregivers increases adaptation and functioning after stroke. Phase(s): Phase III Study Type: Interventional Contact(s): Ivan W. Miller, Ph.D. 401-444-3918; Rhode Island; Rhode Island Hospital, Providence, Rhode Island, 02769, United States; Recruiting; Ivan W. Miller, Ph.D. 401-444-3918; Ivan W. Miller, Ph.D., Principal Investigator. Study chairs or principal investigators: Ivan W. Miller, Ph.D., Principal Investigator Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00031265;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Electrical Stimulation to Improve Hand Function in Patients with Chronic Stroke Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will determine whether an electric shock to the forearm can improve hand function in patients with chronic stroke and, if so, whether the improvement is related to brain reorganization. Some studies indicate that electromyography-triggered neuromuscular electrical stimulation (EMG-triggered NMES) on the forearm improves wrist motor function in patients with chronic stroke. The shock is delivered to the wrist extensor muscle of the forearm, causing greater hand movement than the patient can make on his or her own. The study will determine if the electric shock is more effective given after the patient initiates the hand movement (EMG-triggered NMES) than at times unrelated to patient effort (NMES alone). Stroke patients with muscle weakness on one side of the body may be eligible for this study. The stroke must have occurred at least 12 months before the patient enters the study. Candidates will have a medical history and physical and neurological examinations. Participants will be divided randomly into two groups: EMG-triggered NMES, and NMES alone. For EMGtriggered NMES, two electrodes from the NMES machine and two EMG
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electrodes are placed on the wrist extensor muscle of the forearm. The patient relaxes the hand, then contracts the wrist extensor muscle to produce movement. This movement triggers the NMES to deliver enough electrical stimulation to produce maximum wrist extension. For NMES alone, only the two NMES electrodes are placed on the forearm. The patient relaxes the hand and stimulation is applied at an intensity to produce full wrist extension without any patient effort. At the first clinic visit, baseline hand function is measured with the following tests: - Wrist extension - wrist extension is measured with a digital instrument called an accelerometer - Pinch power - grip strength between thumb and index finger is measured with a digital pinch analyzer - Jebsen-Taylor hand function - function is evaluated through activities such as moving a can and lifting a pin - H reflex - (Note: I could not find a description of this test or its purpose in the consent or the protocol) In addition, transcranial magnetic stimulation (TMS) is done to examine brain activity. For this test, an insulated wire coil is placed on the patient's scalp. A brief electrical current passes through the coil, creating a magnetic pulse that travels through the scalp and skull and causes small electrical currents in the outer part of the brain. The stimulation may cause muscle, hand or arm twitching, or may affect movement or reflexes. During the stimulation, electrical activity of muscles are recorded with a computer or other recording device, using electrodes attached to the skin with tape. Participants will be instructed in how to use the NMES machine at the first visit. They will be required to practice with the machine at home 30 minutes twice a day every day for 4 weeks, for a total of about 56 sessions. Follow-up evaluations of hand function will be done one day after the first NMES or EGM-triggered NMES task, then after 2 weeks and after 4 weeks of performing the exercise. These evaluations include the tests described above for baseline measurements, plus TMS. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023569;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Enhancement of Use-Dependent Stimulation in Chronic Stroke Condition(s): Cerebrovascular Accident
Plasticity
by
Somatosensory
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Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: Recent studies have demonstrated that electrical stimulation delivered over the skin increases the muscle strength as measured by a dynamometer in chronic stroke patients. We recently also found out that such stimulation enhances the ability of healthy brains to learn faster, enhancing the beneficial effects of the motor training. The purpose of this study is to find out if this stimulation can enhance the ability of stroke patients to experience plastic changes in the brain. It may aid in the development of new strategies for rehabilitation after brain injury in the future. A clinical and neurological exam will be administered. Each patient will participate in three different sessions separated by at least 48 hours: a 2-hour peripheral nerve stimulation to the weak hand, a 2-hour peripheral nerve stimulation to the leg, and no stimulation. The sessions will be randomly ordered. A magnetic resonance imaging scan of the brain will be done as well. Nerve stimulation will be done by transcranial magnetic stimulation (TMS). In TMS, the head is immobilized within a frame. An insulated coil wire is placed on the scalp and brief electrical current passed through it. Participants may be asked to perform movements, do simple tasks, or simply tense muscles. Electrical activity of the muscles will be recorded with a computer. Some experiments may be recorded on videotape. Participants must be stroke patients who have recovered to the point of being able to make thumb movements, and the stroke must have occurred more than 6 months ago. Study Type: Interventional Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00028379;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Hand Exercise and Upper Arm Anesthesia to Improvements Hand Function in Chronic Stroke Patients Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients.
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Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will examine the effectiveness of an experimental treatment to improve hand function in patients who have had a stroke affecting one side of the body. One of the main problems of stroke patients is difficulty using the affected hand. Most treatments focus on acute (early) intervention, although special exercises may help some chronic patients. Previous studies have indicated that combining hand exercises with anesthesia (blocking motor and sensory function) of the upper arm may improve hand movement in stroke patients, even in the chronic state. This study will examine whether the exercise plus anesthesia treatment is more beneficial for these patients over the longterm than exercise alone. Patients 18 years or older who are at least 12 months post stroke, which has affected only one side of the body, may be eligible for this study. Candidates will have a medical history and physical and neurological examinations. Participants will be randomly divided into two groups: one will practice hand exercises without upper arm anesthesia and the other will exercise with anesthesia. All patients will perform two consecutive sessions of 30-minute pinch practiceforceful pinching of the thumb and index finger. Patients in the anesthesia group will have the anesthetic injected in the lower neck. Enough anesthetic will be administered to block motor and sensory function in the shoulder and upper arm, while maintaining as much function as possible in the forearm and hand. All patients will also have transcranial magnetic stimulation (TMS) testing. For this procedure, a very brief electrical current is passed through an insulated wire coil placed on the head, producing a magnetic pulse. The pulse travels through the scalp and skull and causes small electrical currents in the outer part of the brain. During the study, the patient will be asked to make movements, do simple tasks, or tense muscles, while the electrical activity of the muscles is recorded. Patients will have four sessions at 3week intervals and three follow-up sessions at 3 weeks, 9 weeks and 24 weeks after the testing. Follow-up evaluations will include pinch power testing, TMS, sensory function test and hand function measurement. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006414;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Magnetic Resonance Imaging to Investigate Silent Strokes During Neck and Skull Angioplasty Condition(s): Brain Ischemia Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will use magnetic resonance imaging (MRI) to determine if silent strokes occur during angioplasty of the blood vessels in the neck or skull. Neck and skull angioplasties are relatively new procedures whose possible complications are still under investigation. Patients 18 years of age or older who are admitted to Suburban Hospital in Bethesda, Maryland, for angioplasty of one or more of the blood vessels in the neck or skull may participate in this study. Participants must be able to undergo a brain MRI. Within 24 hours before their angioplasty, patients will provide a medical history and have a physical examination and brain MRI. The physical examination and MRI will be repeated within 24 hours after the angioplasty. MRI is a diagnostic test that uses a magnetic field and radio waves to show structural and chemical changes in tissues. This technique is more sensitive than X-rays in detecting some changes that occur in diseases of the brain. For the procedure, the patient lies on a table that slides into a metal cylinder (the scanner). The confined space may produce anxiety in some patients, and patients can talk to the technician at all times during the procedure. Earplugs are provided to muffle loud knocking and pulsing noises that occur while the scanner is taking pictures. During the study, the contrast material gadolinium may be injected into an arm vein. Gadolinium "brightens" the pictures, producing better images of brain blood flow. Patients will be contacted by telephone 30 days after the procedure to follow how they are doing and learn whether any complications resulted from the angioplasty. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00015717;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Motor Learning in Stroke Patients and Healthy Volunteers Condition(s): Stroke; Healthy Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will try to elucidate learning processes associated with motor training in the weak arm of stroke patients compared with healthy controls. Results from previous clinical trials indicate that training may enhance motor function in healthy volunteers, and perhaps also in stroke patients, even more than 1 year after the stroke. Normal, healthy volunteers and stroke patients 18 years of age and older may be eligible for this study. Study subjects will have a physical examination and participate in 6 additional clinic visits-training and testing sessions on study days 1, 2, 3, 4 and 5, and a final testing session on day 12. During these sessions, they will perform a series of motor tasks, including writing, picking up objects, turning cards, stacking checkers and moving cans, which will be timed and videotaped. Each session will be divided into blocks of 10 trials for each task, separated by 2-minute rest periods. Before and after training on days 1, 2, 5 and 12, subjects will have transcranial magnetic stimulation (TMS) to determine brain changes associated with learning a motor task. For this procedure, the patient is seated in a comfortable chair, and an insulated wire coil is placed on the scalp or skin. A brief electrical current is passed through the coil, creating a magnetic pulse that stimulates the brain. These pulses generate very small electrical currents in the brain cortex, briefly disrupting the function of the brain cells in the stimulated area. The stimulation may cause muscle twitching or tingling in the scalp, face, or limb. During the stimulation, the subject may be asked to slightly tense certain muscles or perform other simple actions. Electrical nerve stimulation and electromyography will be done to record muscle responses to stimulation. A nerve is stimulated by placing wires on the skin over the nerve and passing a brief electrical current between the wires. Electromyography involves taping metal electrodes to the skin over the muscle. Before and after each session, subjects' muscle strength will be tested with a pinch gauge. They will also be asked to make a mark on a line drawn on paper, to rate their test performance and levels of attentiveness and fatigue. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United
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States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00021710;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Motor Recovery in Recent Stroke Patients Treated with Amphetamine and Physical Therapy Condition(s): Cerebrovascular Accident; Paralysis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to determine if giving amphetamines along with standard rehabilitation speeds motor recovery after a stroke. In addition, if motor recovery is improved, the study will also identify the areas of the brain involved with the recovery. Researchers will use motor function ratings, PET scans, functional MRI (fMRI), electroencephalographs, and transcranial magnetic stimulation (TMS) to evaluate patients. Patients participating in the study will be placed in one of two groups; 1. Patients receiving dextroamphetamine and routine Rehabilitation Medicine 2. Patients receiving a placebo "sugar pill" and routine Rehabilitation Medicine Patients that have improved motor recovery will undergo neuroimaging and neurophysiological studies to identify areas of the brain involved. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001783;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Natural History of Stroke: Cause and Development Condition(s): Cerebrovascular Accident; Transient Ischemic Attack Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS)
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Purpose - Excerpt: The purpose of this study is to learn more about stroke and obtain information that may serve as the basis for future investigations. It will 1) establish a registry of patients with cerebrovascular disease (stroke); 2) characterize the natural history of acute stroke and transient ischemic attacks (TIA)-an interruption of blood flow to the brain that causes stroke symptoms for a short period of time); and 3) evaluate the data to generate ideas for future studies. Patients 18 years of age or older with suspected acute stroke or TIA may be eligible for this study. Subjects will be recruited from patients who present with stroke at the emergency department of Suburban Hospital in Bethesda, Maryland. The study will gather data collected from diagnostic and laboratory tests the patient undergoes as part of standard medical care, including findings of medical and neurological examinations and other tests. In addition, studies will be done for research purposes only to gather data about stroke and TIA. These may include the following: Blood and urine tests-not more than 2 tablespoons of blood will be drawn for various tests. - Electrocardiogram (EKG) (heart tracing)-electrodes placed on the chest wall detect the heartbeat and heart rhythm. Computed tomgraphy (CT) scan of the head-specialized X-rays are used to obtain images of the brain. - Magnetic resonance imaging (MRI) of the brain-a strong magnetic field and radio waves are used to produce images that provide information about the brain tissue and blood vessels. - Transcranial Doppler (TCD)-sound waves are used to image the arteries of the brain and neck. - Echocardiogram-sound waves are used to image the heart and evaluate heart function. Patients may be asked to return to Suburban Hospital for follow-up testing in 1, 3, and/or 12 months, when some of these tests may be repeated to assess changes over time Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00009243;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Potential Risk Factors for Stroke Condition(s): Carotid Atherosclerosis; Cerebrovascular Diabetes Mellitus; Hypercholesterolemia; Hypertension Study Status: This study is currently recruiting patients.
Accident;
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Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: Early studies have shown that the immune system may play a role in the development of strokes. Conditions such as high blood pressure, high cholesterol, diabetes, and old age can activate the immune system and increase the risk of developing hardening of the arteries (atherosclerosis) and damaged blood vessels. Researchers will attempt to characterize factors that may contribute to atherosclerosis and stroke by measuring certain components of the immune system, cytokines and leukocyte activation. Measurements will be taken from patients that are considered to be stroke prone and from patients without risk factors for the development of stroke. Researchers will measure the immune system components at the beginning of the study, at six months, and at the one-year completion of the study. The study will attempt to determine; I) If patients with risk factors for stroke have an increased activation of the immune system II) If patients with risk factors for stroke that are symptomatic have higher levels of immune system activation compared to patients who do not have symptoms III) If patients with increased activation of the immune system have accelerated hardening of the arteries (atherosclerosis) Phase(s): Phase I Study Type: Interventional Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001368;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
ReoPro and Retavase to Restore Brain Blood Flow After Stroke Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will evaluate the safety and effectiveness of two types of blood thinners, abciximab (ReoPro) and reteplase (Retavase) for restoring normal brain blood flow after ischemic stroke (stroke resulting from a blood clot in the brain). The only therapy approved by the Food and Drug Administration to treat ischemic stroke is the clot
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buster drug rt-PA. This treatment, however, is effective only if begun within 3 hours of onset of the stroke and most patients do not get to the hospital early enough to benefit from it. There is thus a pressing need to develop effective stroke treatments that can be initiated more than 3 hours after onset. Patients between 18 and 80 years of age who have experienced a mild or moderate acute stroke between 3 and 24 hours before starting study drugs may be eligible for this study. Candidates will be screened with a physical examination, blood tests and a magnetic resonance imaging (MRI) scan (if an MRI was not done during the stroke evaluation). All participants will receive ReoPro. Some will also receive Retavase, which may boost the effectiveness of ReoPro. Retavase is administered in a single dose through a needle in the vein over 2 minutes. ReoPro is infused into the vein over 12 hours. Patients will be monitored with physical examinations, blood tests, computed tomography (CT) scans, and three or four MRI scans of the brain to evaluate both the response to treatment and side effects of the drugs. An MRI scan will be done 24 hours, 5 days and 30 days after starting the study medication, and possibly during screening for this study. CT involves the use of specialized x-rays to obtain images of the brain. The patient lies still in the scanner for a short time while the X-ray images are formed. MRI uses a strong magnetic field and radio waves to demonstrate structural and chemical changes in tissue. MRI is more sensitive than x-ray in evaluating acute stroke. The patient lies on a table in a metal cylinder (the scanner) while the pictures are being taken. During part of the MRI, a medicine called gadolinium contrast is injected in a vein. This medicine brightens the images, creating better pictures of the blood flow. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00039832;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Role of the Intact Hemisphere in Recovery of Motor Function after Stroke Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients.
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Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to better understand the role of the motor part of the brain in the recovery of motor function after stroke. The motor deficits that follow a stroke are compensated for over several months. It has been proposed that the ipsilateral motor cortex mediates these recovery processes. The results of this study will provide fundamental information on the role of ipsilateral M1 in recovery of motor function after chronic stroke. A general patient evaluation will determine the location of the lesion site and assess the degree of impairment in motor and global cognitive functioning. An assessment of motor function will also be performed. Patients will be divided into two groups: well and poorly recovered. An MRI (magnetic resonance imaging) scan may also be done if one has not been performed in the past 6 months. Two main procedures will be performed: transcranial magnetic stimulation (TMS) and test of motor performance. In the first procedure, a metal coil surrounded by a plastic mold will be placed on the head and electrical current will be pulsed through it. The electrical muscle activity will be recorded through these electrodes with a computer. The second procedure involves a reaction time test. The task will consist of reacting to a visual stimulus by performing a voluntary movement. TMS pulses will be given before each movement. This is done to determine whether this type of stimulation interferes with reaction time, which would indicated that it interferes with the brain centers executing the reaction to the visual Go-signal. Patients with single ischemic hemispheric lesions at least 12 months after the stroke who initially had a severe paralysis of the arm will be recruited for the study. Healthy normal volunteers will also be included in the study. A special effort will be made to increase the participation of women and diverse racial groups. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00028184;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Safety, Efficacy, and Tolerablity of Repinotan in Patients with Acute Ischemic Stroke Condition(s): Acute ischemic stroke
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Study Status: This study is currently recruiting patients. Sponsor(s): Bayer Corporation Purpose - Excerpt: Evaluation of Repinotan HCl in patients with acute ischemic stroke. At study entry patients will be randomized to Repinotan HCl or placebo in a 1:1 ratio. The total treatment period wil be 72 hours. Phase(s): Phase II; Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00044915;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Stroke Rehabilitation Ambulation Training
Outcomes
with
Supported
Treadmill
Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Rehabilitation Research and Development Service Purpose - Excerpt: This project seeks to overcome the reduced walking capability, poor health status, decreased functional capacity, and sedentary lifestyle of stroke patients. The specific objectives are to compare the effects of regular inpatient stroke rehabilitation to regular rehabilitation combined with STAT after an acute stroke on: a) gait performance; b) functional outcomes; c) oxygen consumption during a seated task; and finally: d) using Brain Motor Control Assessment to obtain neurophysiological characteristics, as possible predictors of rehabilitation outcomes. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037895;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Study of Abnormal Blood Clotting in Children with Stroke Condition(s): Abnormalities; Blood Coagulation Disorder; Brain Disease; Cerebrovascular Accident; Vascular Disease Study Status: This study is currently recruiting patients.
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Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: A stroke is a sudden neurological condition caused by an abnormality in blood flow to the brain. Studies on strokes in children estimate that 2.5 out of 100,000 children will suffer a stroke. Pediatric strokes occur more frequently in children less than 2 years old. The causes of strokes in children are often undetermined. Effective treatment and prevention plans for childhood strokes can only be developed once the causes are understood. There is increasing evidence that bloodclotting abnormalities alone or in combination with environmental factors may be responsible for blood clots in arteries and veins. There are many compounds that play a role in the normal pathway of blood clotting in the body. Abnormalities in any one of these compounds can account for the development of stroke-causing blood clots. Presently, there is very little information on these abnormalities in children. This study is designed to measure the frequency of several specific bloodclotting abnormalities in children with a history of stroke and porencephaly (pockets/cavities within the brain). Data collected from this study will be compared to statistics of these conditions in the rest of the population. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001927;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Treatment for Post-Stroke Depression Condition(s): Stroke; Depression Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to evaluate a program of education, medicine, and monitoring for the treatment of depression after a stroke. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00029172;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Video-Based Functional Performance and Assessment Following Stroke Condition(s): Stroke Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Purpose - Excerpt: For hemiplegic, stroke patients wheelchair transfers is a critical, safety-related area of physical function. This project will develop a personalized training and clinical assessment instrument based on the Video-Based F-PAT (Functional Performance Assessment and Training.) The objectives of the study are: (1) Enhance the pilot F-PAT web site to allow clinicians password-protected access to the digitized video and assessment information; and (2) train an Occupational Therapist collaborator to create the personalized videotapes for patients to take home with them. This study has the dual goal of evaluating the effectiveness of the personalized training videotapes and the effectiveness of the video-based assessment methodology. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00013494;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Antiplatelet therapy to prevent stroke in African Americans Condition(s): Stroke; Cerebral Infarction Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The African-American Antiplatelet Stroke Prevention Study is designed to prevent recurrent strokes by administration of aspirin or ticlopidine. The study also provides community information on reducing risk of stroke and recognizing the symptoms of stroke. The study involves more than 50 participating hospitals located throughout the United States. Study medication is provided free of charge, and a transportation stipend is available for those in need.
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Phase(s): Phase IV Study Type: Interventional Contact(s): Merryl Billingsley, B.A. 1-312-432-5214
[email protected]; Illinois; Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, 60612-3227, United States. Study chairs or principal investigators: Philip B. Gorelick, M.D., M.P.H, Principal Investigator; Rush-Presbyterian-St. Luke's Medical Center Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004727;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Cardiovascular Health Study (CHS) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Cerebrovascular accident; Diabetes Mellitus; Hypertension Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the extent to which known risk factors predict coronary heart disease and stroke in the elderly, to assess the precipitants of coronary heart disease and stroke in the elderly, and to identify the predictors of mortality and functional impairments in clinical coronary disease or stroke. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005133;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Cerebrovascular Involvement in Sickle Cell Disease - Comprehensive Sickle Cell Center Condition(s): Anemia, Sickle Cell; Blood Disease; Cerebrovascular accident Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To continue studies on the two major neurological complications of sickle cell disease (SCD): namely, stroke and chronic encephalopathy. Study Type: Longitudinal Human Study Contact(s): see Web site below
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005326;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Coronary Artery Calcium, Exercise Tests, and CHD Outcome Condition(s): Cardiovascular Diseases; Coronary Disease; Cerebrovascular Disorders; Heart Diseases; Cerebrovascular accident Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate coronary artery calcium (CAC), detected by electron beam computed tomography (EBCT), as a predictor of coronary heart disease (CHD) mortality and morbidity, stroke, and allcause mortality in a historical cohort epidemiological study. Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005562;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Dietary Patterns and Risk of Cardiovascular Disease Condition(s): Cardiovascular Diseases; Coronary Disease; Cerebrovascular Disorders; Heart Diseases; Cerebrovascular accident Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To study, prospectively, the association between dietary patterns and risk of coronary heart disease (CHD), ischemic stroke, and hemorrhagic stroke in cohort studies of 121,700 women age 30 to 55 years at baseline in 1976 (the Nurses; Health Study; NHS) and 51,529 men aged 40-75 years at baseline in 1986 (the Health Professionals Follow-up Study; HPFS). Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005514;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Families In Recovery From Stroke Trial (F.I.R.S.T.) Condition(s): Stroke
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Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this trial is to assess the effects of a psychosocial intervention on functional recovery after stroke. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037492;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Health Professionals Follow-up Study Condition(s): Cardiovascular Diseases; Cerebrovascular accident; Coronary Disease; Peripheral Vascular Diseases; Heart Diseases; Myocardial Infarction Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To test the hypothesis that increased risk of coronary heart disease, stroke, peripheral vascular disease, and cancer is related to diets high in saturated fat, animal protein, and hydrogenated vegetable oil, and low in polyunsaturated fat, fiber, vitamins A, C, and E, calcium, selenium, and chromium. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005182;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Inflammation, Infection, and Future Cardiovascular Risk Condition(s): Cardiovascular Diseases; Coronary Disease; Cerebrovascular accident; Myocardial Infarction; Venous Thromboembolism; Heart Diseases; Infection; Chlamydia infections; Cytomegalovirus Infections; Helicobacter infections; Herpesviridae infections; Inflammation Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)
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Purpose - Excerpt: To examine markers of underlying chronic inflammation and infection as potential risk factors for future myocardial infarction (MI), stroke (CVA), and venous thromboembolism (VTE) in plasma samples collected at baseline from healthy participants in the Physicians' Health Study (PHS). Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005496;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Pediatrics:Chlamydia, Sickle Cell Anemia and Stroke Risk - Ancillary to STOP II Condition(s): Blood Disease; Anemia, Sickle Cell; Chlamydia infections; Cerebrovascular accident Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To establish a link among Chlamydia infection, sickle cell anemia, and stroke risk. Study Type: Epidemiology, Analysis of Clinical Trials Contact(s): Styles, Lori A. Oakland, California, United States. Study chairs or principal investigators: Styles, Lori A., Study Chair; Children's Hospital, Oakland Oakland, California, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037388;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Stroke Prevention in Sickle Cell Anemia (STOP 2) Condition(s): Blood Disease; Cerebrovascular accident; Anemia, Sickle Cell Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine how long blood transfusions are needed for primary stroke prevention. Also, to determine the duration of risk associated with abnormal transcranial Doppler ultrasound (TCD) and to determine the specificity of the stroke risk model developed in STOP 1 in patients with abnormal TCD measurements. Phase(s): Phase III
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Study Type: Prevention Contact(s): Brambilla, Donald J. Watertown, Massachusetts, United States Adams, Robert J. Augusta, Georgia, United States. Study chairs or principal investigators: Brambilla, Donald J., Study Chair; New England Research Institutes, Inc. Watertown, Massachusetts, United States; Adams, Robert J., Study Chair; Medical College of Georgia Augusta, Georgia, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00006182;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Vitamin therapy for prevention of stroke Condition(s): Stroke; Cerebral Infarction; Myocardial Infarction Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: A stroke occurs when part of the brain is damaged from lack of normal blood supply. This may result in difficulty with feeling, speech, muscle strength or coordination, movement, thinking, or other brain functions. Having a stroke increases the risk of another stroke occurring in the future. Higher blood levels of a natural chemical known as homocysteine may contribute to hardening of the arteries in the brain or heart and increase the risk of stroke or heart attack. Folic acid, vitamin B6 (pyridoxine), and vitamin B12 (cyanocobalamin) may lower blood levels of homocysteine and reduce the risk of having another stroke or a heart attack. Phase(s): Phase III Study Type: Interventional Contact(s): Elizabeth Sides 1-336-716-1074
[email protected]; North Carolina; Wake Forest University School of Medicine, Winston Salem, North Carolina, 27157-1068, United States. Study chairs or principal investigators: James F. Toole, M.D., Principal Investigator; Wake Forest University Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004734;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Boston Area Anticoagulation Trial for Atrial Fibrillation (BAATAF) Condition(s): Arrhythmia; Atrial Fibrillation; Cardiovascular Diseases; Cerebral Embolism and Thrombosis; Cerebrovascular Disorders; Heart Diseases; Thrombophlebitis; Cerebrovascular accident Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the benefits and risks of oral anticoagulant therapy in reducing embolic stroke and systemic emboli in patients with atrial fibrillation without rheumatic heart disease. Phase(s): Phase III Study Type: Prevention, Treatment Contact(s): Kistler, John P. Boston, Massachusetts, United States. Study chairs or principal investigators: Kistler, John P., Study Chair; Massachusetts General Hospital Boston, Massachusetts, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000517;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Effects of Flumazenil on Brain Excitability Condition(s): Stroke; Healthy Study Status: This study is completed. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will investigate the effects of the drug flumazenil on brain excitability and the drug's relationship to a natural brain chemical called GABA. Flumazenil is commonly used in hospitals to reverse the effects of a group of drugs called benzodiazepines, one of which is Valium. Benzodiazepines act by enhancing the effects of GABA. Healthy volunteers 21 years of age and older may be eligible for this study. Candidates will be screened with a medical history and physical and neurological examinations. Participants will have transcranial magnetic stimulation (TMS) four times on two different days, before and after receiving an intravenous (through a vein) infusion of either flumazenil or placebo (an inactive sugar solution), as follows: TMS study 1 Drug or placebo infusion TMS study 2 - 15 minutes after infusion TMS study 3 - 60 minutes after infusion TMS study 4 - 120 minutes after infusion In transcranial magnetic stimulation, a very brief electrical current is passed through an insulated coil wire placed on the scalp. These currents stimulate the cortex (outer part of the brain). They may
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cause muscle, hand, or arm twitching if the coil is near the part of the brain that controls movement, or they may affect other reflexes or movements. During the study, subjects may be asked to make movements, do simple tasks or tense muscles. To record the electrical activity of muscles, electrodes will be taped to the skin over the muscles tested. In some cases, the studies will be videotaped. Flumazenil will be infused through a catheter (thin plastic tube) attached to a needle placed in an arm vein. On one day, subjects will receive a 1-mg injection of flumazenil followed by a continuous infusion of 0.5 mg of the drug for about 30 minutes. On the other day, they will receive placebo, administered in the same manner. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00015678;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Honolulu Heart Program-Study of Stroke and Dementia Condition(s): Cardiovascular Diseases; Cerebrovascular Disorders; Dementia
Cerebrovascular
accident;
Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To clarify the relationship of the arterial lesions to aging, define the influence of the arterial changes on the development of stroke, brain infarction, and dementia, and provide a better understanding of vascular dementia. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005395;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Mechanisms of Human Plasticity in the Human System Condition(s): Blindness; Cerebrovascular Accident; Spinal Cord Injury Study Status: This study is completed.
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Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to investigate the physiology associated with plasticity of the motor system. Plasticity refers to the process by which neighboring brain cells assume the responsibilities of damaged or diseased brain cells. The mechanisms behind this process are unknown. However, researchers have several theories about how plastic changes take place. Possible explanations include the growth of new connections between brain cells and the use of previously unused connections. Researchers plan to use transcranial magnetic stimulation and drug intervention in order to determine the mechanisms responsible for specific types of plasticity. Previous studies have shown that certain drugs can affect the mechanisms involved in these changes. By using one drug at a time, researchers plan to evaluate the role of each of several different mechanisms in brain reorganization. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001661;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Postmenopausal Progestins, MI and Stroke Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Cerebrovascular accident; Myocardial Infarction; Postmenopause Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate the cardiovascular effects of postmenopausal hormone replacement therapy and the suspected beneficial effects on myocardial infarction and stroke. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005220;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Stenting vs. Surgery to Prevent Stroke Condition(s): Stroke; Atherosclerosis
Cerebral
Infarction;
Carotid
Stenosis;
Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: CREST compares the relatively new procedure of stent-assisted carotid angioplasty (CAS) to the traditional and accepted surgical approach of carotid endarterectomy (CEA) for the treatment of carotid artery stenosis to prevent recurrent strokes in those patients who have had a TIA (transient ischemic attack) or a mild stroke. Phase(s): Phase III Study Type: Interventional Contact(s): Alice Sheffet, PhD 1-973-972-7718
[email protected]; New Jersey; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, 07017, United States. Study chairs or principal investigators: Robert W. Hobson, II, M.D., Principal Investigator; University of Medicine and Dentistry of New Jersey Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004732;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Stroke and MI in Users of Estrogen/Progestogen Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Cerebrovascular accident; Myocardial Infarction; Postmenopause Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To estimate the relative risks of acute myocardial infarction (MI) and of stroke in postmenopausal users of estrogen/progestogen (E/P) combinations and to estimate the relative risks of MI and of stroke in users of estrogen alone. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005466;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Stroke Belt Initiative Condition(s): Cardiovascular Hypertension
Diseases;
Cerebrovascular
accident;
Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: For State Health Departments located in Stroke Belt states, to assess high risk target audiences' needs and identify opportunities for more effective delivery of medical and/or educational services to reduce the high rate of stroke mortality experienced in the southeastern United States. Study Type: Demonstration and Education Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005722;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Stroke Prevention in Sickle Cell Anemia (STOP 1) Condition(s): Anemia, Sickle Cell; Cerebral Embolism and Thrombosis; Cerebrovascular Disorders; Hematologic Diseases; Hemoglobinopathies Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To reduce episodes of first time stroke by 75 percent in children with sickle cell anemia by the administration of prophylactic transfusion therapy. Phase(s): Phase III Study Type: Prevention Contact(s): Brambilla, Donald J. Watertown, Massachusetts, United States. Study chairs or principal investigators: Brambilla, Donald J., Study Chair; New England Research Institute Inc. Watertown, Massachusetts, United States; Adams, Robert J., Principal Investigator; Medical College of Georgia Augusta, Georgia, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000592;jsessionid=850715E 24189833F850C2F9F1F0833A2
·
Stroke Risk in the NAS-NRC Twin Registry Condition(s): Cardiovascular Diseases; Myocardial Infarction; Coronary Disease
Cerebrovascular
accident;
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Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate stroke risk using the National Academy of Sciences Twin Registry. Study Type: Epidemiology Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005413;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial Condition(s): Heart Disease; Stroke; Ischemic Heart Disease; Myocardial Infarction; Atrial Fibrillation Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to determine which of two treatments, Warfarin or aspirin, is better for preventing death and stroke in patients with poor heart function. Phase(s): Phase III Study Type: Interventional Contact(s): Mary Ellen Ruzycky, R.N., M.S. 973-972-3915; New Jersey; University Medicine and Dentistry of New Jersey, Department of Neurosciences, Newark, New Jersey, 07003-2714, United States; Mary Ellen Ruzycky, R.N., M.S. 973-972-3915; Patrick Pullicino, M.D., Principal Investigator. Study chairs or principal investigators: Patrick Pullicino, M.D., Principal Investigator; University Hospital Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00041938;jsessionid=850715E 24189833F850C2F9F1F0833A2
·
Warfarin Versus Aspirin Recurrent Stroke Study Condition(s): Stroke Study Status: This study is completed. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS)
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Purpose - Excerpt: The goal of this study is to compare aspirin to warfarin for the prevention of recurrent stroke. Phase(s): Phase III Study Type: Interventional Contact(s): New York; Columbia University Health Sciences, New York, New York, United States; J. P. Mohr, M.D., Principal Investigator. Study chairs or principal investigators: J. P. Mohr, M.D., Principal Investigator; Columbia University Health Sciences Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00027066;jsessionid=850715E 24189833F850C2F9F1F0833A2 ·
Women's Estrogen for Stroke Trial (WEST) Condition(s): Stroke Study Status: This study is completed. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: To determine if estrogen hormone replacement therapy reduces the risk of stroke or death in postmenopausal women who have already had stroke or a transient ischemic attack (TIA). Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026039;jsessionid=850715E 24189833F850C2F9F1F0833A2
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Benefits and Risks20 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for stroke. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with stroke. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 20
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How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for stroke? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
·
How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
·
Will I be able to see my own doctor? Who will be in charge of my care?
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·
Will taking part in the study affect my daily life? Do I have time to participate?
·
How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “stroke” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
·
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
·
For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinica l_Trials
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General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
·
The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU]
Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any H-isomer. [NIH] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Chronic: Persisting over a long period of time. [EU] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Dextroamphetamine: The d-form of AMPHETAMINE. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
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Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gadolinium: Gadolinium. An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Gait: Manner or style of walking. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Herpesviridae: A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. There are three subfamilies based on biological characteristics: alphaherpesvirinae, betaherpesvirinae, and gammaherpesvirinae. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH]
Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Mime: Facial expression. (NOT: mimicry = adaptation for survival in which an organism takes on the semblance another organism or a non-living object.) [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Postmenopause: The physiological period following the menopause, the permanent cessation of the menstrual life. Since in the United States the age of the menopause ranges between 48 and 55 years, generally conceived as middle age, the postmenopause often refers to women considerably older. [NIH]
Progestogen: A term applied to any substance possessing progestational activity. [EU] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the
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excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alpha-adrenergic neurotransmission. [NIH] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sotalol: An adrenergic beta-antagonist that is used in the treatment of lifethreatening arrhythmias. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Systemic: Pertaining to or affecting the body as a whole. [EU] Thromboembolism: Obstruction of a blood vessel with thrombotic material carried by the blood stream from the site of origin to plug another vessel. [EU] Thrombophlebitis: formation. [EU]
Inflammation of a vein associated with thrombus
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on stroke. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on stroke. In Part II, as in Part I, our objective is not to interpret the latest advances on stroke or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with stroke is suggested.
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CHAPTER 4. STUDIES ON STROKE Overview Every year, academic studies are published on stroke or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on stroke. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on stroke and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and stroke, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “stroke” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Dementia in the Severely Aphasic: Global Aphasia Without Hemiparesis -- A Stroke Subtype Simulating Dementia Source: American Journal of Alzheimer's Disease. 14(2): 74-78. MarchApril 1999. Summary: This journal article provides case reports of four patients who were referred for evaluation of probable dementia and were found to have severe aphasia over 3 or more years without a history of any other neurological impairment such as hemiplegia. The study examined the utility of several commonly used dementia scales in patients with severe aphasia and possible dementia. Findings identify the limitations of verbal and non-verbal cognitive tests and the reliance on informant reports. Additionally, the authors suggest appropriate weighting of these tests may help in arriving at a more accurate diagnosis; and until guidelines for reliable criteria are established, the clinician should assess the patient in a holistic way rather than in only one aspect of the patient's symptomatology. Data are provided from test results using the Boston Diagnostic Aphasia Examination at onset, 3 years, and past 3 years. 1 table, 24 references.
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Low-Density Lipoprotein Cholesterol and the Risk of Dementia With Stroke Source: JAMA. 282(3): 254-260. July 21, 1999. Summary: This journal article presents a study of the relationship of plasma lipids and lipoproteins to dementia with stroke. The participants were 1,111 participants without dementia (mean age 75 years) who were followed for an average of 2.1 years. Plasma lipid and lipoprotein fraction levels and apolipoprotein E (apoE) genotype were determined at baseline. A total of 286 participants (25.7%) developed dementia during follow-up; of those, 61 (21.3%) were classified as having dementia with stroke and 225 (78.7%) as having Alzheimer's disease (AD). Elevated levels of low density lipoprotein (LDL) cholesterol were significantly associated with an increased risk of dementia with stroke. After adjusting for vascular risk factors and demographic variables, the relative risk (RR)
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for dementia with stroke was 3.1 in the highest quartile of LDL cholesterol compared with the lowest quartile. The RR increased to 4.1 in the adjusted analysis with LDL levels corrected for lipoprotein(a). Neither lipid nor lipoprotein levels were associated with risk of AD. 1 figure, 5 tables, 40 references. ·
Effect of Patient Attrition on Estimates of the Frequency of Dementia Following Stroke Source: Archives of Neurology. 55: 390-394. March 1998. Summary: This journal article describes a study of the effect of patient attrition on estimates of the frequency of dementia following ischemic stroke. A total of 297 patients, mean age 72 years, were seen for an initial assessment 7 to 10 days after stroke onset. The assessment included a neurological examination, measures of the physical and cognitive aspects of functional ability, and a cognitive test. At 3 months after stroke, 251 patients were reassessed with the same examinations and a battery of neuropsychological tests, and 66 of these (26.3 percent) were determined to have dementia. Most of the 46 patients who were not reassessed were unavailable due to death, severe stroke, or comorbid medical conditions. The probability of dementia for each of these 46 patients was calculated using a logistic model of the clinical determinants of dementia based on the 251 patients who had been examined. By this method, 21 of the 46 patients unavailable for followup (45.7 percent) were estimated to have dementia. The factors that increased the risk of becoming unavailable for followup were similar to those that increased the risk of dementia after stroke. The authors conclude that patient attrition may result in the underestimation of dementia following stroke. 2 tables, 18 references.
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Natural History and Survival of 14 Patients With Corticobasal Degeneration Confirmed at Postmortem Examination Source: Journal of Neurology, Neurosurgery and Psychiatry. 64: 184-189. 1998. Summary: This journal article describes the natural history and clinical predictors of survival in 14 patients with corticobasal degeneration confirmed by postmortem examination. The patients were selected from the research and clinical files of seven medical centers in Austria, the United States, and the United Kingdom. They included eight females and six males; the mean age at onset of symptoms was 63 years and the mean duration of disease was 7.9 years. All cases met the National Institute of Neurological Disorders and Stroke (NINDS) preliminary neuropathological criteria for corticobasal degeneration (CG). The hallmarks of CG pathology, according to the NINDS criteria, include
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frontoparietal atrophy with severe cortical neuronal loss and intense astrogliosis as well as swollen and achromatic neurons (without Pick bodies) in the affected cortex. The most common symptoms at onset were limb clumsiness, gait disorder, sensory problems, tremor, memory problems, and behavioral changes. At the first neurological visit, an average of 3 years after symptom onset, features present that were suggestive of cortical dementia included aphasia, ideomotor apraxia, and frontal lobe behavior. The most commonly observed extrapyramidal features included unilateral limb rigidity, bradykinesia, postural instability, and unilateral limb dystonia. During the course of the disease, virtually all of the patients developed asymmetric or unilateral akinetic rigid parkinsonism and a gait disorder. Levodopa treatment was ineffective. Survival after symptom onset ranged from 2.5 to 12.5 years, and shorter survival was predicted by early parkinsonian signs and frontal lobe features. Bronchopneumonia represented the cause of death in all patients with information available on the genereal postmortem findings. 1 figure, 3 tables, 25 references. ·
Spousal Interactions in Alzheimer's Disease and Stroke Caregiving: Relationship to Care Recipients' Functional Abilities and Physical and Emotional Health Source: Journal of the American Psychiatric Nurses Association. 4(6): 169181. December 1998. Summary: This journal article examines spousal interactions in Alzheimer's disease (AD) and stroke caregiving, and their relationship to the care recipients' functional abilities and health status. The study groups consisted of 14 patients with early AD and their spouses, 14 stroke patients and their spouses, and 14 healthy couples. The participants were assessed at baseline and 6 months later on measures of cognitive impairment, functional abilities, physical health, depression, present and past spousal interactions, and commitment to the future of the relationship. At baseline, the average time since symptom onset was 34 months for spouses with AD and 3 months for spouses with stroke. Although the functional abilities of the two groups of care recipients were similar at baseline, both the quantity and quality of interactions were lower for the AD group than for the stroke group. Spousal interactions were significantly correlated with physical health and depression in the AD group and with functional abilities in the stroke group. The implications for psychiatric nursing are discussed. 7 tables, 20 references.
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Apolipoprotein E epsilon4 and the Risk of Dementia With Stroke: A Population-Based Investigation Source: JAMA. Journal of the American Medical Association. 277(10): 818-821. March 12, 1997. Summary: This article describes a study of the association between the apolipoprotein E (apoE) gene statuses and dementia in patients with strokes. Data were collected from two population-based, case-control studies in Rotterdam, the Netherlands, and New York City. A total of 187 patients with dementia and stroke were compared with 507 controls matched for age and ethnic group. The patients were diagnosed as having vascular dementia (VaD), Alzheimer's disease with cardiovascular disease (AD with CVD), or dementia with strokeunclassified. The main outcome measures were the apoE allele frequencies in patients and controls; the odds ratios for dementia with stroke, VaD, and AD with CVD, adjusted for age, sex, residency, and education; and the percent attributable risk related to the apoE4 allele. The results suggest that the frequency of the apoE4 allele was higher in patients with dementia and strokes than in controls. The risks associated with apoE4 were elevated regardless of the subtype of dementia with stroke, age, or sex. The percent attributable risk related to the apoE allele among patients with strokes was 41 percent overall, 33 percent among those with VaD, and 44 percent among those with AD with CVD. The researchers conclude that the apoE4 allele may be a genetic risk factor for dementia with strokes. 2 tables, 32 references. (AA-M).
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Why Are Stroke Patients Prone to Develop Dementia? Source: Journal of Neurology. 244: 135-142. 1997. Summary: This journal article explores possible reasons why stroke patients are at risk for developing dementia. The authors suggest that three factors may explain the occurrence of dementia after a stroke. First, post-stroke dementia may be the direct consequence of the cerebrovascular lesions. Second, it may be due to an associated asymptomatic Alzheimer's disease pathology that is unrecognized before the stroke. Third, white matter changes may contribute to dementia because they often indicate small vessel disease, are associated with a higher risk of stroke recurrence, and may induce specific cognitive decline. The authors conclude that the additive effect of these three factors might lead to dementia, even when each change, on its own, is not severe enough to cause dementia. They suggest that the term post-stroke dementia may be more appropriate than vascular dementia because it encompasses all possible causal factors. 1 figure, 94 references.
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Dementia After Stroke Increases the Risk of Long-Term Stroke Recurrence Source: Neurology. 48(5): 1317-1325. 1997. Summary: This journal article describes a study of dementia after ischemic stroke as an independent risk factor for long-term stroke recurrence. The participants were 242 patients, average age 72 years, who were admitted within 30 days of stroke onset to the ColumbiaPresbyterian Medical Center in New York, New York, and who survived the first 3 months without stroke recurrence. All patients received neurological, neuropsychological, and functional assessments at 3 months after stroke onset; and dementia was diagnosed using modified Diagnostic and Statistical manual of mental Disorders, Third Edition Revised (DSM-III-R) criteria. The patients were reassessed annually for up to 5 years to determine the effects of dementia status and other stroke risk factors on stroke recurrence. The results showed that dementia, cardiac disease, and gender were significant independent predictors of long-term stroke recurrence, whereas education, admission systolic blood pressure, and alcohol consumption of more than 160 grams per week were only weakly related. The authors discuss possible explanations for the association between dementia and stroke recurrence. 1 figure, 2 tables, 59 references.
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Preexisting Dementia in Stroke Patients: Baseline Frequency, Associated Factors, and Outcome Source: Stroke. 28(12): 2429-2436. December 1997. Summary: This journal article describes a study of the baseline frequency of dementia in stroke patients, associated factors, and outcomes. The participants were patients admitted to the acute stroke unit of the Lille University Hospital in Lille, France. A total of 202 patients with ischemic or hemorrhagic stroke, aged 42 to 101 years, were enrolled. The patients were assessed for preexisting dementia within 48 hours of stroke onset using a French translation of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Six months later, survivors underwent a battery of neuropsychological tests that assessed a range of cognitive functions, functional impairment, and psychiatric symptoms. Thirtythree patients had preexisting dementia according to the IQCODE; the dementia had been previously diagnosed in only one case. Logistic regression analysis revealed that female gender, a family history of dementia, leukoaraiosis, and cerebral atrophy were independently associated with preexisting dementia. All of the survivors with prestroke dementia met the criteria for dementia at the 6-month neuropsychological evaluation. The authors conclude that some patients
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with poststroke dementia may have had unrecognized preexisting dementia. 4 tables, 68 references. ·
Risk Factors for Dementia Associated With Stroke in African Americans: A Case Control Analysis Source: Journal of Mental Health and Aging. 2(1): 51-65. Spring 1996. Summary: This article describes a case-control study to identify potential risk factors for vascular dementia among African-Americans with cerebral infarcts who did (77 cases) or did not (53 controls) have dementia associated with stroke. Study participants were examined at the Rush Medical Center between September 1991 and September 1992. The diagnoses of dementia and dementia associated with stroke were based on history of cognitive dysfunction, neurophysiologic test results, and recently proposed criteria that incorporate the information from computed tomography and magnetic resonance imaging. Participants with dementia generally were older, had less education and income; less frequently had a history of myocardial infarction, hypercholesterolemia, and cigarette smoking; were less independent in instrumental activities of daily living and activities of daily living; and had lower systolic blood pressure and greater stroke severity as compared to controls. Education had a modest protective effect for dementia associated with stroke. The authors conclude that stroke is preventable, and primary prevention of stroke may lead to a significant reduction in morbidity and mortality of dementia associated with stroke. 4 tables, 67 references. (AA-M).
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Caregivers of Alzheimer's Disease and Stroke Patients: Immunological and Psychological Considerations Source: Gerontologist. 34(4): 534-540. August 1994. Summary: This study addresses whether observed psychological and immunological changes in caregivers of patients with Alzheimer's disease (AD) were unique to AD caregivers. Participants consisted of 25 caregivers of AD patients, 25 caregivers of stroke patients, and 25 noncaregivers. Researchers compared all subjects on several psychological and immunologic indices. Measurements included the Zung Self-Rating Depression Scale; Burden Interview; Older Americans' Resources and Services Multidimensional Functional Assessment Questionnaire, Social Resources Scale; and Perceived Social Support From Friends and Perceived Social Support From Family questionnaires. Comparisons show that the AD caregiving group was more psychologically distressed than the stroke caregiving group; Both groups were more psychologically distressed than a control group. AD caregivers reported spending an average of 5 hours daily in caregiving
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activities, often resulting in restrictions on social activities, the sacrifice of friends, hobbies, and jobs. With respect to immunologic function, there were no differences among the three groups. Clinical implications for these findings range from early outreach educational programs for AD caregivers to an increased need for social support groups and respite programs. 4 tables, 31 references. (AA-M). ·
Comparison of Caregivers for Elderly Stroke and Dementia Victims Source: Journal of the American Geriatrics Society. 40(9): 896-901. September 1992. Summary: This study compared elderly caregivers of persons with stroke or dementia to see whether caring for persons with mental disabilities such as Alzheimer's disease is more stressful than caring for those with physical disabilities such as stroke. A total of 99 caregivers aged 60 or older who lived with their care recipients were interviewed. The Relatives Stress Scale was used to measure caregivers' burden, defined as personal distress and life upset produced by caregiving and negative feelings toward the care recipient. The General Health Questionnaire was used to measure psychological morbidity. Both groups of caregivers were found to be experiencing similar degrees of burden and high psychological morbidity. Also, burden and psychological distress were higher in both groups of caregivers when the care recipients exhibited behavioral problems or mood disturbance. Findings did suggest, however, that social impact may be greater for dementia caregivers than for stroke caregivers, and that dementia caregivers had a tendency to receive less help from family and friends and to be less satisfied with the help they received. The authors conclude that all assessments of the disabled elderly should include measures of caregiver burden and psychological morbidity. 38 references.
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Dementia Associated With Stroke Source: Stroke. 21(Supplement 2): II-9-II-11. September 1990. Summary: Vascular-type dementia (VTD) is the second most common dementing illness, accounting for 10-39 percent of all demented patients. This journal article uses (VTD) to include arteriosclerotic dementia, multiinfarct dementia (MID), subcortical arteriosclerotic encephalopathy (SAE), and the lacunar state. Emphasis is placed on a proposed set of clinical criteria to be used in future research on VTD. It is argued that the standardization of criteria for the clinical diagnosis of VTD will facilitate future studies of pathophysiology. Following a review of studies reported in the literature, it is concluded that patients with VTD could be defined as those who: (a) meet criteria for dementia outlined in the
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Diagnostic and Statistical Manual of Mental Disorders (DSMIII); (b) score at least 7 on the Hachinski ischemic score; (c) are neither depressed nor delirious; and (d) have no other identifiable cause of dementia (including vitamin B-12 deficiency, hypothyroidism, brain tumor, subdural hematoma, communicating hydrocephalus, or drug toxicity). Several standardized tests of cognitive and functional abilities are useful in estimating the severity of dementia and in providing concrete evidence for DSMIII criteria. 24 references. ·
Aphasia Management During the Early Phases of Recovery Following Stroke Source: American Journal of Speech-Language Pathology. 10(1): 19-28. February 2001. Contact: Available from American Speech-Language-Hearing Association (ASHA). Subscription Sales Coordinator, 10801 Rockville Pike, Rockville, MD 20852-3279. (888) 498-6699. Fax (301) 897-7358. Website: www.asha.org. Summary: Training in speech language pathology seldom distinguishes treatment of aphasia (complete or partial impairment in language comprehension) in its early phases from treatment that occurs when aphasia has become more chronic. This article proposes an approach to therapy for the early phases of recovery following stroke that emphasizes the provision of support, prevention, and education, rather than structured language therapy. The authors first define the period of treatment under discussion, then review the literature in this area. The next section reviews the medical considerations of the newly aphasic patient, and the psychological considerations for both patients and their families. The authors then discuss clinicians' roles with patients in the areas of assessment, the setting of therapy (in the patient's room, generally), early therapy, the conversational approach, the functions of counseling, and aphasia management with families. Other topics include modeling communication strategies for family members, team communication, and reimbursement issues. The authors reiterate that, whenever possible, and to the best of patients', families' and therapists' abilities, positive emotions such as warmth, grace, good humor, and laughter should be sought and cherished in the early aftermath of stroke. 2 tables. 34 references.
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Swallowing Disorders Following Acute Stroke: Prevalence and Diagnostic Accuracy Source: Cerebrovascular Diseases. 10(5): 380-386. September-October 2000.
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Contact: Available from Karger. Customer Service, P.O. Box, CH-4009, Basel, Switzerland. Fax 41 61 306 12 34. Website: www.karger.com. Summary: This article reports on a study of 128 patients with acute, first ever, stroke (cerebrovascular accident). The study was undertaken to determine the prevalence of swallowing disorders, the diagnostic accuracy of the clinical assessment of swallowing function compared with videofluoroscopy, and interobserver agreement for the clinical and videofluoroscopic diagnosis of swallowing disorders and aspiration. The authors found clinical and videofluoroscopic evidence of a swallowing disorder in 51 percent and 64 percent of patients, respectively, and aspiration in 49 percent and 22 percent of patients, respectively. The interobserver agreement between two speech pathologists for the clinical diagnosis of a swallowing disorder and aspiration was food. Between a speech pathologist and radiologist for the videofluoroscopic, diagnosis of a swallowing disorder and aspiration was good' and fair' respectively. Although clinical bedside examination underestimates the frequency of swallowing abnormalities and overestimates the frequency of aspiration compared with videofluoroscopy, bedside examination may still offer valuable information for the diagnosis of swallowing impairment. Long term follow up studies are necessary to determine the use of these types of examinations in predicting the occurrence of important outcome events such as aspiration pneumonia. 2 appendices. 1 figure. 4 tables. 31 references.
Federally-Funded Research on Stroke The U.S. Government supports a variety of research studies relating to stroke and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.21 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to stroke and related conditions.
21 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore stroke and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for stroke: ·
Project Title: A Post Discharge Intervention to Improve Stroke Outcomes Principal Investigator & Institution: Allen, Kyle R.; Summa Health System Box 2090, 525 E Market St Akron, Oh 44304 Timing: Fiscal Year 2002; Project Start 1-JUN-2002; Project End 1-MAY2005 Summary: A need exists for effective and cost-efficient approaches to the management of stroke survivors, not only to prevent recurrent stroke but also to prevent and manage other post-stroke complications. Currently, it is assumed that by the time of discharge from an acute care or rehabilitation setting the patient, family, primary care physician, physiatrist, and neurologist have negotiated a shared responsibility to assure compliance with prescribed treatments. Often, this assumption is not met, resulting in fragmented care and negative patient outcomes that could have been prevented. As has been shown to be effective for the management of other chronic diseases, effective post-discharge stroke care management must not only address the physical needs of the stroke survivor, but also psychosocial issues which are known to impact on stroke outcomes. Previous post-stroke care research has found little improvement in patient outcomes due, in part, to the lack of a truly comprehensive care model. Many studies have been narrowly focused on medical management of targeted stroke-related conditions, for example hypertension or diabetes, with little or no consideration of the effect of the interplay between psychosocial and other variables. Other studies focused more on psychosocial, rather than physical, interventions. No previous studies have measured the patient's global well being as a study outcome. We propose a randomized controlled trial of 380 post-discharge ischemic stroke patients. The primary aim of this study is to determine the effectiveness of an integrated post-discharge interdisciplinary stroke care model in improving stroke survivor's global well being (a composite of neuromotor function, severe complications, management of risk for common post-stroke complications, quality of life, and stroke knowledge) by six months as compared to stroke patients who receive usual postdischarge care. Our model, tested and refined in a pilot study at this
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community teaching hospital, overcomes many of the weaknesses of previous trials of post-stroke care management. The pilot results showed that this intervention had a significant positive overall impact on stroke survivors' well being. This study will advance the field's knowledge of the effectiveness of truly comprehensive post-discharge stroke care management. The standardized assessments and intervention protocols can be used as a template that is easily adapted to a variety of health care settings. Such information will allow more effective and efficient management of stroke survivors Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Center for Stroke Research Principal Investigator & Institution: Chopp, Michael; Professor and Vice Chairman; Neurology; Case Western Reserve Univ-Henry Ford Hsc Henry Ford Health Science Ctr Detroit, Mi 48202 Timing: Fiscal Year 2001; Project Start 1-APR-1986; Project End 1-AUG2005 Summary: (Applicant's Abstract): The applicants propose a highly integrated application focused on preclinical and clinical studies to investigate and develop treatment of stroke with an anti-platelet aggregation agent alone, and in combination with thrombolysis using recombinant tissue plasminogen activator (rtPA). Permeating this Program is the development and application of MRI to enhance the management of the stroke patient. Three interdependent Projects and two Cores constitute this grant application. Project 1, Anti-Platelet Aggregation Therapy for Embolic Stroke, will investigate the mechanisms promoting secondary thrombosis after embolic stroke and treatment with rtPA in rat, and will test, in a controlled experimental model, treatment of embolic stroke with an antibody against the GPIIb/IIIa receptor. This receptor binds the platelet to fibrin and is responsible for platelet aggregation and therefore, platelet mediated thrombosis. This project leads into Project 2, MR Assessment of Transient Cerebral Ischemia, which develops and applies a multi-parameter MRI model to experimental embolic stroke in rats. The goals of this Project are to develop and test the application of the multi-parameter MRI model to identify candidates for therapy and to exclude candidates from therapy after embolic stroke. In addition, the MRI response to thrombolysis with rtPA and rtPA in combination with an antagonist to platelet aggregation will be tested. Projects 1 and 2 form the preclinical support for a Phase II Pilot Clinical Trial of treatment of stroke with an anti-platelet aggregation agent, abciximab. This Project will test activity of treatment of the stroke patient with abciximab and will identify an MRI based surrogate marker
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for activity and accrue MR data to select patients for anti-platelet aggregation therapy. Core A is an Administrative and Biostatistical Core. Core B, the MRI core, services all three Projects. The Program Project provides an integrated highly coherent effort to enhance management and therapeutic intervention in the treatment of acute stroke. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Complement-Mediated Neuronal Injury in Stroke Principal Investigator & Institution: Connolly, E S.; Neurological Surgery; Columbia University Health Sciences Ogc New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 0-JUN2005 Summary: (From Applicant's Abstract): Ischemic stroke is a leading cause of death and disability, for which treatment options are very limited. The therapeutic dilemma created by the opposing goals of achieving rapid reperfusion and preventing intracerebral hemorrhage (ICH), has led us to consider the utility of targeting an inflammatory paradigm, the complement cascade, for inhibition in ischemic stroke. Studies are driven by the hypothesis that complement activation contributes directly to cerebral injury in stroke and may indirectly reduce the efficacy of tPA due to plasmin-dependent activation of complement. Preliminary data in a model of stroke using gene deficient mice have pointed to the critical deleterious role for leukocyte recruitment via the P- and E-selectin and ICAM-1 glycoprotein adhesion receptors. More recently, we have shown that ischemia triggers neurons to express an early complement component (C1q, thereby potentially flagging themselves for lysis or receptor mediated immune clearance. C1q-expressing, ischemically injured neurons bind a soluble truncated form of the extracellular domain of the complement receptor 1 (sCR1), which inhibits local complement activation and confers partial cerebral protection in stroke. When this complement-inhibitory protein is covalently modified by sLexglycosylation to additionally inhibit selectin-mediated events, striking gains are observed in terms of reducing leukocyte and platelet recruitment, leading to a safe, durable protection even with delayed treatment. Preliminary data in our new primate (baboon) model of reperfused stroke demonstrate similar upregulation of cerebral microvascular selectin and neuronal C1q expression in the ischemic zone. In a double-blind placebo-controlled trial of baboon stroke we have just completed, a humanized anti-P-/E-selectin antibody demonstrated moderate cerebral protective efficacy. Together, these data lead us to hypothesize that selectin- and complement-mediated immuneinflammatory mechanisms are pathophysiologically relevant in stroke,
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and that simultaneous inhibition of both mechanisms may provide a novel and useful therapeutic target. Furthermore, given that plasmin may activate complement, and anti-complement approach might be especially useful in stroke to increase the efficacy of and therapeutic window for rtPA. These data lead directly to the Specific Aims, which are: (1) demonstrate the role of C1q expression in murine stroke using C1qa -/mice and determine whether the effect of c1q expression is injurious via activation of the complement cascade and/or via local binding of transmembrane and cytosolic receptors leading to enhanced oxidative stress and phagocytosis; (2) determine whether thrombolysis with tPA activates complement, thereby diminishing it's capacity to protect the brain in stroke; and (3) determine the pathophysiological contribution of C1q expression in primate stroke using complement blockade (with sCR1) strategy as well as a combined anti-adhesion receptor, anticomplement strategy (sCR1/SLex). Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Echocardiographic Stroke Predictors in a Tri-Ethnic Comm Principal Investigator & Institution: Di Tullio, Marco R.; Medicine; Columbia University Health Sciences Ogc New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-AUG2004 Summary: (Adapted From The Applicant's Abstract): The candidate's previous activity has been devoted to patient-oriented research. In recent years, he has focused on the use of echocardiography to identify new cardioembolic sources for ischemic stroke, especially patent foramen ovale and aortic arch plaques, and has`been awarded two R01 grants from NINDS for such efforts. The candidate's overall career goal is to continue his research in the field of cardioembolic stroke, contributing to the explanation of the mechanisms of some cryptogenic strokes and therefore to a rational preventive and therapeutic approach. The candidate is also committed to mentoring young investigators, as documented by his long-standing and successful training of cardiology, fellows. Columbia University is an ideal environment to foster the candidate's career growth because of the strong, infrastructure for clinical research, the presence of world renowned cardiologists and neurologists for consultation and collaboration, and the firm institutional commitment to patient-oriented research. Crucial to the candidate's career development will be the transition from the relatively small case-control studies performed so far to the proposed large prospective study of subclinical echocardiocraphic abnormalities and stroke risk. A
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population-based prospective cohort study is proposed to determine the independent contribution of left ventricular hypertrophy (LVH) and geometric pattern, decreased LV ejection fraction, segmental wall motion abnormalities and left atrial enlargement to the risk of ischemic stroke and vascular events in a tri-ethnic population, and the existence of a dose-response relationship. The progression of these abnormalities over time will also be assessed. Secondary aims will be to evaluate the modification of risk by traditional stroke risk factors, and the assessment of the risk associated with less frequent abnormalities (patent foramen ovale, mitral annular calcification, mitral valve prolapse). Finally, the prevalence of a patent foramen ovale in each race-ethnic group will be evaluated. A cohort of 2500 white, black and Hispanic adults over age 55 will be enrolled from the ongoing Northern Manhattan Stroke Study (NOMASS), assuring cost-effective recruitment, data collection and follow-up. Two-dimensional echocardiography with contrast injection will be performed. A new three-dimensional technique will also be used to assess LVH. Annual telephone follow-up will be performed to ascertain stroke, myocardial infarction and death. In-person follow-up will be done in subjects with suspected outcome and in a random 10% of the cohort. Kaplan Meier curves and Cox-proportional hazard models will be used to calculate adjusted event rates and assess the dependence of exposures of interest on stroke and vascular events adjusting for demographics and stroke risk factors. In a subgroup of 900 subjects, echocardiography will be repeated 3 years after the first test to study the progession of echocardioaraphic abnormalities. This study will be the first prospective cohort study to evaluate the role of multiple echocardiographic risk factors for ischemic stroke in a community of whites, blacks and Hispanics living in the same area. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Family Function, Stroke Recovry, and Caregiver Outcomes Principal Investigator & Institution: Clark, Patricia C.; Adult and Elder Health; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-AUG2003 Summary: Of the estimated four million stroke survivors in the United States, approximately 66% live with moderate to severe impairment. Family caregivers have a major role in stroke survivors' recovery including all aspects of rehabilitation; however, caregivers may experience negative psychological and physical outcomes including increased risk of mortality. The effects of factors such as family
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functioning and characteristics of the stroke survivor (e.g. memory and behavior problems) on caregiver outcomes and stroke survivors' physical recovery are not well understood. Because of the variable trajectory of the stroke recovery process, a prospective longitudinal design based on the strength-vulnerability model will be used to study outcomes in a sample of 170 caregiver-stroke survivor dyads during the first year post stroke. This innovative proposal is a complementary sub-study to a national clinical trial, "Extremity Constraint Induced Therapy Evaluation (EXCITE)" developed in response to RFA NR-4-00-003. The purposes of the sub-study are to: (1) determine relationships among family caregiver outcomes (depression, fatigue and overall health), family functioning, and stroke survivor physical function and memory/behavior problems over time, (2) determine predictors of caregiver outcomes approximately one year post-stroke, and (3) examine the interaction of family function and the EXCITE treatment group on stroke survivor functional recovery. Data will be collected at baseline (3-6 months post-stroke), and four and eight months later via in-person administration of questionnaires and a semi-structured interview. A cost-effective strategy will combine prospectively collected caregiver data with stroke survivor data collected for the EXCITE clinical trial. Identification of the most salient factors associated with caregiver depression, fatigue, and health status at different points in recovery is essential for future development and testing of interventions to improve outcomes of caregivers and stroke survivors. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Gene-Environment Interactions and Stroke Susceptibility Principal Investigator & Institution: Fornage, Myriam; Human Genetics Center; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 1-AUG2005 Summary: Stroke is the third leading cause of death in the United States and is frequently associated with long-term disability. The stroke-prone spontaneously hypertensive rat (SHRSP), which was developed by selective breeding from the spontaneously hypertensive rat (SHR), represents a suitable model of hypertension-associated stroke. Stroke occurrence is influenced by the complex interaction of multiple genes and environmental factors. The role of dietary sodium and potassium in modulating the onset of stroke has been well documented both in humans and animal models. In the SHRSP, diet high in sodium and low in potassium accelerates the development of stroke. In contrast, a high
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intake of potassium markedly protects against stroke occurrence, even though blood pressure levels remain unchanged. We have applied a gene expression profiling strategy using oligonucleotide micro-arrays to identify genes and gene pathways implicated in the development of stroke in this animal model. Because gene expression profiles uniquely and comprehensively reflect the complex and dynamic interaction of a defined set of genes with the environment, characterization of gene expression changes induced by dietary perturbations among inbred rat strains differing in their genetic propensity to develop stroke will provide clues on the mechanisms governing the interaction of stroke susceptibility genes with the dietary factors known to influence the disease process. The proposed application will focus on identifying stroke-susceptibility genes interacting with dietary salt intake to influence the initiation of stroke events in the SHRSP by comparing the gene expression profiles in the cortical regions of the brain of male SHRSPs and SHRs exposed to a regular vs. stroke- permissive diet. We will then identify genetic variants in these expressional candidate genes, as well as a panel of selected biological/positional candidate genes. We will assess the cosegregation of the genetic variants with stroke latency in the F2 progeny of SHRSP x SHR parental crosses. In addition, we will examine whether the relationship between genetic variants in candidate genes and variation in stroke latency in the F2 is modified by dietary factors. We will finally evaluate the potential relevance of a paradigm of stroke causation established in an experimental model to human disease. Specifically, we will characterize sequence variation within or near the human homologue of ten genes identified in this proposal and determine whether variation in these genes is associated with stroke incidence in a large population-based sample of individuals participating in the Atherosclerosis Risk in Communities (ARIC) study. We will also identify and characterize DNA variation in a panel of selected stroke-candidate human genes and test whether variation in these genes is associated with risk of developing a stroke in the ARIC sample. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Hemorrhagic and Ischemic Stroke among Blacks and Whites Principal Investigator & Institution: Broderick, Joseph P.; Professor; Neurology; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2000; Project Start 2-SEP-1992; Project End 1-MAY2003
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Summary: (Adapted from Investigator's Abstract) The primary goal of the proposed studies is to identify temporal trends in the incidence rate, causes, treatment and outcome of stroke among a large biracial metropolitan population in Cincinnati. There are 1,299,901 people in the greater metropolitan area, 187,806 of whom are black, a percentage that compares favorably with the U.S. population as a whole. The investigators propose to identify every hospitalized or autopsied and almost all non-hospitalized strokes during 1/1/99 through 12/31/99 at all 19 regional hospitals and 147 outpatient screening sites as per the previous five-year funding period. They will identify and abstract detailed information from the medical record for every potential stroke case (methods identical to their ongoing five-year study). In addition, they plan on contacting 500 new ischemic stroke patients (250 blacksexcluding TIAs) and/or their families, to obtain detailed information concerning prior risk factors, knowledge about stroke, outcome following stroke, and buccal cells and/or blood for genetic material. They will replicate a random digit-dialing telephone surgery of 2000 persons from the general population during the year 2000. The estimated 3000 strokes and 700 TIAs as well as the 2000 surveyed persons from the general population will be used to test the following primary hypotheses. 1) The age, sex, and race-adjusted incidence rate of all first-ever stroke, cerebral infarction, and subarachnoid hemorrhage will decrease and the rate of intracerebral hemorrhage will increase during 1999 as compared to incidence rates during 1988 and 1993/4. 2) The 3-month mortality after stroke will be similar for blacks and whites and unchanged from 1993/94, but functional outcome at 3-months as measured by the Barthel Index, Pfeffer Instrumental Activities of Daily Living Scale, and Medical Outcome Study will be poorer among blacks as compared to whites. The investigators state that the long-term goal of this research is to study temporal trends in stroke incidence rates, treatment, and outcome and their relationships to the prevalence of environmental and genetic risk factors for stroke as well as to changes in public knowledge of stroke risk factors and warning signs. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Hormone Replacement Therapy and Ischemic Stroke Severity Principal Investigator & Institution: Bushnell, Cheryl D.; Associate in Medicine; Medicine; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 1-AUG2006
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Summary: (provided by applicant): Experimental studies in laboratory animals have shown that estrogen reduces stroke severity, but the impact of hormone replacement therapy (HRT) on ischemic stroke severity in humans is not known. There are 2 broad, longterm objectives of this project. The first objective is to determine whether there are differences in stroke severity and outcome between women who are HRT users and women who are nonHRT users. The second objective is to determine whether any difference in these 2 groups is related to enhanced fibrinolysis. The Specific Aims of this proposal are 1) to compare the initial stroke severity in women who are users and nonusers of HRT, 2) to measure any differences in markers of the coagulation and fibrinolytic systems in the acute stroke period, and 3) to assess stroke outcomes in women based on poststroke use or nonuse of HRTs. Subjects for this prospective, observational study will be women admitted with acute ischemic stroke to an academic medical center. In the acute stroke period, initial stroke severity will be assessed using the NIHSS and markers of coagulation (prothrombin fragment F1,2 and thrombinantithrombin III complex) and fibrinolysis (plasminogen activator inhibitor type I) will be measured. Relevant historical and demographic data will be collected. At 3 months poststroke, neurologic impairment (NIHSS), functional status (Barthel Index and Modified Rankin), and quality of life (Stroke Impact Scale) will be assessed. The differences in initial stroke severity will be analyzed accounting for co-variates, and the 3month outcomes will be adjusted for initial stroke severity. This work will provide critical information for physicians prescribing HRT for women at risk for stroke and address whether it is safe to continue these medications in the subacute period after stroke. As a K23 proposal, this project will not only provide important clinical information, but is a natural extension of the candidate's previous experience with coagulopathies and stroke, now combined with the commitment to study the impact of stroke in women. This proposal will also provide critical transitional support in a mentored environment leading to the candidate's complete independence as a clinical investigator. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Inflammation and Infection as Risk Factors in Stroke Principal Investigator & Institution: Elkind, Mitchell S.; Gertrude H Sergievsky Center; Columbia University Health Sciences Ogc New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 5-JAN-2002; Project End 1-DEC2006
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Summary: (provided by applicant): Serum markers of infection and inflammation have been associated with both incident myocardial infarction (Ml) and prognosis after Ml, but very little data about the relationship of these markers to stroke incidence or prognosis is available. Preliminary studies by the applicant have shown that chronic infection with Chlamydia pneumoniae (C. pneumoniae) is associated with stroke risk, and that elevated white blood cell count and soluble tumor necrosis factor receptor levels are associated with carotid atherosclerosis. The applicant has training in epidemiology, but no advanced training in laboratory techniques or in the basic biology of inflammation or infection. This career development award will train the applicant in the pathobiology of inflammation and infection, in basic techniques of molecular biology, and in advanced epiderniologic and biostatistical analysis. The proposed study will test the following hypotheses: 1) Elevated levels of markers of inflammation (CRP, interleukin 6, tumor necrosis factor receptor levels) and specific infections (C. pneumoniae, CMV) are independent predictors of first ischemic stroke, and 2) elevated levels of these markers of inflammation and infection are associated with worse prognosis after stroke. Two concurrent prospective study designs are proposed to test these hypotheses. For hypothesis 1, levels of these markers will be compared in 125 stroke cases and 250 controls, all of whom are drawn from the 3300 initially strokefree subjects in the Northern Manhattan Stroke Study (NOMASS, NINDS 2RO1-29993). ELISA will be used to measure marker levels. The blood samples analyzed will be those drawn at baseline, prior to stroke occurrence, using a strong design, the nested casecontrol study. Multiple conditional logistic regression analysis will be used to assess the significance of the main exposure variables after matching for age, gender, and race/ethnicity, and after adjustment for other risk factors. For hypothesis 2, 300 prospectively enrolled stroke patients in the Aortic Plaque and Risk of Ischemic Stroke Study (APRIS, NINDS R01-36286) will be followed up annually for 3 years for the occurrence of stroke, death, or Ml, and the levels of these markers in blood samples will be analyzed by ELISA. Cox proportional hazards modeling will be used to assess survival based on baseline inflammatory marker status after adjustment for other risk factors and stroke severity. The applicant will pursue coursework in infectious diseases and pathobiology of inflammation, as well as in advanced epidemiologic and biostatistical analysis. He will participate in laboratory practicums at Columbia and the CDC to gain handson knowledge of laboratory techniques, including ELISA and PCR, necessary for the present and future studies. It is anticipated that these experiences and the successful completion of the proposed project will allow him to compete for independent investigator
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awards. Nationally recognized experts in stroke epidemiology and basic vascular biology will serve as mentors for these studies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Stroke Prevention Trial in Sickle Cell Anemia Principal Investigator & Institution: Brambilla, Donald J.; Principal Research Scientist; New England Research Institutes, Inc. 9 Galen St Watertown, Ma 02472 Timing: Fiscal Year 2000; Project Start 5-JUL-1994; Project End 0-JUN2000 Summary: Stroke occurs in about 10% of pediatric patients with Sickle Cell Disease (Hb SS) and is a major cause of morbidity. The 46-90% rate of recurrence can be reduced to less than 10% by chronic blood transfusion. Secondary prevention programs based on transfusion have become the standard of care, but most patients have already suffered irreversible brain injury. Prevention of first stroke is now possible using transcranial Doppler (TCD) ultrasound which can detect arterial abnormalities which place these children at high risk for cerebral infarction. Prediction is based on the detection of high arterial blood flow rates which are associated with arterial narrowing and subsequent cerebral infarction. Combining predictive screening and a potentially effective treatment, prevention of stroke before brain injury occurs is now possible. A randomized, controlled trial is needed to determine if first stroke in high risk children is significantly reduced by prophylactic transfusion. This randomized, controlled, multicenter trial of efficacy of periodic blood transfusion will test the hypothesis that reduction of sickle hemoglobin to 30% or less with transfusion will reduce first time stroke by at least 70% compared to supportive medical care. Primary endpoints will be clinically evident symptoms of cerebral infarction with consistent findings on Magnetic Resonance Imaging (MRI), symptomatic intracranial hemorrhage and death from any cause; secondary endpoints will be asymptomatic brain lesions, detected by MR in brain areas not implicated in primary endpoints. Hematologic characteristics of the high risk group will be analyzed and serum and DNA samples frozen for future analyses. Study design calls for 6-month start-up, TCD screening and randomization conducted during months 6-24, and observation for stroke from entry through month 54. TCD will be interpreted blindly. Endpoints will be adjudicated and MRIs interpreted centrally by blinded panels. Sample size calculation is based on prospective data relating to TCD velocity to risk of stroke and a randomization criterion associated with a 46% risk of cerebral infarction over 36 months of observation. Sample size (60 each group) is sufficient to detect 70% reduction in the
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primary endpoint of stroke at 90% power allowing for up to a 10% dropout. The pool of asymptomatic children to be screened at the 12 centers participating in this trial is two times that needed to find the 120 patients. Random TCD screening at four centers suggests prevalence rates of the high risk state comparable to those reported by this investigative team in the pilot study on which trial assumptions are based. This trial is significant because it will determine if transfusion is effective in the primary prevention of stroke in Hb SS children at risk for stroke. Primary prevention is preferable to secondary prevention because it intervenes before the occurrence of brain injury. Secondary aims may further understanding of the effects of transfusion on the brain and guide future research into the cause(s) of cerebrovascular involvement in Hb SS. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Stroke Prevention Trial in Sickle Cell Anemia (STOP) Principal Investigator & Institution: Adams, Robert J.; Neurology; Medical College of Georgia 1120 15Th St Augusta, Ga 30912 Timing: Fiscal Year 2000; Project Start 5-JUL-1994; Project End 3-AUG2000 Summary: Stroke occurs in 7-8% of pediatric patients with Sickle Cell Disease (Hb SS) and is a major cause of morbidity. The 46-90% rate of recurrence can be reduced to less than 10% by chronic blood transfusion. Secondary prevention programs based on transfusion have become the standard of care, but most patients have already suffered irreversible brain injury. Prevention of first stroke is now possible using transcranial Doppler (TCD) ultrasound which can detect arterial abnormalities which place these children at high risk for cerebral infarction. Prediction is based on the detection of high arterial blood flow rates which are associated with arterial narrowing and subsequent cerebral infarction. Combining predictive screening and a potentially effective treatment, prevention of stroke before brain injury occurs is now possible. A randomized, controlled trial is needed to determine if first stroke in high risk children is significantly reduced by prophylactic transfusion. This randomized, controlled, multicenter trial of efficacy of periodic blood transfusion will test the hypothesis that reduction of sickle hemoglobin to 30% or less with transfusion will reduce first time stroke by at least 75% compared to supportive medical care. Primary endpoints will be clinically evident symptoms of cerebral infarction with consistent findings on Magnetic Resonance Imaging (MRI), symptomatic intracranial hemorrhage and death from any cause; secondary endpoints will be asymptomatic brain lesions, detected by MRI in brain areas not
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implicated in primary endpoints. Hematologic characteristics of the high risk group will be analyzed and serum and DNA samples frozen for future analyses. Study design calls for 6-month start-up, TCD screening and randomization conducted during months 6-24, and observation for stroke from entry through month 54. TCD will be interpreted blindly. Endpoints will be adjudicated and MRIs interpreted centrally by blinded panels. Sample size calculation is based on prospective data relating TCD velocity to risk of stroke and a randomized criterion associated with a 46% risk of cerebral infarction over 39 months of observation. Sample size (60 each group) is sufficient to detect 75% reduction in the primary endpoints of stroke at 90% power allowing for up to a 10% dropout. The pool of asymptomatic children to be screened at the 12 centers participating in this is two times that needed to find the 120 patients. (See companion proposal for Data Coordinating Center: Donald Brambla, Ph.D., P.I.) Random TCD screening at four centers suggests prevalence rates of the high risk state comparable to those reported by this investigative team in the pilot study on which trial assumptions are based. This trial is significant because it will determine if transfusion is effective in the primary prevention of stroke in Hb SS children at risk for stroke. Primary prevention is preferable to secondary prevention because it intervenes before the occurrence of brain injury. Secondary aims may further understanding of the effects of transfusion on the brain and guide future research into the cause(s) of cerebrovascular involvement in Hb SS. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Electrostimulation for Hemiplegia Principal Investigator & Institution: Chae, John; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001; Project Start 4-MAY-2001; Project End 0-APR2005 Summary: (Verbatim from the application) Stroke is the most common serious neurological disorder in the United States and its incidence doubles with each decade after the age of 55. Hemiplegia is a striking manifestation of stroke and contributes significantly to the physical disability and impaired quality of life of stroke survivors. The evolving scientific data suggest that active repetitive movement of the hemiparetic limb is effective in facilitating the motor recovery of stroke survivors. However, present rehabilitation strategies emphasize compensatory training of the unimpaired extremity to maximize function, and prevention of complications of immobility. The broad goal or this project is to develop strategies to facilitate the motor recovery of stroke
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survivors, and thereby maximize. their function and quality of life. Previous studies have suggested that repetitive exercises facilitated by electromyogram (EMG) controlled neuromuscular electrical stimulation (NMES) enhance the upper extremity motor recovery of stroke survivors. However, these early studies were poorly controlled, sample sizes were small, long-term follow up were absent and outcomes were limited to motor impairments only. The aim of this project is to assess the tong-term effect of EMG-controlled NMES on the motor impairment and physical disability of chronic stroke survivors. This study complements an approved project that investigates the short-term effect of EMGcontrolled NMES on neurophysiologic measures of central motor function. A stratified randomized clinical trial design will be utilized. This study will demonstrate that EMG-controlled neuromuscular stimulation enhances the upper extremity motor and functional recovery of chronic stroke survivors. The proposed intervention may be effective for acute stroke survivors and for persons with other forms of central nervous system motor dysfunction such as traumatic brain injury, cerebral palsy, multiple sclerosis and incomplete spinal cord injury. EMG-controlled NIMES may also be effective for lower extremity motor and functional recovery. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Functional Genomics of Arterial Thrombosis Principal Investigator & Institution: Boerwinkle, Eric A.; Professor; Human Genetics Center; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-AUG2005 Summary: Stroke is the third leading cause of death in the United States and is frequently associated with long-term disability. We propose to apply a systematic strategy using oligonucleotide micro-array technology to identify genes involved in the initiation of stroke in two animal models: the stroke-prone spontaneously hypertensive rat (SHRSP) and the atherosclerosis-susceptible dog. We then propose to investigate the relevance of DNA sequence variation in the expressional candidate genes to susceptibility for human stroke in a large population-based study. We postulate that deviations from normal physiologic processes leading to stroke are accompanied by cellular and biochemical alterations which are reflected by changes in gene expression patterns in susceptible tissues. We further hypothesize that inherited DNA sequence variation in these same genes are at least partially responsible for interindividual variation in stroke susceptibility. These hypotheses will be addressed in four
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specific aims. In the first aim, we propose to apply the newly developed oligonucleotide micro-array technology to identify expressional candidate genes contributing to stroke occurrence in the SHRSP, a hypertension-related model of human stroke. The expression level of more than 24,000 gene transcripts will be simultaneously monitored in brain tissue and compared between the SHR and SHRSP rat. In the second aim, we propose to apply a similar but more focused technology to identify expressional candidate genes contributing to stroke in the atherosclerosis- susceptible dog, a unique atherosclerosis-related model of human stroke. In the last two aims, we will evaluate the potential relevance to human disease of the information obtained from the two animal models. Specifically, we will characterize sequence variation within or near the human homologue of 20 genes and determine whether variation in these genes is associated with stroke incidence in a large population-based sample of individuals participating in the Atherosclerosis Risk in Communities (ARIC) study. In the third aim, we will use direct DNA re- sequencing to identify variation within or near the human homologue of 10 expressional candidate genes identified in aims 1 and 2. We will also identify sequence variation in the coding and 5' regulatory regions of 10 additional biological candidate genes. In the fourth aim, we will determine whether DNA sequence variation in the genes identified in Aim 3 contributes to interindividual variation in risk of developing stroke in a well characterized sample of Caucasians and African-Americans. These studies represent a first step in unraveling the genetic architecture of stroke susceptibility in the population-at-large. This collaborative effort is novel for its ability to translate unique animal model research findings to the human condition. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: MRI Of Brain Ischemia and Reperfusion in a Primate Model Principal Investigator & Institution: De Crespigny, Alexander J.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 5-DEC-2001; Project End 0-NOV2005 Summary: (provided by applicant): The focus of this proposal is the application of advanced magnetic resonance imaging techniques, specifically diffusion and perfusion weighted MRI, to study the evolution of ischemic brain injury in a model of stroke in nonhuman primates (macaques). The use of diffusion and perfusion MRI for assessing stroke in animal models is well established and is becoming increasingly popular for diagnosing and monitoring acute stroke in human patients.
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Their clinical application remains somewhat controversial however, primarily because of an apparent lack of validation of the methodology in humans. This proposal will address this deficiency using clinically applicable MRI techniques in a macaque stroke model that closely resembles human stroke, but with the advantages of a controlled experimental setting and histologically defined endpoints. The overall objective of this proposal is to distinguish reversible from nonreversible brain damage in ischemic stroke using MRI. We will also show that MRI provides a "surrogate endpoint" to supplement or replace neurological testing in the assessment of stroke outcome in humans. We will use an endovascular stroke model in macaques, recently developed at MGH. Under fluoroscopic guidance, animals will receive 10, 20, 40, 60, 120, or 240 minutes of middle cerebral artery occlusion, or permanent occlusion. The specific aims are (1) to measure the natural evolution of the brain lesion using continuous T2-diffusion-and perfusion-weighted MRI during and up to 30 days after transient and permanent focal cerebral ischemia and (2) determine the combination of MRI derived parameters that can reliably predict reversible/nonreversible brain damage after transient ischemia using a statistical model that incorporates all the imaging findings. In addition to MRI, we will perform serial neurological testing and finally histological analysis of the brain slices. We hypothesize that (1) injury indicated by diffusion abnormality is reversible beyond a critical ischemia duration and that stroke evolution in macaques is closer to that in humans than rats, and (2) acute MRI scans can predict regional brain tissue status at the endpoint and that the statistical model can predict infarct location and neurological outcome from the chronic MRI data. A successful outcome from this study on nonhuman primates will generate data that will be directly relevant to the study and management of stroke in humans. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Warfarin vs Aspirin for Intracranial Arterial Stenosis Principal Investigator & Institution: Chimowitz, Marc I.; Neurology; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2000; Project Start 5-SEP-1998; Project End 1-JUL-2003 Summary: Background and Relevance. Atherosclerotic stenosis of the major intracranial arteries causes 40,000 strokes per year in the USA, costing the country at least 600,000,000 dollars annually. There have been no prospective trials evaluating optimal medical therapy for this disease. The main objective of this clinical trial is to compare warfarin (INR 2-3) with aspirin (1300 mg/day) for preventing stroke (ischemic and hemorrhagic) and vascular death in patients with symptomatic stenosis
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of a major intracranial artery. Study Design. Prospective, randomized, double-blind, multi-center trial. The sample size required will be 403 patients per group (based on stroke and vascular death rates of 33 percent/3 years in the aspirin group vs 22 percent/3 years in the warfarin group, an alpha of 0.05, beta of 0.80, a 24 percent withdrawal of therapy rate, and a 1 percent drop out rate). Conduct of Trial. Patients with transient ischemic attack (TIA) or stroke caused by angiographically proven stenosis (greater than or equal to 50 percent) of a major intracranial artery will be randomized to warfarin or aspirin. The dose of warfarin will be adjusted to maintain the INR between 2-3 based on monthly blood tests. Patients will be contacted monthly by phone and examined every four months (mean follow-up of 3 years) to determine whether any endpoints have occurred. The primary analysis will compare the rates of stroke (ischemic and hemorrhagic) and vascular death in the two treatment groups. Secondary analyses will compare the two treatment groups with respect to rates of i) all vascular deaths and disabling stroke, ii) all stroke (ischemic and hemorrhagic), iii) fatal and nonfatal ischemic stroke, iv) all ischemic stroke, myocardial infarction and vascular death, v) all major systemic and any intracranial hemorrhage, vi) all ischemic stroke in the territory of the stenotic intracranial artery. Conclusion. This study will 1) define optimal medical therapy for patients with symptomatic intracranial arterial stenosis, and 2) identify patients whose rate of ischemic stroke in the territory of the stenotic intracranial artery on best medical therapy is sufficiently high (i.e., greater than or equal to 6 percent per year) to justify a subsequent trial comparing intracranial angioplasty with best medical therapy in these patients. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central22 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).23 Access to this growing archive of e-journals is free and unrestricted.24 To search, go Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 23 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 24 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals 22
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to http://www.pubmedcentral.nih.gov/index.html#search, and type “stroke” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for stroke in the PubMed Central database: ·
A multicentre observational study of presentation and early assessment of acute stroke by Farzaneh Harraf, Anil K Sharma, Martin M Brown, Kennedy R Lees, Richard I Vass, and Lalit Kalra; 2002 July 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=116666
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Accuracy of a single question in screening for depression in a cohort of patients after stroke: comparative study by Caroline Watkins, Leanne Daniels, Cathy Jack, Hazel Dickinson, and Martin van den Broek; 2001 November 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59850
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Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up by Carole L Hart, George Davey Smith, David J Hole, and Victor M Hawthorne; 1999 June 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31100
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Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men by Anders Romelsjo and Anders Leifman; 1999 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28235
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Beat-to-beat changes in stroke volume precede the general circulatory effects of mechanical ventilation: a case report by N Nelson and B Janerot-Sjoberg; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29056
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Cervical manipulation and risk of stroke by Moira K. Kapral and Susan J. Bondy; 2001 October 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81499
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Clinical Update:ASA or low-molecular-weight heparin in the initial management of acute ischemic stroke complicating atrial fibrillation? by Donald Farquhar; 2001 February 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80756
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Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients by Antithrombotic Trialists' Collaboration; 2002 January 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64503
already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Commentary:A radical approach to stroke therapy by James McCulloch and Deborah Dewar; 2001 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58670
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Creating a Canadian stroke system by Elinor Wilson, Gregory Taylor, Stephen Phillips, Paula J. Stewart, Garth Dickinson, Vivian R. Ramsden, Robert W. Teasell, Nancy Mayo, Jack Tu, Steven Elson, Barbara Strauss, and on behalf of the Canadian Stroke Systems Coalition; 2001 June 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81194
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Cyclin-dependent kinases as a therapeutic target for stroke by Hitoshi Osuga, Sachiko Osuga, Fuhu Wang, Raouf Fetni, Matthew J. Hogan, Ruth S. Slack, Antoine M. Hakim, Joh-E Ikeda, and David S. Park; 2000 August 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27851
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Data quality assurance and quality control measures in large multicenter stroke trials: the African-American Antiplatelet Stroke Prevention Study experience by DeJuran Richardson and Shande Chen; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59632
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Dehydroascorbic acid, a blood --brain barrier transportable form of vitamin C, mediates potent cerebroprotection in experimental stroke by Judy Huang, David B. Agus, Christopher J. Winfree, Szilard Kiss, William J. Mack, Ryan A. McTaggart, Tanvir F. Choudhri, Louis J Kim, J Mocco, David J. Pinsky, William D. Fox, Robert J. Israel, Thomas A. Boyd, David W. Golde, and E. Sander Connolly, Jr.; 2001 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58796
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Delayed minocycline but not delayed mild hypothermia protects against embolic stroke by Chen Xu Wang, Tao Yang, Raza Noor, and Ashfaq Shuaib; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=107740
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Design of the Intravenous Magnesium Efficacy in Acute Stroke (IMAGES) trial by Andrew Bradford and Kennedy Lees; 2000 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=56206
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Displacement of insulin-like growth factors from their binding proteins as a potential treatment for stroke by Sarah A. Loddick, Xin-Jun Liu, Zi-Xian Lu, Changlu Liu, Dominic P. Behan, Derek C. Chalmers, Alan C. Foster, Wylie W. Vale, Nicholas Ling, and Errol B. De Souza; 1998 February 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19209
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Disseminated Zygomycosis Due to Rhizopus schipperae after Heatstroke by Gregory M. Anstead, Deanna A. Sutton, Elizabeth H.
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Thompson, Irene Weitzman, Randal A. Otto, and Sunil K. Ahuja; 1999 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85306 ·
Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial by Louise Gilbertson, Peter Langhorne, Andrew Walker, Ann Allen, and Gordon D Murray; 2000 March 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27300
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Ethnic differences in incidence of stroke: prospective study with stroke register by Judith A Stewart, R Dundas, R S Howard, A G Rudd, and C D A Wolfe; 1999 April 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27822
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Five year follow up of a randomised controlled trial of a stroke rehabilitation unit by N B Lincoln, S Husbands, C Trescoli, A E R Drummond, J R F Gladman, and P Berman; 2000 February 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27298
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Functional magnetic resonance imaging of reorganization in rat brain after stroke by Rick M. Dijkhuizen, JingMei Ren, Joseph B. Mandeville, Ona Wu, Fatih M. Ozdag, Michael A. Moskowitz, Bruce R. Rosen, and Seth P. Finklestein; 2001 October 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60128
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Genetically determined chloride-sensitive hypertension and stroke by Masae Tanaka, Olga Schmidlin, Sai-Li Yi, Andrew W. Bollen, and R. Curtis Morris, Jr.; 1997 December 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=25108
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Immunologic tolerance to myelin basic protein decreases stroke size after transient focal cerebral ischemia by Kyra J. Becker, Richard M. McCarron, Christl Ruetzler, Olgica Laban, Esther Sternberg, Kathleen C. Flanders, and John M. Hallenbeck; 1997 September 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23514
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Improving stroke patients' care: a patient held record is not enough by Mulunish Ayana, Pandora Pound, Fiona Lampe, and Shah Ebrahim; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=32174
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Incidence and Characteristics of Total Stroke in the United States by G Rhys Williams, MS, ScD; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=32314
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Infant mortality, stomach cancer, stroke, and coronary heart disease: ecological analysis by David A Leon and George Davey Smith; 2000 June 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27414
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Knowledge and perception about stroke among an Australian urban population by Sung Sug Yoon, , Richard F. Heller, , Christopher Levi, , and John Wiggers,; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=60659
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Migraine and stroke in young women: case-control study by C L Chang, Michael Donaghy, Neil Poulter, and World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception; 1999 January 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27668
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National stroke surveillance program needed in Canada by Kenneth C. Johnson and Yang Mao; 2001 October 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81489
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Neurologists warn about link between chiropractic, stroke by Jennifer Jones; 2002 March 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=99474
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Neurotoxicity of Advanced Glycation Endproducts During Focal Stroke and Neuroprotective Effects of Aminoguanidine by GA Zimmerman, M Meistrell, III, O Bloom, KM Cockroft, M Bianchi, D Risucci, J Broome, P Farmer, A Cerami, H Vlassara, and KJ Tracey; 1995 April 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42038
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Observation of transient disorder during myosin subfragment-1 binding to actin by stopped-flow fluorescence and millisecond time resolution electron cryomicroscopy: Evidence that the start of the crossbridge power stroke in muscle has variable geometry by Matthew Walker, Xue-Zhong Zhang, Wei Jiang, John Trinick, and Howard D. White; 1999 January 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15159
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On the Regeneration of the Actin-Myosin Power Stroke in Contracting Muscle by Y Chen and B Brenner; 1993 June 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46672
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Perceptions of stroke in the general public and patients with stroke: a qualitative study by Sung Sug Yoon and Julie Byles; 2002 May 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=104333
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Phenylpropanolamine, stroke and hypertension by Otto Kuchel; 2001 March 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80813
176 Stroke
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PISA. The effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute stroke: Protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690] by Eric J van Breda, Bart van der Worp, Maarten van Gemert, Ron Meijer, Jaap Kappelle, Peter J. Koudstaal, Diederik W. Dippel, and the PISAinvestigators; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=101394
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Predicted impact of intravenous thrombolysis on prognosis of general population of stroke patients: simulation model by Henrik Stig Jorgensen, Hirofumi Nakayama, Lars Peter Kammersgaard, Hans Otto Raaschou, and Tom Skyhoj Olsen; 1999 July 31 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28179
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Prenatal growth and risk of occlusive and haemorrhagic stroke in Swedish men and women born 1915-29: historical cohort study by E Hypponen, D A Leon, M G Kenward, and H Lithell; 2001 November 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59382
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Prospective cohort study to determine if trial efficacy of anticoagulation for stroke prevention in atrial fibrillation translates into clinical effectiveness by Lalit Kalra, Gloria Yu, Inigo Perez, Anil Lakhani, and Nora Donaldson; 2000 May 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27364
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Qualitative analysis of stroke patients' motivation for rehabilitation by Niall Maclean, Pandora Pound, Charles Wolfe, and Anthony Rudd; 2000 October 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27512
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Reactions to alteplase in patients with acute thrombotic stroke by William B. Chodirker; 2000 August 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80367
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Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study by P James, C J Ellis, R M L Whitlock, A R McNeil, J Henley, and N E Anderson; 2000 June 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27391
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Relationships between volume and pressure measurements and stroke volume in critically ill patients by Alexander JGH Bindels, Johannes G van der Hoeven, Antonie D Graafland, Jan de Koning, and Arend E Meinders; 2000 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29043
Studies 177
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Retrospective case note review of acute and inpatient stroke outcomes by Nabil Aly, Kevin McDonald, Michael Leathley, Anil Sharma, and Caroline Watkins; 2000 June 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27394
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Social stress exacerbates stroke outcome by suppressing Bcl-2 expression by A. Courtney DeVries, Hung-Dong Joh, Ora Bernard, Kimihiko Hattori, Patricia D. Hurn, Richard J. Traystman, and Nabil J. Alkayed; 2001 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58815
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Stroke protection by 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase inhibitors mediated by endothelial nitric oxide synthase by Matthias Endres, Ulrich Laufs, Zhihong Huang, Tadashi Nakamura, Paul Huang, Michael A. Moskowitz, and James K. Liao; 1998 July 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=21171
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Suicide in patients with stroke: epidemiological study by Elsebeth Nylev Stenager, Claus Madsen, Egon Stenager, and Jesper Boldsen; 1998 April 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28522
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The Siblings With Ischemic Stroke Study (SWISS) Protocol by James F. Meschia, Robert D. Brown, Jr, Thomas G. Brott, Felix E. Chukwudelunzu, John Hardy, and Stephen S. Rich; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=79001
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The use of alternative therapies in the Saskatchewan stroke rehabilitation population by Jeff Blackmer and Ludmilla Jefromova; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=117436
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Thrombolysis for acute ischaemic stroke: consumer involvement in design of new randomised controlled trial by Liedeke Koops and Richard I Lindley; 2002 August 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=119434
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tPA for acute stroke: balancing baseline imbalances by Jeffrey Mann; 2002 June 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=116149
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Update from the Canadian Stroke Consortium by John W. Norris and Vadim Beletsky; 2001 October 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81490
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Update on intravenous tissue plasminogen activator for acute stroke: from clinical trials to clinical practice by David J. Gladstone and Sandra E. Black; 2001 August 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81334
178 Stroke
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Use of diffusion and perfusion magnetic resonance imaging as a tool in acute stroke clinical trials by Steven Warach; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59649
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Use of ramipril in preventing stroke: double blind randomised trial by Jackie Bosch, Salim Yusuf, Janice Pogue, Peter Sleight, Eva Lonn, Badrudin Rangoonwala, Richard Davies, Jan Ostergren, and Jeff Probstfield; 2002 March 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=99052
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ZK200775: A phosphonate quinoxalinedione AMPA antagonist for neuroprotection in stroke and trauma by Lechoslaw Turski, Andreas Huth, Malcolm Sheardown, Fiona McDonald, Roland Neuhaus, Herbert H. Schneider, Ulrich Dirnagl, Frank Wiegand, Poul Jacobsen, and Eckhard Ottow; 1998 September 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28003
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.25 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with stroke, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “stroke” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “stroke” (hyperlinks lead to article summaries): ·
Fruit and vegetable intake in relation to risk of ischemic stroke. Author(s): Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Hennekens CH, Spiegelman D, Willett WC.
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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Studies 179
Source: Jama : the Journal of the American Medical Association. 1999 October 6; 282(13): 1233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10517425&dopt=Abstract ·
Fruits and vegetables and the risk of stroke. Author(s): Feldman EB. Source: Nutrition Reviews. 2001 January; 59(1 Pt 1): 24-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11281250&dopt=Abstract
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Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke. Author(s): Lennon S. Source: Physical Therapy. 2001 March; 81(3): 924-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11268157&dopt=Abstract
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Genistein is neuroprotective in murine models of familial amyotrophic lateral sclerosis and stroke. Author(s): Trieu VN, Uckun FM. Source: Biochemical and Biophysical Research Communications. 1999 May 19; 258(3): 685-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10329446&dopt=Abstract
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Genistein, daidzein and glycitein inhibit growth and DNA synthesis of aortic smooth muscle cells from stroke-prone spontaneously hypertensive rats. Author(s): Pan W, Ikeda K, Takebe M, Yamori Y. Source: The Journal of Nutrition. 2001 April; 131(4): 1154-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11285318&dopt=Abstract
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Human marrow stromal cell therapy for stroke in rat: neurotrophins and functional recovery. Author(s): Li Y, Chen J, Chen XG, Wang L, Gautam SC, Xu YX, Katakowski M, Zhang LJ, Lu M, Janakiraman N, Chopp M. Source: Neurology. 2002 August 27; 59(4): 514-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12196642&dopt=Abstract
180 Stroke
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Hydroxyurea as an alternative to blood transfusions for the prevention of recurrent stroke in children with sickle cell disease. Author(s): Ware RE, Zimmerman SA, Schultz WH. Source: Blood. 1999 November 1; 94(9): 3022-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10556185&dopt=Abstract
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Hyperbaric oxygen therapy for treatment of postischemic stroke in adult rats. Author(s): Chang CF, Niu KC, Hoffer BJ, Wang Y, Borlongan CV. Source: Experimental Neurology. 2000 December; 166(2): 298-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11085895&dopt=Abstract
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Impact of circadian amplitude and chronotherapy: relevance to prevention and treatment of stroke. Author(s): Shinagawa M, Kubo Y, Otsuka K, Ohkawa S, Cornelissen G, Halberg F. Source: Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2001; 55 Suppl 1: 125S-132S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11774859&dopt=Abstract
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Impaired direction and extent specification of aimed arm movements in humans with stroke-related brain damage. Author(s): Velicki MR, Winstein CJ, Pohl PS. Source: Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale. 2000 February; 130(3): 362-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10706435&dopt=Abstract
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In vivo antioxidant activity of genistein in a murine model of singlet oxygen-induced cerebral stroke. Author(s): Trieu VN, Dong Y, Zheng Y, Uckun FM. Source: Radiation Research. 1999 November; 152(5): 508-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10523874&dopt=Abstract
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Inadequacies in the provision of information to stroke patients and their families. Author(s): Rodgers H, Bond S, Curless R.
Studies 181
Source: Age and Ageing. 2001 March; 30(2): 129-33. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11395342&dopt=Abstract ·
Influence of sources of dietary oils on the life span of stroke-prone spontaneously hypertensive rats. Author(s): Ratnayake WM, Plouffe L, Hollywood R, L'Abbe MR, Hidiroglou N, Sarwar G, Mueller R. Source: Lipids. 2000 April; 35(4): 409-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10858026&dopt=Abstract
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Ischaemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for body building. Author(s): Vahedi K, Domigo V, Amarenco P, Bousser MG. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2000 January; 68(1): 112-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10671124&dopt=Abstract
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Ischemic stroke in a user of Thermadrene: A case study in alternative medicine. Author(s): Kaberi-Otarod J, Conetta R, Kundo KK, Farkash A. Source: Clinical Pharmacology and Therapeutics. 2002 September; 72(3): 343-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12235456&dopt=Abstract
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Ischemic stroke secondary to vertebral and cartid artery dissection following chiropractic manipulation of the cervical spine. Author(s): Turgut M. Source: Neurosurgical Review. 2002 August; 25(4): 267. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12206133&dopt=Abstract
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Knee position feedback: its effect on management of pelvic instability in a stroke patient. Author(s): Aruin AS, Sharma A, Larkins R, Chaudhuri G.
182 Stroke
Source: Disability and Rehabilitation. 2000 October 15; 22(15): 690-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11087065&dopt=Abstract ·
Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. Author(s): Spence JD, Barnett PA, Linden W, Ramsden V, Taenzer P. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1999 May 4; 160(9 Suppl): S46-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10333853&dopt=Abstract
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Lipid peroxide, beta-carotene and alpha-tocopherol in ischaemic stroke and effect of exogenous vitamin E supplementation on outcome. Author(s): Daga MK, Madhuchhanda, Mishra TK, Mohan A. Source: J Assoc Physicians India. 1997 November; 45(11): 843-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11229181&dopt=Abstract
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Low TENS treatment on post-stroke paretic arm: a three-year followup. Author(s): Sonde L, Kalimo H, Fernaeus SE, Viitanen M. Source: Clinical Rehabilitation. 2000 February; 14(1): 14-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10688340&dopt=Abstract
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Management of haemorrhagic stroke with hyperbaric oxygen therapy-a case report. Author(s): Lim J, Lim WK, Yeo TT, Sitoh YY, Low E. Source: Singapore Med J. 2001 May; 42(5): 220-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11513061&dopt=Abstract
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Management of shoulder pain in patients with stroke. Author(s): Walsh K.
Studies 183
Source: Postgraduate Medical Journal. 2001 October; 77(912): 645-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11571371&dopt=Abstract ·
Manipulation of the neck and stroke: time for more rigorous evidence. Author(s): Breen A. Source: The Medical Journal of Australia. 2002 April 15; 176(8): 364-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12041629&dopt=Abstract
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Mechanisms of phytosterolemia in stroke-prone spontaneously hypertensive and WKY rats. Author(s): Ikeda I, Nakagiri H, Sugano M, Ohara S, Hamada T, Nonaka M, Imaizumi K. Source: Metabolism: Clinical and Experimental. 2001 November; 50(11): 1361-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11699058&dopt=Abstract
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Mediterranean diet and stroke: objectives and design of the SUN project. Seguimiento Universidad de Navarra. Author(s): Martine-Gonzalez MA, Sanchez-Villegas A, De IJ, Marti A, Martinez JA. Source: Nutr Neurosci. 2002 February; 5(1): 65-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11929200&dopt=Abstract
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Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke. Author(s): Page SJ, Levine P, Sisto SA, Johnston MV. Source: Physical Therapy. 2001 August; 81(8): 1455-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11509075&dopt=Abstract
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Mental practice effect on line-tracing accuracy in persons with hemiparetic stroke: a preliminary study. Author(s): Yoo E, Park E, Chung B.
184 Stroke
Source: Archives of Physical Medicine and Rehabilitation. 2001 September; 82(9): 1213-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11552193&dopt=Abstract ·
Multichannel alternate electrostimulation using the new Bulgarian Vita 2007 equipment in post-stroke rehabilitation. Author(s): Ilieva E, Marinkev M. Source: Folia Med (Plovdiv). 1999; 41(1): 75-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10462928&dopt=Abstract
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Muscle spindle activity in the affected upper limb after a unilateral stroke. Author(s): Wilson LR, Gandevia SC, Inglis JT, Gracies J, Burke D. Source: Brain; a Journal of Neurology. 1999 November; 122 ( Pt 11): 207988. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10545393&dopt=Abstract
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Neurologists warn about link between chiropractic, stroke. Author(s): Jones J. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 March 19; 166(6): 794. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11944773&dopt=Abstract
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Neuromuscular electrical stimulation in stroke rehabilitation. Author(s): Kimberley TJ, Carey JR. Source: Minn Med. 2002 April; 85(4): 34-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11975052&dopt=Abstract
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New center a stroke of gene-ius. Author(s): Greene LA. Source: Environmental Health Perspectives. 2001 January; 109(1): A22-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11171539&dopt=Abstract
Studies 185
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Novel approach for the determination of the redox status of homocysteine and other aminothiols in plasma from healthy subjects and patients with ischemic stroke. Author(s): Williams RH, Maggiore JA, Reynolds RD, Helgason CM. Source: Clinical Chemistry. 2001 June; 47(6): 1031-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11375288&dopt=Abstract
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Observing washing and dressing of stroke patients: nursing intervention compared with occupational therapists. What is the difference? Author(s): Booth J, Davidson I, Winstanley J, Waters K. Source: Journal of Advanced Nursing. 2001 January; 33(1): 98-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11155113&dopt=Abstract
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Older adults' descriptions of hope after a stroke. Author(s): Bays CL. Source: Rehabil Nurs. 2001 January-February; 26(1): 18-20, 23-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12035195&dopt=Abstract
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Optimal patterns of care for dysphagic stroke patients. Author(s): Daniels SK. Source: Seminars in Speech and Language. 2000; 21(4): 323-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11085256&dopt=Abstract
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Pattern of localisation error in patients with stroke to sound processed by a binaural sound space processor. Author(s): Sonoda S, Mori M, Goishi A. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2001 January; 70(1): 43-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11118246&dopt=Abstract
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Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK. Author(s): Lennon S, Baxter D, Ashburn A.
186 Stroke
Source: Disability and Rehabilitation. 2001 April 15; 23(6): 254-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11336098&dopt=Abstract ·
Phytoestrogens attenuate oxidative DNA damage in vascular smooth muscle cells from stroke-prone spontaneously hypertensive rats. Author(s): Mizutani K, Ikeda K, Nishikata T, Yamori Y. Source: Journal of Hypertension. 2000 December; 18(12): 1833-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11132608&dopt=Abstract
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Plasticity of the human motor cortex and recovery from stroke. Author(s): Hallett M. Source: Brain Research. Brain Research Reviews. 2001 October; 36(2-3): 169-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11690613&dopt=Abstract
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Premotor cortex is involved in restoration of gait in stroke. Author(s): Miyai I, Yagura H, Oda I, Konishi I, Eda H, Suzuki T, Kubota K. Source: Annals of Neurology. 2002 August; 52(2): 188-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12210789&dopt=Abstract
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Preventive effects of Shichimotsu-koka-to on renal lesions in strokeprone spontaneously hypertensive rats. Author(s): Higuchi Y, Ono K, Sekita S, Onodera H, Mitsumori K, Nara Y, Satake M. Source: Biol Pharm Bull. 1998 September; 21(9): 914-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9781838&dopt=Abstract
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Protective effect of resveratrol on oxidative damage in male and female stroke-prone spontaneously hypertensive rats. Author(s): Mizutani K, Ikeda K, Kawai Y, Yamori Y. Source: Clinical and Experimental Pharmacology & Physiology. 2001 January-February; 28(1-2): 55-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11153537&dopt=Abstract
Studies 187
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Quality of life of stroke survivors. Author(s): Kim P, Warren S, Madill H, Hadley M. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 1999 June; 8(4): 293301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10472161&dopt=Abstract
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Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Author(s): Lincoln NB, Parry RH, Vass CD. Source: Stroke; a Journal of Cerebral Circulation. 1999 March; 30(3): 573-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10066854&dopt=Abstract
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Re: Does acupuncture have additional value to standard poststroke motor rehabilitation? Author(s): Ernst E. Source: Stroke; a Journal of Cerebral Circulation. 2002 July; 33(7): 1744; Discussion 1744. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12105342&dopt=Abstract
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Reflections upon rehabilitation by members of a community based stroke club. Author(s): Sabari JS, Meisler J, Silver E. Source: Disability and Rehabilitation. 2000 May 10; 22(7): 330-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10877487&dopt=Abstract
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Rehabilitative management of post-stroke visuospatial inattention. Author(s): Diamond PT. Source: Disability and Rehabilitation. 2001 July 10; 23(10): 407-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11400902&dopt=Abstract
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Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Author(s): Whitall J, McCombe Waller S, Silver KH, Macko RF.
188 Stroke
Source: Stroke; a Journal of Cerebral Circulation. 2000 October; 31(10): 2390-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11022069&dopt=Abstract ·
Repetitive epileptic fits--a possible adverse effect after transcutaneous electrical nerve stimulation (TENS) in a post-stroke patient. Author(s): Rosted P. Source: Acupunct Med. 2001 June; 19(1): 46-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11471584&dopt=Abstract
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Retraining reaching in chronic stroke with real-time auditory feedback. Author(s): Maulucci RA, Eckhouse RH. Source: Neurorehabilitation. 2001; 16(3): 171-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11790902&dopt=Abstract
Vocabulary Builder Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Bilateral: Having two sides, or pertaining to both sides. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bradykinesia: Abnormal slowness of movement; sluggishness of physical and mental responses. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU]
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Cardiology: The study of the heart, its physiology, and its functions. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Causal: Pertaining to a cause; directed against a cause. [EU] Contraception: The prevention of conception or impregnation. [EU] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH] Criterion: A standard by which something may be judged. [EU] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Hematoma: tissue. [NIH]
An extravasation of blood localized in an organ, space, or
Hobbies: Leisure activities engaged in for pleasure. [NIH] Hydrocephalus: A condition marked by dilatation of the cerebral ventricles,
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most often occurring secondarily to obstruction of the cerebrospinal fluid pathways, and accompanied by an accumulation of cerebrospinal fluid within the skull; the fluid is usually under increased pressure, but occasionally may be normal or nearly so. It is typically characterized by enlargement of the head, prominence of the forehead, brain atrophy, mental deterioration, and convulsions; may be congenital or acquired; and may be of sudden onset (acute h.) or be slowly progressive (chronic or primary b.). [EU]
Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypovitaminosis: A condition due to a deficiency of one or more essential vitamins. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interindividual: Occurring between two or more individuals. [EU] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and
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caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Pelvic: Pertaining to the pelvis. [EU] Perindopril: An angiotensin-converting enzyme inhibitor. It is used in patients with hypertension and heart failure. [NIH] Phagocytosis: Endocytosis of particulate material, such as microorganisms or cell fragments. The material is taken into the cell in membrane-bound vesicles (phagosomes) that originate as pinched off invaginations of the plasma membrane. Phagosomes fuse with lysosomes, forming phagolysosomes in which the engulfed material is killed and digested. [EU] Pneumonia: Inflammation of the lungs with consolidation. [EU] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]
Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU]
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Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Rhizopus: A genus of zygomycetous fungi of the family Mucoraceae, order mucorales, a common saprophyte and facultative parasite of mature fruits and vegetables. It may cause cerebral mycoses in diabetes and cutaneous infection in severely burned patients. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Spastic: 1. of the nature of or characterized by spasms. 2. hypertonic, so that the muscles are stiff and the movements awkward. 3. a person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]
Transcutaneous: Transdermal. [EU] Tremor: An involuntary trembling or quivering. [EU] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponintropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Ventilation: 1. in respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. in psychiatry, verbalization of one's emotional problems. [EU]
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Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Zygomycosis: Infection in humans and animals caused by fungi in the class Zygomycetes. It includes mucormycosis and entomophthoramycosis. The latter is a tropical infection of subcutaneous tissue or paranasal sinuses caused by fungi in the order Entomophthorales. Phycomycosis, closely related to zygomycosis, describes infection with members of Phycomycetes, an obsolete classification. [NIH]
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CHAPTER 5. PATENTS ON STROKE Overview You can learn about innovations relating to stroke by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.26 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with stroke within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with stroke. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
26Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Stroke By performing a patent search focusing on stroke, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on stroke: ·
Microwave hemorrhagic stroke detector Inventor(s): Haddad; Waleed S. (Dublin, CA), Trebes; James E. (Livermore, CA) Assignee(s): The Regents of the University of California (Oakland, CA) Patent Number: 6,454,711 Date filed: April 23, 1999 Abstract: The microwave hemorrhagic stroke detector includes a low power pulsed microwave transmitter with a broad-band antenna for producing a directional beam of microwaves, an index of refraction matching cap placed over the patients head, and an array of broad-band microwave receivers with collection antennae. The system of microwave transmitter and receivers are scanned around, and can also be positioned up and down the axis of the patients head. The microwave hemorrhagic stroke detector is a completely non-invasive device designed to detect and localize blood pooling and clots or to measure blood flow within the head or body. The device is based on low power pulsed microwave technology combined with specialized antennas and tomographic methods. The system can be used for rapid, non-invasive detection of blood pooling such as occurs with hemorrhagic stroke in human or animal patients as well as for the detection of hemorrhage within a patient's body. Excerpt(s): The present invention relates to the detection of the presence of blood pooling or blood flow within the body and within the head, and more specifically, it relates to the diagnosis of stroke. ... The are two forms of stroke: hemorrhagic and ischemic. Hemorrhagic stroke is caused by internal bleeding within the brain. Ischemic stroke is caused by blockage of a blood vessel that feeds the brain or a region of the brain. A
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stroke attack can occur suddenly and with little or no warning, and can result in severe physical impairment or death. Due to the rapid timescale for potentially severe or fatal damage to the brain these must be treated as rapidly as possible. Surgical intervention can be used to treat hemorrhagic stroke. An anti-clotting agent can be used to treat ischemic stroke. Unfortunately applying an anticlotting agent in the case of hemorrhagic stroke can cause fatal internal bleeding within the brain. At present, there is no non-invasive way to check patients for, and to differentiate between hemorrhagic and ischemic stroke other than computed tomography (CT) and magnetic resonance imaging (MRI). ... It is an object of the present invention to provide a microwave hemorrhagic stroke detector that is a low cost, non-invasive, portable device for screening patients for the presence, approximate location, approximate size and rate of internal bleeding within the brain. Web site: http://www.delphion.com/details?pn=US06454711__
Patent Applications on Stroke As of December 2000, U.S. patent applications are open to public viewing.27 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to stroke: ·
Pharmaceutical combinations for the treatment of stroke and traumatic brain injury Inventor(s): Chenard, Bertrand L.; (Waterford, CT), Menniti, Frank S.; (Mystic, CT), Saltarelli, Mario D.; (Mystic, CT) Correspondence: Pfizer Inc; 150 East 42nd Street; 5th Floor - Stop 49; New York; NY; 10017-5612; US Patent Application Number: 20020123510 Date filed: September 6, 2001 Abstract: This invention relates to methods of treating traumatic brain injury (TBI) or hypoxic or ischemic stroke, comprising administering to a patient in need of such treatment an NR2B subtype selective N-methyl-Daspartate (NMDA) receptor antagonist in combination with either: (a) a sodium channel antagonist; (b) a nitric oxide synthase (NOS) inhibitor; (c) a glycine site antagonist; (d) a potassium channel opener; (e) an AMPA/ kainate receptor antagonist; (f) a calcium channel antagonist; (g) a GABA-
27
This has been a common practice outside the United States prior to December 2000.
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A receptor modulator (e.g., a GABA-A receptor agonist); or (h) an antiinflammatory agent. This invention also relates to methods of treating hypoxic or ischemic stroke comprising administering to a patient in need of such treatment an NMDA receptor antagonist in combination with a thrombolytic agent. Excerpt(s): This invention relates to methods of treating traumatic brain injury (TBI) or ischemic or hypoxic stroke, comprising administering to a patient in need of such treatment an NR2B subtype selective N-methyl-Daspartate (NMDA) receptor antagonist in combination with one or more other compounds that protect neurons from toxic insult, inhibit the inflammatory reaction after brain damage or promote cerebral reperfusion. ... More specifically, this invention relates to methods of treating traumatic brain injury (TBI) or hypoxic or ischemic stroke, comprising administering to a patient in need of such treatment an NR2B subtype selective N-methyl-D-aspartate (NMDA) receptor antagonist in combination with either: (a) a sodium channel antagonist; (b) a nitric oxide synthase (NOS) inhibitor; (c) a glycine site antagonist; (d) a potassium channel opener; (e) an AMPA/kainate receptor antagonist; (f) a calcium channel antagonist; (g) a GABA-A receptor modulator (e.g., a GABA-A receptor agonist); (h) an antiinflammatory agent; or (i) a matrix metalloprotease (MMP) inhibitor. ... This invention also relates to methods of treating hypoxic or ischemic stroke comprising administering to a patient in need of such treatment an NR2B subtype selective NMDA receptor antagonist in combination with a thrombolytic agent. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with stroke, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “stroke” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on stroke. You can also use this procedure to view pending patent applications concerning stroke. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search
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Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH]
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Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically: serving to suppress activity, function, symptoms. [EU] Thermal: Pertaining to or characterized by heat. [EU]
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CHAPTER 6. BOOKS ON STROKE Overview This chapter provides bibliographic book references relating to stroke. You have many options to locate books on stroke. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on stroke include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “stroke” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on stroke: ·
Family Guide to Surviving Stroke and Communication Disorders Source: Needham Heights, MA: Allyn and Bacon. 1999. 273 p.
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Contact: Available from Allyn and Bacon. 160 Gould Street, Needham Heights, MA 02194. (800) 278-3525. Website: www.abacon.com. Price: $20.95. ISBN: 0205285384. Summary: This book offers families practical information on stroke related communication disorders, particularly aphasia, apraxia, and dysarthrias. Through nontechnical terms, a short story, case studies, questions and answers, and examples, the book engages families, stroke and rehabilitation specialists, and counselors on a journey toward understanding and healing. Twelve chapters cover stroke and the ability to communicate, the loss of language, motor speech disorders, complications, loss of awareness, thinking without language, depression and the stroke survivor, anxiety and the stroke survivor, maintaining relationships, accepting unwanted change, and speech and language rehabilitation. The book includes a glossary of stroke terminology and a subject index. Appendices offer lists of associations and agencies, resources for further reading and research, and a list of aphasia community groups. ·
Communication Problems After a Brain Injury or Stroke Source: Washington, DC: American Association of Retired Persons (AARP). 1994. 12 p. Contact: Available from Pritchett and Hull Associates, Inc. 3440 Oakcliff Road, N.E., Suite 110, Atlanta, GA 30340-3079. (800) 241-4925. Price: $3.20 for health professionals; $6.25 retail; plus shipping and handling. ISBN: 0939838443. Summary: This booklet is written to help patients and their families and caregivers understand common communication problems that can occur after a brain injury or stroke. Topics include communication and the brain, what happens to the brain during a stroke, the symptoms of communication disorders, using gestures as a basic way to communicate, the role of the speech language pathologist or therapist, aphasia, dysarthria, apraxia, cognitive problems, writing, understanding speech, memory problems, and getting respite. For each of the common communication problems, the authors provide communication strategies to address the disorder. The booklet is illustrated with cartoon-like line drawings depicting a variety of ethnic groups.
·
Motor Relearning Programme for Stroke. 2nd ed Source: Rockville, MD: Aspen Publishers, Inc. 1992. 196 p. Contact: Available from Aspen Publishers, Inc. Distribution Center/Order Department, 7201 McKinley Circle, Frederick, MD 21701-
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9782. For telephone orders contact Telemarketing Division at (301) 4177500 or (800) 638-8437. Price: $50.00. ISBN: 0750602724. Summary: This book presents a motor relearning program (MRP) for stroke. In addition, some guidelines are given for establishing an environment which is conducive to learning and in which the person can achieve the best possible recovery of function. Appendices outline the factors which seem particularly essential for motor training, and indicate the theoretical mechanisms by which recovery may take place. The authors note that the underlying theoretical assumptions presented apply not only to persons with stroke but to any person with a motor disability who wants or needs to learn some particular motor task and to become skilled in it. The MRP is presented in 8 sections: an introduction, upper limb function, oro-facial function, sitting up over the side of a bed, balanced sitting, standing up and sitting down, balanced standing, and walking. A subject index concludes the volume. ·
Understanding Stroke and Aphasia Source: Austin, TX: Pro-Ed, Inc. 1990. 96 p. Contact: Available from Pro-Ed, Inc. 8700 Shoal Creek Boulevard, Austin, TX 78757-6897. (512) 451-3246; Fax (800) FXPROED or (512) 451-8542; http://www.proedinc.com. Price: $14.00 plus shipping and handling. Order Number 1490. Summary: This book provides information for patients and families who are adapting to changes caused by stroke and aphasia. The author, using a question and answer format, discusses definitions, causes, prognosis, nonlanguage problems associated with aphasia, and residual problems following a stroke and aphasia. The author also provides specific suggestions for activities of daily living and for coping with the psychosocial factors. A glossary and resource list are included. 35 references.
·
Pathways: Moving Beyond Stroke and Aphasia Source: Detroit, MI: Wayne State University Press. 1990. 198 p. Contact: Available from Wayne State University Press. Leonard N. Simons Building, 4809 Woodward Avenue, Detroit, MI 48201-1309. (800) 978-7323 or (313) 577-6120; Fax (313) 577-6131. Price: $34.95 plus shipping and handling. ISBN 0814320740. Summary: This book portrays the experiences of six Detroit-area families when stroke and aphasia intrude on their lives. The book explores issues, such as physical and emotional reactions to stroke and aphasia and the
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responses of other family members to stroke and aphasia, that are universal to those coping with these crises. There is also information about prescription drugs, medical tests, and suggestions for other resources. Includes bibliographic references. ·
Living a Healthy Life With Chronic Conditions: Self-Management of Heart Disease, Arthritis, Stroke, Diabetes, Asthma, Bronchitis, Emphysema and Others Source: Palo Alto, CA: Bull Publishing Company. 1994. 296 p. Contact: Available from Bull Publishing Company. P.O. Box 208, Palo Alto, CA 94302-0208. (800) 676-2855 or (415) 322-2855. Fax (415) 327-3300. E-mail:
[email protected]. Price: $14.95. ISBN: 0923521283. Summary: This book is a complete self-management guide for people with chronic diseases. The authors focus on day-to-day living skills, in the context of the specific chronic diseases, including heart disease, arthritis, stroke, diabetes, asthma, bronchitis, and emphysema. General topics include the psychological aspects to self-management; finding resources; smoking and quitting; understanding common symptoms; using one's mind to manage symptoms; exercising for fun and fitness; exercising for flexibility and strength; exercising for endurance; exercising tips for people with specific chronic diseases; the importance of communication; durable powers of attorney for health care; eating well; and managing medications. The chapter on diabetes covers diabetes and its causes; maintaining an appropriate blood glucose level; symptoms of hyperglycemia and hypoglycemia; dietary management; exercise; insulin injections; oral medications; emotions; self-monitoring of blood glucose and urine; the complications of diabetes; and diabetes resources. Each chapter includes limited references and a subject index concludes the volume.
·
Prevention of Coronary Heart Disease and Stroke: A Workbook for Primary Care Teams Source: London, Faber and Faber, 244 p., 1988. Contact: Faber and Faber, Burnt Mill, Elizabeth Way, Harlow, Essex CM20 2HX, England. Telephone: 0279 21352/3. Summary: The authors discuss the concept of community screening to detect persons with high blood pressure and other cardiovascular risk factors. Aimed at all members of the primary health care team -physicians, nurses, and office staff -- the book deals with the prevention of heart attacks and stroke in general medical practice. The first section defines the problem, with chapters on its nature and its scope in Great
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Britain, where studies indicate that only 17 percent of the middle-aged adult population is free from known risk factors. The second section discusses what can be done about the risk factors of (1) age, sex, and family history; (2) smoking; (3) high blood pressure; (4) obesity and diabetes; (5) blood cholesterol and exercise; and (6) secondary prevention, i.e., the management of survivors of heart attack and stroke to reduce the risk of further events. A third section presents details about managing prevention and controlling the specific risk factors. The fourth section discusses the division of labor among the staff engaged in preventive screening. Various types of professional education are available for all members of the primary care team. Help in establishing and maintaining preventive health programs is available from government and private organizations. The final chapter presents content information for leaflets for patient education on (1) high blood pressure, (2) noninsulin dependent diabetes, (3) a weight reduction and cholesterol-lowering diet, and (4) a low-sodium, low-fat diet for poorly controlled high blood pressure. References follow each chapter.
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “stroke” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:28 ·
2000 Victoria declaration: women, heart diseases, and stroke: science and policy in action: declaration of the Advisory Board of the First International Conference on Women, Heart Disease, and Stroke (Victoria, Canada), May 8-10, 2000. Author: Rowland, Lewis P; Year:
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
28
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2000; [Ottowa]: Heart and Stroke Foundation of Canada, [2000]; ISBN: 1896242154 ·
Anticonvulsant Screening Project: Antiepileptic Drug Development Program. Author: Epilepsy Branch, Neurological Disorders Program, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Year: 1978; Bethesda, Md.: U. S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health, [1978?]
·
Cerebrovascular diseases: Nineteenth Princeton Stroke Conference. Author: edited by Michael A. Moskowitz, Louis R. Caplan; Year: 1995; Boston: Butterworth-Heinemann, c1995; ISBN: 0750696036 http://www.amazon.com/exec/obidos/ASIN/0750696036/icongroupin terna
·
Changing face of heart disease and stroke in Canada, 2000 [electronic resource]. Author: prepared in collaboration with Laboratory Centre for Disease Control, Health Canada ... [et al.]; Year: 1999; Ottawa: Heart and Stroke Foundation of Canada, c1999; ISBN: 1896242286 (English)
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Contemporary diagnosis and management of stroke. Author: Jesse Weinberger; Year: 2000; Newtown, Pa.: Handbooks in Health Care, c2000; ISBN: 1884065856 http://www.amazon.com/exec/obidos/ASIN/1884065856/icongroupin terna
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Control of systolic blood pressure and cardiovascular benefits with a reference diuretic: proceedings of a satellite symposium held during the XXth Congress of the European Society of Cardiology, Vienna, Austria, 22-26 August 1998. Author: edited by N.M. Kaplan; Year: 1999; London; Philadelphia: Saunders, c1999
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Drug therapy for stroke prevention. Author: edited by Julien Bogousslavsky; Year: 2001; London; New York: Taylor ; Francis, 2001; ISBN: 0748409343 http://www.amazon.com/exec/obidos/ASIN/0748409343/icongroupin terna
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Epidemiological study of oral contraceptive use and stroke among childbearing age women in Taiwan: prevalence of pill use and stroke mortality rates. Author: L.P. Chow; Year: 1978; 1978
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Evaluation of research opportunities and needs of the NINCDS in the neurological and communicative sciences. Author: prepared for the Committee on Appropriations of the Senate of the United States; Year: 1983; [Rockville, Md.: Tracor Jitco, Inc., 1983]
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Health Utilities Index Mark 3: evidence of construct validity for stroke and arthritis in a population health survey. Author: Paul Grootendorst,
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David Feeny, William Furlong; Year: 1999; Hamilton, Ont.: Centre for Health Economics and Policy Analysis, McMaster University, [1999] ·
Heart, stroke, and vascular diseases: Australian facts. Author: National Centre for Monitoring Cardiovascular Disease; Year: 2001; Canberra: Australian Institute of Health and Welfare: National Heart Foundation of Australia; [Melbourne]: National Stroke Foundation of Australia, c2001; ISBN: 1740241053
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Huntington's disease: research highlights, 1992. Author: National Institute of Neurological Disorders and Stroke; Year: 1992; [Bethesda, Md.?: The Institute, 1992?]
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Life course perspectives on coronary heart disease, stroke, and diabetes: the evidence and implications for policy and research. Author: Intercollegiate Working Party for Stroke; Year: 2002; Geneva: Ageing and Life Course, Dept. of Noncommunicable Diseases Prevention and Health Promotion, Noncommunicable Diseases and Mental Health Cluster, World Health Organization, 2002
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Management of stroke: a practical guide for the prevention, evaluation and treatment of acute stroke. Author: Harold P. Adams, Gregory J. del Zoppo, Rudiger von Kummer; Year: 1998; Caddo, OK: Professional Communications, Inc., c1998; ISBN: 1884735355 http://www.amazon.com/exec/obidos/ASIN/1884735355/icongroupin terna
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Measuring clinical outcome in stroke: acute care. Author: edited by Anthony Rudd, Michael Pearson, and Andrew Georgiou; Year: 2000; London: Clinical Effectiveness ; Evaluation Unit, Royal College of Physicians, c2000; ISBN: 1860161219
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National clinical guidelines for stroke [electronic resource]. Author: prepared by the Intercollegiate Working Party for Stroke; Year: 2002; London: Royal College of Physicians, 2002
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Neuroleptic malignant syndrome and related conditions. Author: Stephan C. Mann ... [et al.]; Year: 2003; Washington, DC: American Psychiatric Pub., c2003; ISBN: 1585620114 (alk. paper)
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Neuroscience at the new millennium: priorities and plans for the National Institute of Neurological Disorders and Stroke, fiscal years 2000-2001. Author: National Institute of Neurological Disorders and Stroke (U.S.); Year: 1999; Bethesda, Md.: The Institute, [1999]
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NINDS at 50: an incomplete history celebrating the fiftieth anniversary of the National Institute of Neurological Disorders and Stroke. Author: Lewis P. Rowland; Year: 2001; Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, [2001]
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Occupational therapy and stroke. Author: edited by Judi Edmans... [et al.]; consulting editor, Clephane Hume; Year: 2001; London; Philadelphia: Whurr, 2001; ISBN: 1861561989 http://www.amazon.com/exec/obidos/ASIN/1861561989/icongroupin terna
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Prevention of stroke. Author: edited by Philip B. Gorelick and Milton Alter; Year: 2002; Boca Raton: Parthenon Pub. Group, c2002; ISBN: 1842141155 http://www.amazon.com/exec/obidos/ASIN/1842141155/icongroupin terna
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Promoting independence following a stroke: a guide for therapists and professionals working in primary health care. Author: Matchar, David B; Year: 1999; [Geneva]: Disability and Rehabilitation, World Health Organization; [Bologna]: Associazione italiana Amici di Raoul Follereau, c1999
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Report of the Brain Tumor Progress Review Group. Author: Brain Tumor Progress Review Group; Year: 2000; [Bethesda, Md.]: National Institute of Neurological Disorders and Stroke: National Cancer Institute, [2000]
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Report on a second retrospective mortality study in North-East England. Part 1: Factors related to mortality from lung cancer, bronchitis, heart disease and stroke in Cleveland County. Author: G. Dean ... [et al.]; Year: 1977; Tobacco Research Council, London, England, 1975
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Secondary and tertiary prevention of stroke: patient outcomes research team (PORT) final report--phase 1. Author: David B. Matchar and Gregory P. Samsa; Year: 2000; Rockville, MD: Agency for Healthcare Research and Quality, 2000; ISBN: 1587630095
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Spinal cord regeneration: hearing before the Subcommittee on Health and the Environment of the Committee on Interstate and Foreign Commerce, House of Representatives, Ninety-sixth Congress, second session, on H.R. 4358 ... July 22, 1980. Author: United States. Congress. House. Committee on Interstate and Foreign Commerce. Subcommittee on Health and the Environment; Year: 1980; Washington: U.S. G.P.O., 1980
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Stroke prevention. Author: edited by John W. Norris and Vladimir Hachinski; Year: 2001; Oxford; New York: Oxford University Press, 2001; ISBN: 019513382X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/019513382X/icongroupi nterna
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Stroke services: policy and practice across Europe. Author: edited by Charles Wolfe, Christopher McKevitt, and Anthony Rudd; Year: 2002; Abingdon: Radcliffe Medical, c2002; ISBN: 1857754557
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Subcortical stroke. Author: edited by Geoffrey Donnan ... [et al.]; Year: 2002; Oxford; New York: Oxford University Press, 2002; ISBN: 0192631578 (hbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0192631578/icongroupin terna
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Uncommon causes of stroke. Author: edited by Julien Bogousslavsky and Louis R. Caplan; Year: 2001; Cambridge, UK; New York: Cambridge University Press, 2001; ISBN: 0521771455 http://www.amazon.com/exec/obidos/ASIN/0521771455/icongroupin terna
Chapters on Stroke Frequently, stroke will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with stroke, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and stroke using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “stroke” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on stroke: ·
Unilateral Stroke Source: in DeFeo, A.B., ed. Parent Articles 2. San Antonio, TX: Communication Skill Builders. 1995. p. 149-150. Contact: Available from Communication Skill Builders. Customer Service, 555 Academic Court, San Antonio, TX 78204-2498. (800) 211-8378; Fax (800) 232-1223. Price: $55.00 plus shipping and handling. Order Number 3073-CS5. Summary: This fact sheet, from a communication skills book for parents, provides information on unilateral stroke, or injury to one side of the brain due to a blocked or damaged blood vessel. The authors outline the cognitive, speech-language, and academic characteristics associated with
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unilateral stroke. They then discuss the factors related to recovery of language abilities. Children with left-hemisphere strokes often have mild language comprehension and/or production problems. Children with right-hemisphere damage frequently have problems with attention, impulse inhibition, and memory. 2 references. ·
Stroke and Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 449-456. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. E-mail:
[email protected]. Price: $20.00. Also available at http://www.niddk.nih.gov/. Summary: This chapter on stroke and diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Diabetes is more common in the African American population than in the white population in the United States and contributes to the increased risk of stroke among African Americans. Persons with diabetes may have a worse prognosis after a stroke. Elevated blood pressure is the major risk factor for stroke. Other risk factors for stroke, besides diabetes, include cigarette smoking and a high level of low density lipoprotein (LDL) cholesterol. Stroke is substantially increased in individuals who have other vascular diseases, especially coronary heart disease, left ventricular hypertrophy, atrial fibrillation, and peripheral vascular disease. The author maintains that preventing stroke in people with diabetes is feasible through identifying and treating risk factors, especially hypertension, cigarette smoking, and high LDL cholesterol. It is unknown whether reduction of blood glucose levels by either pharmacologic or nonpharmacologic methods will reduce the risk of stroke. It is also possible to identify individuals with atherosclerosis and to more aggressively intervene to reduce the risk of stroke by a combination of therapies. 6 figures. 6 tables. 32 references. (AA-M).
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Epidemiology of Seizures and Epilepsy in the Elderly Source: in Seizures and Epilepsy in the Elderly. Rowan, A.J.; Ramsay, R.E. eds. Boston, MA, Butterworth-Heinemann, pp. 7-18, 1997. Contact: Butterworth-Heinemann, 313 Washington Street, Newton, MA 02158-1626. (617) 928-2500. FAX: (617) 928-2620. Internet/Email: http://bh.com/med.
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Summary: Epidemiology of Seizures and Epilepsy in the Elderly, a chapter in Seizures and Epilepsy in the Elderly, considers epidemiologic data supporting an increased incidence of epilepsy in the elderly and discusses potential causes of seizures and epilepsy in this population. The incidence of acute symptomatic seizures was considered with respect to the general elderly population and to specific conditions. The incidence of acute symptomatic seizures in those over the age of 60 years is 100 per 100,000 and increases with age. It is related to the frequency of the underlying condition in the target population; 40 to 50 percent of these individuals will have acute symptomatic seizures due to cerebrovascular insult. Between 5 and 10 percent of those with an acute cerebrovascular insult will experience a seizure at the time of the stroke. For both stroke and head injury conditions, those with early or acute symptomatic seizures have a substantial increased risk for subsequent seizures when compared to those without early seizures. The incidence of unprovoked seizures and epilepsy is considered with respect to seizure type, etiology, and idiopathic (cryptogenic) epilepsy. Increased risk for epilepsy in the elderly is associated with increased incidences of cerebrovascular disease, trauma, infection of the central nervous system, neoplasm, degenerative disease, and alcohol use. Understanding the concept of prevalence is difficult considering the combination of chronic and new cases, the use of varying methodologies and definitions in most studies of prevalence, and variations linked to geography and the use of certain highly selected populations for surveys. ·
Heart Disease and Stroke Source: in Healthy People 2010 (Conference Edition), Volume I. U.S. Department of Health and Human Services, Washington, DC, pp. 12-112-35, January 2000. Contact: U.S. Government Printing Office, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. (202) 512-1800. Stock No. 017-001-00547-9. Internet/Email: www.health.gov/healthypeople. Summary: Heart Disease and Stroke, a chapter in Healthy People 2010 (Conference Edition), notes that one goal of Healthy People 2010 is to improve cardiovascular health and quality of life through (1) the prevention, detection, and treatment of risk factors; (2) early identification and treatment of heart attacks and strokes; and (3) prevention of recurrent cardiovascular events. Heart disease is the leading cause of death for all Americans. Stroke is the third leading cause of death. Epidemiologic and statistical studies have identified a number of factors that increase the risk of heart disease and stroke. Clinical trials and prevention research studies have demonstrated effective strategies to
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prevent and control these risk factors and thereby reduce illnesses, disabilities, and deaths caused by heart disease and stroke. Specific objectives of Healthy People 2010 in this area include (1) reducing coronary heart disease deaths, (2) increasing the proportion of adults age 20 and older who are aware of the early warning symptoms and signs of a heart attack and the importance of accessing rapid emergency care by calling 911, (3) increasing the proportion of eligible patients with heart attacks who receive artery-opening therapy within an hour of symptom onset, (4) increase the proportion of adults age 20 and older who call 911 and administer cardiopulmonary resuscitation when they witness a cardiac arrest, (5) increase the proportion of persons with witnessed outof-hospital cardiac arrest who are eligible and receive their first therapeutic electrical shock within 6 minutes after collapse recognition, (6) reduce hospitalizations of older adults with heart failure as the principal diagnosis, (7) reduce stroke deaths, (8) increase the proportion of adults who are aware of the early warning symptoms and signs of a stroke, (9) reduce the proportion of adults with high blood pressure, (10) increase the proportion of adults with high blood pressure whose blood pressure is under control, (11) increase the proportion of adults with high blood pressure who are taking action to help control their blood pressure, (12) increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high, (13) reduce the mean total blood cholesterol levels among adults, (14) reduce the proportion of adults with high total blood cholesterol levels, (15) increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years, and (16) increase the proportions of persons with coronary heart disease who have their LDL-cholesterol level treated to a goal of less than or equal to 100 milligrams per deciliter. ·
Physical Activity, Fitness, and Stroke Source: in Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement. Bouchard, C.; Shephard, R.J.; Stephens, T.; eds. Champaign, IL, Human Kinetics pp. 609-621, 1994. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825-5076. (800) 747-4457. Internet/Email: http://www.humankinetics.com/;
[email protected]. Summary: Physical Activity, Fitness, and Stroke, a chapter in Physical Activity, Fitness, and Health: International Proceedings and Consensus Statement, provides a review and analysis of evidence that physical activity or physical fitness levels may be a risk factor for the development of stroke. Physical activity assessment is a major weakness in studies of
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physical activity and health. Estimates of exposure and issues related to exposure and outcome can result in misclassification. Therefore, results of physical activity and stroke must be viewed within these constraints. Physical fitness assessment is a more valid measure for comparison, although it may be confounded by preexisting disease. Many animal studies of cerebral ischemia exist but few specifically examine the effect of physical activity on the occurrence of stroke. Studies that do exist rely on results of other studies showing that exercise decreases resting blood pressure in hypertensive animals. The results of human studies on physical activity and the risk of stroke are variable. Design weaknesses in existing studies include incomplete control for confounding influences, crude measures of physical activity exposure, and incomplete case definition. No published studies exist on the effect of physical fitness on the risk of stroke. Despite these limitations and the variability of results, most results show an inverse relationship between exercise and risk of stroke. Possible explanations for this inverse relationship are (1) activity slows the development of atherosclerotic lesions; and (2) activity positively influences known risk factors for stroke, such as blood pressure, clotting factors, glucose tolerance, and smoking habits. Future research should focus on a more thorough assessment of physical activity or physical fitness and more innovative designs. ·
Heart Disease, Stroke, and Hypertension in Blacks Source: in Health Issues in the Black Community. Braithwaite, R.L.; Taylor, S.E.; eds. San Francisco, CA, Jossey-Bass, Inc., Publishers, pp. 90105, 1992. Contact: Jossey-Bass, Inc., Publishers, 350 Sansome Street, San Francisco, CA 94104. Internet/Email: http://www.josseybass.com. Summary: Heart Disease, Stroke, and Hypertension in Blacks, a chapter in Health Issues in the Black Community, focuses on the problem of excess mortality from hypertension and related conditions (heart disease and stroke) among blacks versus whites. Hypertension tends to appear at an earlier age among blacks and often is not treated early or aggressively enough, which leads to a higher prevalence of more severe hypertension among blacks. Hypertension among black patients is also more often accompanied by target organ damage. The effective treatment of hypertension among blacks is hampered by limited access to medical care, cost of treatment, and lack of education about the disease. The chapter provides details on (1) the incidence and epidemiology of this problem; (2) genetic research and hypertension in blacks; (3) hormonal and physiological factors in blacks with hypertension; (4) environmental theory that suggests that an interaction of the environment with genetics
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is necessary for developing hypertension; (5) barriers to controlling hypertension among blacks; (6) social, psychological, political, and environmental factors considerations in treatment; (7) promoting compliance; and (8) community projects to increase education and compliance. The paper concludes that this is a community health issue that medical providers must address from social, environmental, and medical perspectives. Black individuals must be empowered to manage those factors that they can control related to cardiovascular morbidity and mortality. They must develop confidence in their health care providers and the medical system so they seek appropriate care. This advice must be individualized to each person's unique needs. Medical providers must be committed to taking the necessary time to establishing lasting relationships with their patients. 5 tables, 43 references. ·
Cardiovascular and Cerebrovascular Diseases: Subcommittee Summary Report Source: in Report of the Secretary's Task Force on Black and Minority Health. Volume I: Executive Summary. pp. 107-127, Washington, DC, DHHS, August 1985. Contact: U.S. Department of Health and Human Services. Summary: The Report of the Secretary's Task Force on Black and Minority Health (U.S. Department of Health and Human Services) contains a section on cardiovascular and cerebrovascular diseases among Blacks, Hispanics, Native Americans, and Asian and Pacific Islanders. As in the white population, heart diseases and stroke cause more deaths, disability, and economic loss among these four minority groups than any other acute or chronic diseases and are the leading causes of days lost from work. Coronary heart disease; hypertension; stroke and hypertensive end-stage renal disease; other cardiovascular risk factors; social, cultural, and economic aspects; knowledge and awareness of cardiovascular disease; and access to care are reviewed for each minority group. Interventions proposed by the subcommittee include the following: Risk reduction interventions to promote cardiovascular health, effective cardiovascular health education, hypertension prevention and control, improved delivery of medical care, minority population studies of cardiovascular disease, direct Federal government activities, and more minority professionals for health care and research. 67 references.
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Cerebrovascular Disease Source: in Clinician's Guide to Treatment of Medically Compromised Patients. Baltimore, MD: American Academy of Oral Medicine (AAOM). 1995. p. 17-19.
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Contact: Available from American Academy of Oral Medicine (AAOM). 2910 Lightfoot Drive, Baltimore, MD 21209-1452. (410) 602-8585. Website: www.aaom.com. Price: $21.00 plus shipping and handling. Summary: This chapter, from a guide for dentists on managing problems of medically compromised dental patients, discusses cerebrovascular disease. The authors provide a definition of cerebrovascular accident (CVA)/stroke syndrome; describe its etiology and clinical presentation; and outline emergency treatment. One chart outlines the different types of strokes and their presentation; another chart outlines drug therapy, primarily anticoagulants, related to prevention.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to stroke have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on stroke. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:29 ·
Associations and Agencies Source: New York, NY: National Aphasia Association. 1997. 2 p. Contact: National Aphasia Association. Distribution Center, 351 Butternut Court, Millersville, MD 21108. (800) 922-4622; http://www.aphasia.org. Price: $0.25 each. Summary: This fact sheet, written for the general public, provides a listing of associations and agencies for obtaining additional information on aphasia. The directory lists organizations alphabetically by name of the organization. Each entry includes an address and telephone number; some entries include one sentence that briefly describes the information or services available. For example, the National Stroke Association offers several free and low cost publications of interest to persons with aphasia and their families. Seventeen organizations are listed.
You will need to limit your search to “Directories” and stroke using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “stroke” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with stroke. You should check back periodically with this database as it is updated every three months.
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Complete Directory for People with Chronic Illness. 4th ed Source: Lakeville, CT: Grey House Publishing, Inc. 2000. 1009 p. Contact: Available from Grey House Publishing, Inc. Pocket Knife Square, Lakeville, CT 06039. (860) 435-0868. Fax (860) 435-0867. Price: $165.00. ISBN: 0939300931. Summary: This directory provides a comprehensive overview of the support services and information resources available for people with any of 80 specific chronic illnesses. It presents information on various organizations, educational materials, publications, and databases. A chapter is devoted to each chronic illness and includes a brief description of it. The sections related to kidney and urologic diseases include: AIDS, Alzheimer's disease, cancer, cerebral palsy, diabetes, hypertension, impotence, incontinence, infertility, kidney disease, multiple sclerosis, sexually transmitted diseases, spina bifida, stroke, and substance abuse. The description of each disease is followed by subchapters that identify national and State associations and agencies, libraries, research centers, reference books, children's books, magazines, newsletters, pamphlets, videotapes and films, support groups and hotlines, and websites. In addition, the directory includes a chapter on death and bereavement, as well as a chapter on Wish Foundations for terminally and chronically ill children.
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Asian Language: Sources of Health Materials Source: Washington, DC: Office of Minority Health Resource Center. 199x. [11 p.]. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Website: www.omhrc.gov. Price: Single copy free. Summary: This directory lists sources identified by the Office of Minority Health Resource Center (OMH RC) that produce or distribute health promotion materials in various Asian languages. Materials concentrate on minority health priority areas and associated risk factors: cancer, cardiovascular diseases and stroke, chemical dependency, diabetes, infant mortality, homicide, suicide, and unintentional injury. Sources of AIDS information and educational materials are also included. Topics related to kidney and urologic diseases include AIDS, cultural awareness, high blood pressure (hypertension), lupus, men's health, nutrition, sexually transmitted diseases, and women's health. Sources are arranged alphabetically. Organization entries include organization name, address, telephone number, source title, and annotation. The primary languages in which the organization provides materials are noted. Organizations
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should be contacted directly to determine the cost and availability of bulk quantities or for permission to photocopy. ·
Southeast Asian health information and resource directory of chronic diseases Source: [San Francisco, CA: Asian and Pacific Islander American Health Forum]. 1994. 149 pp. Contact: Available from Asian and Pacific Islander American Health Forum, 942 Market Street, Second Floor, San Francisco, CA 94102. Telephone: (415) 512-2710 / fax: (415) 512-3881 / e-mail:
[email protected] / Web site: http://www.apiahf.org/apiahf. Summary: This directory contains information about community-based organizations that provide health information or resources to Asians or Pacific Islanders who have chronic diseases. The database upon which the directory is based contains information on the following conditions: cancer, diabetes, heart diseases or stroke, tobacco, and nutrition. The programs described provide assistance to the following ethnic groups among others: Chinese, Vietnamese, Filipinos, Hmong, Japanese, Korean, Thai, Cambodian, Laotian, Mien, and Samoan. The entries list the name of the group and its contact information, program areas, ethnic groups and target populations served, language capabilities, information materials including those in languages other than English, program activities, goals and objectives, and funding sources for each. The directory provides indexes to the groups served and the diseases covered, but not to the information materials.
General Home References In addition to references for stroke, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Adams & Victor’s Principles Of Neurology by Maurice Victor, et al; Hardcover - 1692 pages; 7th edition (December 19, 2000), McGraw-Hill Professional Publishing; ISBN: 0070674973; http://www.amazon.com/exec/obidos/ASIN/0070674973/icongroupinterna · Clinical Neuroanatomy Made Ridiculously Simple (MedMaster Series, 2000 Edition) by Stephen Goldberg; Paperback: 97 pages; 2nd edition
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(February 15, 2000), Medmaster; ISBN: 0940780461; http://www.amazon.com/exec/obidos/ASIN/0940780461/icongroupinterna · It’s Not a Tumor!: The Patient’s Guide to Common Neurological Problems by Robert Wiedemeyer; Paperback: (January 1996), Boxweed Pub; ISBN: 0964740796; http://www.amazon.com/exec/obidos/ASIN/0964740796/icongroupinterna · Neurology for the Non-Neurologist by William J. Weiner (Editor), Christopher G. Goetz (Editor); Paperback (May 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 0781717078; http://www.amazon.com/exec/obidos/ASIN/0781717078/icongroupinterna
Vocabulary Builder Antiepileptic: An agent that combats epilepsy. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bronchitis: Inflammation of one or more bronchi. [EU] Collapse: 1. a state of extreme prostration and depression, with failure of circulation. 2. abnormal falling in of the walls of any part of organ. [EU] Dentists: Individuals licensed to practice dentistry. [NIH] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Homicide: The killing of one person by another. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunization: The induction of immunity. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU]
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Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU]
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CHAPTER 7. MULTIMEDIA ON STROKE Overview Information on stroke can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on stroke. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on stroke is the Combined Health Information Database. You will need to limit your search to “video recording” and “stroke” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “stroke” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on stroke: ·
Linda Laisure and H.O.M.E Source: Chicago, IL: Terra Nova Films. 1992. (videocassette).
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Contact: Available from Terra Nova Films. 9848 South Winchester Avenue, Chicago, IL 60643. (800) 779-8491 or FAX (312) 881-3368. Price: $145.00 purchase or $45.00 rental; plus $7.00 shipping and handling for all sale and rental orders except prepaid orders. Summary: This videotape describes Helping Our Mobile Elderly (H.O.M.E.), a small group home for older women with memory loss due to Alzheimer's disease, stroke, or other disorders. The home was developed and is managed by Linda Laisure, a gerontologist specialist. Four full time staff members provide care for six residents in a restraint free environment. The caretaking is aimed at assisting the women to function at their highest potential, to enjoy themselves, and to live with dignity. The videotape shows H.O.M.E. staff and the women engaged in various activities, including interacting with children, shopping trips, and outings to other adult day care centers. Suggestions are offered for environmental design, staff interaction with residents, entertainment, and simplification of tasks for persons with dementia. ·
Aging: The Mind Source: Alexandria, VA: PBS Video. 1988. (videocassette). Contact: Available from PBS Video. 1320 Braddock Place, Alexandria, VA 22314. (800) 424-7963; FAX (703) 739-5269. Price: $69.95. Summary: This videocassette program questions some of the long-held stereotypes about aging and the mind and explores stroke, Alzheimer's disease, and Parkinson's disease.
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Coping With Caring Source: Albany, NY: New York State Office for the Aging. (videocassette). Contact: Available from Bureau of Technology Applications, Media Distribution Network. Cultural Education Center, Room C-7, Concourse Level, Albany, NY 12230. (518) 474-3168. Price: $60.00; $30.00 if own VHS tape supplied. Summary: This videocassette program presents a first-hand description of coping with caring for a family member who has become seriously incapacitated. The realities of caregiving are illustrated by a wife who provides personal care for her husband who has become partially paralyzed from a stroke. Caregivers describe solutions to problems and the utility of support groups. The caregivers describe a common mixture of confusing emotions, including love, concern, hostility, resentment, anger, sadness, grief, helplessness, and shame in feeling one's helplessness. The film points out the importance that caregivers
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recognize their emotions and deal with them effectively. Emphasis is placed on strategies for effective coping. This is one of three parts of a new three-part video series on family caregiving entitled "Time to Care" produced by the New York State Office for the Aging; the other two parts of this series are entitled "Health and Illness in Old Age" (see AZAV01861) and "Community Services and Legal Issues" (see AZAV01862). ·
Coping and Home Safety Tips for Caregivers of the Elderly Source: Charlottesville, VA: Jefferson Area Board for Aging. 1987. (videocassette). Contact: Available from JABA Video. 2300 Commonwealth Drive, Suite B1, Charlottesville, VA 22901. (804) 978-3644. Price: $89.90 ($79.95 video, $9.95 manual). Summary: This videocassette offers practical, affordable ideas to address the special needs of arthritis, stroke, poor eyesight or limited mobility. It shows how to create an emotional environment that can decrease stress. It demonstrates adaptive equipment for eating, bathing, dressing. It also describes specific coping tips for dealing with Alzheimer's disease, and shows how to make simple, low-cost changes to decrease risk of accident.
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Enable: People with Disabilities and Computers Source: Redmond, WA: Microsoft Corporation. 1999. (videocassette). Contact: Available from Microsoft Corporation. One Microsoft Way, Redmond, WA 98052-6399. (800) 573-2256. TTY (800) 736-1123. Website: www.microsoft.com/enable/productions. Price: Single copy free. Summary: With the help of the personal computer, people with disabilities are working, creating, communicating, and juggling the activities of life. In this videotape program, the Flying Karamazov Brothers introduce viewers to people who are using the personal computer and other technologies to allow them to get back into the rhythm of life. The program begins by discussing how complicated everyone's life has become, then addresses some of the issues that arise when a disability is present. The program emphasizes the role of the computer as a way to empower people and to give them access to what they need, no matter what their disability. The program features interviews with a variety of people, including a person in a wheelchair and on a respirator who uses the computer for his business; a man who was paralyzed on one side by a stroke who uses the computer for enrichment and for keeping in touch with family and friends through email; a young blind woman who uses her computer, a Braille'n'Speak
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program, and a Braille printer; a young hearing impaired woman who uses a computer and notetaker in the university classroom; a man who is in a wheelchair and uses the Internet to run a support network for people with quadraplegia; an older man with cerebral palsy who uses a variety of high and lower tech augmentative and alternative communication devices to communicate; and a deaf blind university student who uses a personal computer and a Braille display to communicate with others. The program features a suppertime gathering of the Karamazov Brothers and a group of people with different disabilities; the group discusses some of the joys and frustrations of coping with a disability and demonstrate some of the ways people can communicate (including sign language). The program also offers numerous inspirational quotes between scenes, stressing the resiliency of the human spirit and the role of the computer in helping all people to achieve their potential. ·
Chronic Broca's Aphasia: Evidence for Right Hemisphere Language Source: Tucson, AZ: National Center for Neurogenic Communication Disorders. 1995. (videocassette and handout). Contact: Available from National Center for Neurogenic Communication Disorders. Telerounds Coordinator, Building 71, Room 500, University of Arizona, Tucson, AZ 85721. (520) 621-1819 or (520) 621-1472. Price: $25.00. Summary: The question regarding what anatomical structures mediate the residual language functions of individuals with chronic Broca's aphasia has been of long-standing interest. In this telerounds program, the authors describe two right-handed males who experienced massive strokes that caused extensive destruction of the left hemisphere, resulting in classic Broca's aphasia. They discuss how these individuals' language performance is consistent with right hemisphere language capacity, and conclude that Broca's aphasia can result when language is mediated exclusively by the nondominant hemisphere. The handout provided with the videotape includes an abstract, a list of objectives, a brief outline of the program, a reference list, and an evaluation form for viewers to complete and return. (AA-M).
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Disordered Swallowing: Case Illustrations Source: Tucson, AZ: National Center for Neurogenic Communication Disorders. 1993. (videocassette and handout). Contact: Available from National Center for Neurogenic Communication Disorders. Telerounds Coordinator, Building 71, Room 500, University of
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Arizona, Tucson, AZ 85721. (520) 621-1819 or (520) 621-1472. Price: $25.00. Summary: Patients with neurogenic disorders may have accompanying dysphagia, or disordered swallowing. A high percentage of patients poststroke and patients with progressive neuromuscular disease have difficulty swallowing. This telerounds program illustrates three cases illustrating a variety of dysphagic symptoms found in this patient population. In addition, a single case of head and neck cancer with postsurgical and post-radiation complications is described. Videofluorographic samples of disordered swallowing are presented for each case, as are treatment strategies and progress. The handout provided with the videotape includes an abstract, a list of objectives, a brief outline of the program, a reference list, and an evaluation form for viewers to complete and return. (AA-M). ·
Stroke: New Frontiers in Diagnosis and Management Source: Tucson, AZ: National Center for Neurogenic Communication Disorders. 1994. (videocassette and handout). Contact: Available from National Center for Neurogenic Communication Disorders. Telerounds Coordinator, Building 71, Room 500, University of Arizona, Tucson, AZ 85721. (520) 621-1819 or (520) 621-1472. Price: $25.00. Summary: In this telerounds program, the causes and risk factors for stroke are reviewed and the latest developments in the treatment of stroke are highlighted. Topics covered include the major types of stroke; treatable risk factors for stroke; and major therapy for and medical management of stroke. The handout provided with the videotape includes an abstract, a list of objectives, a brief outline of the program, a reference list, and an evaluation form for viewers to complete and return. 6 references. (AA-M).
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Doctor is In: Speech Source: Princeton, NJ: Films for the Humanities and Sciences. 1991. (videocassette). Contact: Available from Films for the Humanities and Sciences, Inc. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5726 or (609) 275-1400; Fax (609) 275-3767. Price: $140.00 each; $75.00 (rental); plus shipping and handling. Summary: This videocassette is one in a series of programs that explain and explore major health concerns. This program on speech and speech
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disorders introduces a woman recovering from a stroke, a child with muscular dystrophy, a man who has had his larynx removed, a child who stutters, and an immigrant trying to lose her Polish accent. The program explores how men and women can use their voices effectively and describes what happens when one loses the voice. A featured expert is Dr. Robert Sataloff, Professor of Otolaryngology at Jefferson Medical College in Philadelphia, editor of 'The Journal of Voice', and an opera singer. Host, Jamie Guth, also speaks with speech pathologists and a person who stutters and is helping others cope with the problem. (AAM). ·
What is Aphasia? Source: Detroit, MI: Wayne State University Press. 1991. Contact: Available from Wayne State University Press. Leonard N. Simons Building, 5959 Woodward Avenue, Detroit, MI 48201-6131. (800) 978-7323 or (313) 577-6120; Fax (313) 577-6131. Price: $49.95 plus shipping and handling. Summary: This videotape is for patients and families. Stroke survivors demonstrate their strategies to compensate for communication losses, while family members share experiences of learning to communicate effectively with aphasic individuals. Examples and analogies explain aphasia and its effects on speaking, listening, reading, and writing (AAM).
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Pathways: Moving Beyond Stroke and Aphasia Source: Detroit, MI: Wayne State University Press. 1991. Contact: Available from Wayne State University Press. Leonard N. Simons Building, 5959 Woodward Avenue, Detroit, MI 48201-6131. (800) 978-7323 or (313) 577-6120; Fax (313) 577-6131. Price: $49.95 plus shipping and handling. Summary: With the assistance of six individuals and their families, this videotape is designed to encourage and motivate stroke survivors and their families in the recovery stages of stroke and rehabilitation so that they too can, in time, move beyond their illness (AA).
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Voice in Exile Source: Irwindale, CA: Barr Films, 1986. Contact: Available from Barr Films, P.O. Box 7878, Irwindale, CA 91706. (800)234-7878.
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Summary: This videocassette tells the story of a 17-year-old boy who stutters. His speech is so severely impaired that he has trouble communicating even the simplest phrases. Being a talented artist, he uses his drawings and sketches to communicate his ideas and dreams, and his bitter isolation. It is the boy's grandfather who seems to be best able to communicate with him. Unfortunately, the grandfather suddenly has a stroke and must stay in the hospital. The boy faces his biggest fears when he must attend a ceremony and accept a special award for his grandfather. ·
Preventing Long Term Complications of Diabetes Source: Timonium, MD: Milner-Fenwick. 2000. (videocassette). Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093-3100. (800) 432-8433. Fax (410) 252-6316. Price: $125.00; bulk orders available; plus shipping and handling. Summary: The goal of this video program is to help patients with diabetes understand and prevent the long term complications of their disease. Viewers learn how high blood sugar (hyperglycemia) and the associated damage to blood vessels can possibly lead to heart attack, stroke, loss of vision (diabetic retinopathy), kidney disease (diabetic nephropathy), nerve damage (diabetic neuropathy), and amputation. Information is included about damage to both large and small blood vessels, updated terminology, HbA1c (glycosylated hemoglobin) testing (used to monitor blood glucose levels over time), heart disease risk factors, and erectile dysfunction (impotence). The video stresses that improving blood glucose (sugar) levels can help reduce the patient's risk of complications over time. The videotape was produced in cooperation with the American Association of Diabetes Educators (AADE), which defined the content of the video, selected the program consultants, and approved production at each stage of development. The program is closed-captioned.
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Living with Diabetes: Making the Diagnosis Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 071899A.
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Summary: This videotape, part of a series on living with diabetes, focuses on the diagnosis of diabetes. A moderator discusses the new criteria for the diagnosis and classification of diabetes, the rise in the incidence of diabetes, the symptoms of diabetes, and the prevention of diabetes with an endocrinologist. The videotape begins with a discussion of what diabetes is, how insulin works, the types of diabetes, and risk factors for diabetes. Type 1 diabetes, which was formerly known as insulin dependent diabetes, usually develops quickly, whereas type 2 diabetes, which was formerly known as noninsulin dependent diabetes, usually has a gradual onset. The symptoms of diabetes, which are generally the same regardless of the type, are related to high blood sugar. They include excessive urination and thirst, fatigue, hunger, weight loss, and blurred vision. Risk factors for type 1 diabetes include a genetic predisposition for developing the disease. Risk factors for type 2 diabetes include being overweight, sedentary, and over 45 years old; having a history of stillbirth or gestational diabetes; having high blood pressure and high cholesterol; being African American, Hispanic, or Native American; and having previously been identified with impaired glucose tolerance. The acute complications of diabetes include ketoacidosis, nonketotic hyperosmolar syndrome, and hypoglycemia. The chronic complications are divided into microvascular and macrovascular complications. Microvascular complications include retinopathy, neuropathy, and nephropathy. Macrovascular complications include heart attack, stroke, and peripheral vascular disease. Early diagnosis is important in preventing complications. Diagnosis is based on blood sugar levels obtained from a blood glucose test, a fasting plasma glucose test, or an oral glucose tolerance test. The risk of developing type 2 diabetes may be reduced by eating properly, maintaining an ideal weight, and exercising. The videotape includes a self test that viewers can take to assess their risk of developing type 2 diabetes. ·
Smoking and Diabetes Source: Los Angeles, CA: National Health Video, Inc. 1998. (videocassette). Contact: Available from National Health Video, Inc. 12021 Wilshire Blvd., Suite 550, Los Angeles, CA 90025. (800) 543-6803. Fax (310) 477-8198. Email:
[email protected]. Price: $89.00 plus shipping and handling. Order number 272. Summary: This videotape provides people who have diabetes with information on the effect of smoking on the disease. Smoking has a greater adverse effect on people who have diabetes than on otherwise healthy smokers. For example, the risk of heart disease is 14 times higher
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in a person has diabetes and smokes. In addition, vasoconstriction can lead to blindness and severe peripheral neuropathy. Other adverse effects of smoking in a person with diabetes include increasing the risk of high blood pressure, stroke, respiratory disease, various cancers, and periodontal disease; impeding the control of infection; limiting joint mobility; and contributing to impotence. The video offers tips on quitting, including learning about smoking habits and using a substitute for smoking when a pattern is identified, setting a quitting date, and using nicotine replacement therapy. In addition, the video presents suggestions on avoiding postcessation weight gain.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “stroke” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on stroke: ·
Health, Healing and AIDS: Practicing the Heart of Healing Contact: Access Group, 4 Cielo Ln #4D, Novato, CA, 94949, (415) 8836111. Summary: This sound recording contains some reflections and reminiscences of Buddhist monks on death and dying, and illness. The first part of the presentation includes the Buddhist views on Acquired immunodeficiency syndrome (AIDS) and Human immunodeficiency virus (HIV) infection. Personal experience watching a venerated teacher become helpless after a stroke is also discussed.
Bibliography: Multimedia on Stroke The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer
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software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in stroke (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on stroke. For more information, follow the hyperlink indicated: ·
Acute stroke therapy: clinical and experimental aspects. Source: the University of Texas Medical School at Houston; produced by UT-TV, Houston; Year: 1992; Format: Videorecording; [Houston, Tex.: UT/TV], c1992
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Advanced stroke therapy: left CVA. Source: [presented by] Y13 Productions; Year: 1990; Format: Videorecording; Chicago, IL: Y13 Productions, 1990
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Advanced stroke therapy: right CVA. Source: [presented by] Y13 Productions; Year: 1990; Format: Videorecording; Chicago, IL: Y13 Productions, c1990
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Beginning stroke therapy: left CVA. Source: [presented by] Y13 Productions; Year: 1990; Format: Videorecording; Chicago, IL: Y13 Productions, c1990
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Beginning stroke therapy: right CVA. Source: [presented by] Y13 Productions; Year: 1990; Format: Videorecording; Chicago, IL: Y13 Productions, 1990
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Brain attack: importance of immediate treatment from stroke. Source: Aquarius Health Care Videos; Year: 2001; Format: Videorecording; Sherborn, MA: Aquarius Health Care Videos, c2001
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Cardiovascular physiology. Source: produced by the Department of Biomedical Communications, University of Miami, School of Medicine; Year: 1980; Format: Videorecording; Miami, FL.: The School, 1980
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Controversies in heart failure. Source: with Jay N. Cohn, Spencer H. Kubo, and Maria Teresa Olivari; Year: 1989; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1989
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Current advances in diagnosis and treatment of stroke. Source: produced in collaboration with Medical Department, Ives Laboratories Inc; Year: 1970; Format: Motion picture; [United States: Ives Laboratories, 1970]
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Early recognition of learning disability. Source: presented by the National Institute of Neurological Diseases and Stroke; a Churchill Film production; Year: 1975; Format: Videorecording; [Bethesda, Md.]: The Institute, [between 1968 and 1975]
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Echocardiography of left ventricular ejection fraction. Source: Center for Advanced Instructional Media, Yale University, School of Medicine; Year: 1996; Format: Electronic resource; St. Louis, MO: Mosby-Year Book, c1996
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Environmental emergencies. Source: produced by American Safety Video Publishers, a division of Mosby-Year Book, Inc., in cooperation with Scott Bourn Associates, Inc; Year: 1996; Format: Videorecording; St. Louis, Mo.: Mosby-Year Book, c1996
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Is carotid endarterectomy indicated for ocular TIA and stroke? Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1998; Format: Videorecording; Marshfield, WI: The Network, c1998
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National health priority areas report. Cardiovascular health: a report on heart, stroke, and vascular disease, 1998 . Year: 1999; Format: Electronic resource; Canberra ACT: Commonwealth Dept. of Health and Aged Care: Australian Institute of Health and Welfare, c1999
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New antiplatelet therapy for stroke, post MI & established peripheral arterial disease. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1998; Format: Videorecording; Marshfield, WI: The Network, c1998
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New treatment options for stroke prevention and [presented by] Marshfield Clinic, Saint Joseph's Marshfield Medical Research Foundation; Year: Videorecording; Marshfield, WI: Marshfield Regional [1991]
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Physical rehabilitation for stroke patients. Source: Mosby Lifeline; Samuel Merritt College, Studio Three Productions; Year: 1996; Format: Videorecording; [St. Louis, Mo.]: Mosby-Year Book, c1996
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Physical therapy following stroke: muscle performance deficits. Source: AREN; Year: 1995; Format: Videorecording; Carrollton, TX: Westcott Communications, c1995
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Post-stroke rehabilitation: promoting recovery through a team approach. Source: David Kushner; Year: 1999; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1999
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Rendering the brain resistant to stroke. Source: [Dennis Choi]; Year: 1995; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1995]
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Science of brain disease. Year: 1996; Format: Videorecording; [Bethesda, Md.]: NIH/NINDS, [1996]
TIAs. Source: Hospital, [and] 1991; Format: Video Network,
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Stroke: new frontiers in diagnosis and management. Source: [presented by] the National Center for Neurogenic Communication Disorders; Veterans Health Administration, Office of Academic Affairs, Long Beach Regional Medical EducationCenter; Year: 1994; Format: Videorecording; [Tucson, Ariz.]: Arizona Board of Regents, c1994
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Stroke; Headache. Source: Martin Samuels; Year: 1998; Format: Videorecording; [Irvine, Calif.]: CME, 1998
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Stroke management and prevention. Source: [presented by] the Medical University of South Carolina, College of Medicine and the Health Communications Network; Year: 1993; Format: Videorecording; Charleston, S.C.: The University, c1993
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Stroke rehabilitation: AHCPR clinical practice guideline. Source: Glen E. Gresham; Year: 1995; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1995
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Stroke rehabilitation health care options. Source: co-sponsored by the American Society on Aging; cooperating organizations include the Research and Training Center on Aging, Rancho Los Amigos Medical Center, and the Southern Gerontological Soc; Year: 1991; Format: Videorecording; [Richmond, Va.]: Virginia Commonwealth University, c1991
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Stroke. Source: Martin A. Samuels; Year: 1996; Format: Videorecording; Los Angeles, CA: Mayer Media, 1996
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Stroke. Source: Time Life Medical; produced in association with Sonalysts Studios; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996
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Treating stroke. Source: a presentation of Films for the Humanities & Sciences; Year: 1993; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1993
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Treatment of stroke. Source: a co-production of the Regional Audio Visual Center and Physician Education & Development; Year: 1997; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1997
Vocabulary Builder Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Dreams: A series of thoughts, images, or emotions occurring during sleep which are dissociated from the usual stream of consciousness of the waking state. [NIH]
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Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Nephropathy: Disease of the kidneys. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Shame: An emotional attitude excited by realization of a shortcoming or impropriety. [NIH] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU]
Periodicals and News 235
CHAPTER 8. PERIODICALS AND NEWS ON STROKE Overview Keeping up on the news relating to stroke can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on stroke. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover stroke beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on stroke is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “stroke” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to stroke. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “stroke” (or synonyms). The following was recently listed in this archive for stroke: ·
Diffusion-weighted MRI better than CT in stroke diagnosis Source: Reuters Medical News Date: September 20, 2002 http://www.reuters.gov/archive/2002/09/20/professional/links/20020 920clin024.html
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Air pollution may increase risk of stroke Source: Reuters Health eLine Date: September 19, 2002 http://www.reuters.gov/archive/2002/09/19/eline/links/20020919elin 016.html
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Air pollution increases risk of ischemic stroke Source: Reuters Medical News Date: September 18, 2002 http://www.reuters.gov/archive/2002/09/18/professional/links/20020 918epid004.html
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Texas Biotech's Argatroban begins phase II combination stroke therapy study Source: Reuters Industry Breifing Date: September 17, 2002 http://www.reuters.gov/archive/2002/09/17/business/links/20020917 drgd003.html
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Stroke risk increased in older men with high waist circumference and BMI Source: Reuters Medical News Date: September 12, 2002 http://www.reuters.gov/archive/2002/09/12/professional/links/20020 912epid006.html
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E-selectin tolerization prevents stroke in hypertensive rats Source: Reuters Industry Breifing Date: September 06, 2002 http://www.reuters.gov/archive/2002/09/06/business/links/20020906 scie001.html
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Bone marrow cells help mend stroke damage in rats Source: Reuters Health eLine Date: August 26, 2002 http://www.reuters.gov/archive/2002/08/26/eline/links/20020826elin 034.html
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Putting arm to sleep helps hand recover post-stroke Source: Reuters Health eLine Date: August 15, 2002 http://www.reuters.gov/archive/2002/08/15/eline/links/20020815elin 017.html
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Anesthetizing arm may improve hand function of stroke patients Source: Reuters Medical News Date: August 15, 2002 http://www.reuters.gov/archive/2002/08/15/professional/links/20020 815clin012.html
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Goggles may improve type of stroke impairment Source: Reuters Health eLine Date: August 14, 2002 http://www.reuters.gov/archive/2002/08/14/eline/links/20020814elin 006.html
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Botox found effective for type of stroke disability Source: Reuters Health eLine Date: August 07, 2002 http://www.reuters.gov/archive/2002/08/07/eline/links/20020807elin 002.html
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Linoleic acid may protect against ischemic stroke Source: Reuters Medical News Date: August 02, 2002 http://www.reuters.gov/archive/2002/08/02/professional/links/20020 802epid002.html
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Pre- and post-stroke dementia linked to poor survival Source: Reuters Medical News Date: August 01, 2002 http://www.reuters.gov/archive/2002/08/01/professional/links/20020 801epid002.html
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Linoleic acid intake may cut stroke risk: study Source: Reuters Health eLine Date: August 01, 2002 http://www.reuters.gov/archive/2002/08/01/eline/links/20020801elin 012.html
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Simple clinical factors predict risk of first stroke in type 2 diabetics Source: Reuters Medical News Date: July 25, 2002 http://www.reuters.gov/archive/2002/07/25/professional/links/20020 725epid002.html
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Low body temperature improves stroke survival Source: Reuters Health eLine Date: July 25, 2002 http://www.reuters.gov/archive/2002/07/25/eline/links/20020725elin 006.html
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Docs: Thousands of UK stroke victims die needlessly Source: Reuters Health eLine Date: July 24, 2002 http://www.reuters.gov/archive/2002/07/24/eline/links/20020724elin 015.html
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UK doctors say thousands of stroke patients die needlessly Source: Reuters Medical News Date: July 23, 2002 http://www.reuters.gov/archive/2002/07/23/professional/links/20020 723publ001.html
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Low admission body temperature associated with good long-term stroke outcome Source: Reuters Medical News Date: July 18, 2002 http://www.reuters.gov/archive/2002/07/18/professional/links/20020 718epid003.html
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New AHA guidelines recommend early, life-long screening for CVD, stroke risk Source: Reuters Medical News Date: July 16, 2002 http://www.reuters.gov/archive/2002/07/16/professional/links/20020 716prof001.html
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Intra-arterial thrombolytic therapy for MCA stroke safe and effective Source: Reuters Medical News Date: July 15, 2002 http://www.reuters.gov/archive/2002/07/15/professional/links/20020 715clin013.html
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Reduced renal function predicts higher mortality risk after acute stroke Source: Reuters Medical News Date: July 12, 2002 http://www.reuters.gov/archive/2002/07/12/professional/links/20020 712clin005.html
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Elevated cholesterol increases risk of death from stroke in young women Source: Reuters Medical News Date: July 11, 2002 http://www.reuters.gov/archive/2002/07/11/professional/links/20020 711epid003.html
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Migraineurs with livedo reticularis at high risk for stroke Source: Reuters Medical News Date: July 10, 2002 http://www.reuters.gov/archive/2002/07/10/professional/links/20020 710epid002.html
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Aspirin within 48 hours of ischemic stroke reduces mortality, disability Source: Reuters Industry Breifing Date: July 08, 2002 http://www.reuters.gov/archive/2002/07/08/business/links/20020708 prof001.html
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Hemicraniectomy superior to moderate hypothermia for severe ischemic stroke Source: Reuters Medical News Date: July 05, 2002 http://www.reuters.gov/archive/2002/07/05/professional/links/20020 705clin022.html
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Timely hyperbaric oxygen helps recovery of stroke patients Source: Reuters Medical News Date: June 28, 2002 http://www.reuters.gov/archive/2002/06/28/professional/links/20020 628clin020.html
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Teleconsultation feasible for stroke management Source: Reuters Medical News Date: June 25, 2002 http://www.reuters.gov/archive/2002/06/25/professional/links/20020 625prof000.html
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Body substance helps nerves reconnect post-stroke Source: Reuters Health eLine Date: June 24, 2002 http://www.reuters.gov/archive/2002/06/24/eline/links/20020624elin 014.html
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Selective serotonin reuptake inhibitors not tied to stroke Source: Reuters Medical News Date: June 19, 2002 http://www.reuters.gov/archive/2002/06/19/professional/links/20020 619epid004.html
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Low plasma vitamin C linked with increased stroke risk in men Source: Reuters Medical News Date: June 11, 2002 http://www.reuters.gov/archive/2002/06/11/professional/links/20020 611clin029.html
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Polymorphism linked with risk of nonfatal arterial ischemic stroke Source: Reuters Medical News Date: June 07, 2002 http://www.reuters.gov/archive/2002/06/07/professional/links/20020 607epid003.html
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Low vitamin C intake ups stroke risk: report Source: Reuters Health eLine Date: June 06, 2002 http://www.reuters.gov/archive/2002/06/06/eline/links/20020606elin 011.html
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Gene aberration may up stroke risk in young adults Source: Reuters Health eLine Date: June 06, 2002 http://www.reuters.gov/archive/2002/06/06/eline/links/20020606elin 010.html
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Dual therapy shown to aid stroke recovery Source: Reuters Health eLine Date: June 06, 2002 http://www.reuters.gov/archive/2002/06/06/eline/links/20020606elin 012.html
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Early dramatic recovery often achieved with intravenous tPA for acute stroke Source: Reuters Industry Breifing Date: May 30, 2002 http://www.reuters.gov/archive/2002/05/30/business/links/20020530 clin003.html
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More people in the US are surviving stroke Source: Reuters Health eLine Date: May 27, 2002 http://www.reuters.gov/archive/2002/05/27/eline/links/20020527elin 019.html
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Many die from stroke before getting help: report Source: Reuters Health eLine Date: May 23, 2002 http://www.reuters.gov/archive/2002/05/23/eline/links/20020523elin 018.html
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Delay in seeking care contributes to stroke mortality Source: Reuters Medical News Date: May 23, 2002 http://www.reuters.gov/archive/2002/05/23/professional/links/20020 523epid008.html
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Most people don't recognize early signs of stroke Source: Reuters Health eLine Date: May 03, 2002 http://www.reuters.gov/archive/2002/05/03/eline/links/20020503elin 010.html
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Stroke ups risk of bone loss, fractures Source: Reuters Health eLine Date: May 02, 2002 http://www.reuters.gov/archive/2002/05/02/eline/links/20020502elin 011.html
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Stroke low on list of Americans' most-feared ills Source: Reuters Health eLine Date: May 02, 2002 http://www.reuters.gov/archive/2002/05/02/eline/links/20020502elin 001.html
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More dietary folate lessens stroke risk: survey Source: Reuters Health eLine Date: May 02, 2002 http://www.reuters.gov/archive/2002/05/02/eline/links/20020502elin 002.html
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Folate intake linked with lower risk of stroke and CVD Source: Reuters Medical News Date: May 02, 2002 http://www.reuters.gov/archive/2002/05/02/professional/links/20020 502epid002.html
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Bisphosphonates may prevent bone loss after stroke Source: Reuters Medical News Date: May 02, 2002 http://www.reuters.gov/archive/2002/05/02/professional/links/20020 502clin004.html
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Simple models can predict stroke outcome Source: Reuters Medical News Date: April 29, 2002 http://www.reuters.gov/archive/2002/04/29/professional/links/20020 429clin020.html
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Circulating immune complex levels increased in acute stroke patients Source: Reuters Medical News Date: April 22, 2002 http://www.reuters.gov/archive/2002/04/22/professional/links/20020 422clin010.html
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A drink a day may cut stroke risk for some: study Source: Reuters Health eLine Date: April 19, 2002 http://www.reuters.gov/archive/2002/04/19/eline/links/20020419elin 020.html
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Stroke subtype does not influence outcome of rtPA treatment Source: Reuters Industry Breifing Date: April 17, 2002 http://www.reuters.gov/archive/2002/04/17/business/links/20020417 clin015.html
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Drug implant may prevent stroke complication Source: Reuters Health eLine Date: April 05, 2002 http://www.reuters.gov/archive/2002/04/05/eline/links/20020405elin 015.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “stroke” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
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Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “stroke” (or synonyms). If you know the name of a company that is relevant to stroke, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “stroke” (or synonyms).
Newsletters on Stroke Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “stroke.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “stroke” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Advisor [Newsletter] Source: Burlington, IA: Southeast Iowa Area Agency on Aging. [8 p. average]. Contact: Available from Southeast Iowa Area Agency on Aging. 509 Jefferson Street, Burlington, IA 52601. (319) 752-5433. Summary: A typical issue of this newsletter, which is directed to the elderly and their families and friends, covers regional and national news and happenings in the southeast Iowa area. Articles may describe
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insurance regulations, rent reimbursement programs, social security frauds, heat stroke precautions, or elder recreation programs. Each issue also lists the monthly menu of a meal program for older persons as well as upcoming Alzheimer's disease support group meetings and other announcements. ·
Too Much of the Good Life: Cardiovascular Disease in Oregon Source: CD Summary. 50(18):1-2, August 28, 2001. Contact: Oregon Health Division, 800 Northeast Oregon Street, Portland, OR 97232. (503) 731-4024. FAX: (503) 731-4798. Internet/Email: http://www.oshd.org/cdpe/;
[email protected]. Summary: This newsletter reviews the epidemiology of cardiovascular disease (CVD) and related risk factors among Oregonians and describes Oregon's cardiovascular health program. Age-adjusted death rates for heart disease in Oregon have declined 29 percent over the past decade. Overall, men have a higher heart disease death rate than women. Ageadjusted death rates due to stroke have been higher than the United States rates for the last 30 years, and the disparity has grown wider since 1990. Much of the CVD burden is preventable. Several risk factors can be modified, including smoking, obesity, hypertension, high cholesterol, unhealthy eating, and physical inactivity. Oregonians with coronary heart disease were as likely to smoke as those without, but those with coronary heart disease were 1.3 times more likely to be former smokers. The purpose of the new Cardiovascular Health Program in Oregon is to improve cardiovascular health statewide through policy and environmental changes addressing obesity, physical inactivity, and nutrition. 2 figures, 1 table, 6 references.
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Physical Activity and Women's Health Source: Physical Activity and Fitness Research Digest. 2(5):1-8, March 1996. Summary: Physical Activity and Women's Health is a feature article from a newsletter on physical activity and fitness. The author presents the growing body of evidence for the beneficial relationships between physical activity (including exercise and physical fitness) and the major chronic diseases in women, with special references to race and ethnicity. The most current data on habitual physical activity are from the Behavioral Risk Factor Surveillance System, a state-based survey to collect self-reported information of adults. Only 27 percent of female respondents in 48 states and the District of Columbia reported participation in leisure-time physical activity in levels recommended by
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the Centers for Disease Control and the American College of Sports Medicine. Women, especially women of color, are more likely to be sedentary than men. In 1990, 4 of the 10 leading causes of death in American women are chronic diseases directly associated with modifiable behavioral factors including physical inactivity or sedentary lifestyle such as heart disease, various cancers, hypertension, stroke, and non-insulin-dependent diabetes mellitus. Controlling body fatness, another factor that relates to the increased risk of chronic diseases, also relates to inactivity. The author discusses major modifiable risk factors for cardiovascular diseases and their relation to physical inactivity including high blood cholesterol and high blood pressure. The author also states that habitual physical activity reduces the risk of hypertension in women, a risk factor for stroke, which is the leading cause of disability in American women. Increasing evidence also indicates that physical activity is associated with decreased overall cancer mortality and decreased incidence of specific types of cancers. Several studies in American women suggest that risk for breast cancer may be lowered in those who are habitually active. The author also cites studies indicating that regular physical activity has an important role in both treatment and prevention of non-insulin-dependent diabetes mellitus among women through its association with reduced body weight, and its independent effects on insulin sensitivity and glucose tolerance. Greater attention to prevention and treatment of obesity in minority populations may help to address critical health issues in American women. The author concludes that research and educational efforts must focus on conceptually-based programs in schools and communities that are culturally-sensitive and ethnic-specific. ·
Health Benefits of Physical Activity Source: Physical Activity and Fitness Research Digest. 1(1):1-8, February 1993. Summary: The Health Benefits of Physical Activity is a newsletter issue that provides a simple summary of the benefits of physical activity. Section one, Disease Prevention and Treatment, lists the diseases for which regular physical activity can reduce risk, either of getting the disease or of dying from it, and describes how exercise reduces risk for these diseases. Diseases that can be prevented through physical activity include (1) heart disease, (2) stroke, (3) vascular disease, (4) high blood pressure, (5) diabetes, (6) colon cancer, (7) obesity, (8) depression, (9) back pain, and (10) osteoporosis. Physical activity has been shown to have a significant beneficial health effect on individuals suffering from depression. Section two, Health Promotion, discusses the Healthy People
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2000 report and its health goals. While physical activity's contribution to quality of life and a personal sense of well-being is more difficult to document than its contribution to prevention and treatment of disease, evidence suggests that humans were designed to be physically active and that physical activity has great potential for enhancing quality of life. Section three, Physical Fitness, examines the relationship between physical activity and physical fitness. Physical fitness has been linked to injury prevention and is often an important factor in the level of body fat, which can affect disease risk. Regular physical activity has positive benefits for both good health and adequate physical fitness.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “stroke” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on stroke: ·
Speech After Stroke: Rehabilitation Enhances Recovery and Lifestyle Source: Mayo Clinic Health Letter. 14(8): 1-3. August 1996. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street, S.W., Rochester, MN 55905. (800) 633-4567. Price: $3.00 for single copy of newsletter plus shipping and handling. Summary: This newsletter article describes advances in post-stroke speech and language rehabilitation. Topics include how stroke damages brain cells; the three main stroke-related communication disorders, aphasia, dysarthria, and apraxia; how speech rehabilitation can enhance quality of life for people who have had a stroke; diagnosing speech and language problems; the components of a speech rehabilitation program, including exercise and practice, and the use of picture cards, picture
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boards, workbooks, and computers; and the psychosocial impact of recovering from a stroke. One sidebar outlines the role of family and friends in the recovery process. ·
Stroke: Dental Care for Stroke Survivors Source: Dental Hygienist News. 11(1): 14-16. 1998. Contact: Available from Harfst Communications. P.O. Box 576, Bloomfield, MI 48303-0576. Summary: Medical science has improved the survival rate of stroke victims and, therefore, the dental hygienist is more likely to care for a stroke survivor in the dental practice. This article familiarizes dental hygienists with some care strategies to use when providing dental care for stroke survivors. The author first emphasizes that health care providers should be knowledgeable of the warning signs and risk factors specific to cardiovascular disease. Dental health care professionals, through diligent attention to a patient's health history, can play an active role in stroke prevention. The author reviews risk factors including high blood pressure, cigarette smoking, history of heart disease, and the experience of transient ischemic attacks (TIAs, temporary stroke episodes). The author then summarizes the physical effects of strokes. Understanding the physical effects of a stroke and how stroke may affect the oral self care and dental treatment of the survivor is important to providing optimal dental care. Topics include the rehabilitation and recovery process, the initial post stroke phase, adapting oral care adjuncts, extraoral and intraoral changes, the issue of informed consent, and quality of care. 2 tables. 8 references.
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Physical Activity Lowers Stroke Risk in Women Source: WIN Notes. p. 5. Spring 2001. Contact: Weight-Control Information Network. 1-877-WIN-4627. Summary: A study published in the June 14, 2000, issue of the Journal of the American Medical Association (JAMA) found that increasing levels of physical activity significantly reduces the risk of total stroke and stroke subtypes in women. The research, led by Frank Hu, M.D., Ph.D., at the Harvard School of Public Health, followed 72,488 female nurses from the Nurses' Health Study. Participants ranged in age from 40 to 65 years and were free of cardiovascular disease and cancer at baseline in 1976. The nurses completed physical activity questionnaires in 1986, 1988, and 1992. After controlling for age, body mass index (BMI), hypertension, and other risk factors, the study showed that each 3.5 hour per week increase in moderate or vigorous physical activity was associated with a 19 percent
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reduction in total stroke and a 29 percent reduction in ischemic stroke. The researchers also found that sedentary women who became more active in later life had a considerably lower risk for stroke than women who remained sedentary. This finding indicates a relatively immediate effect of physical activity on stroke risk. ·
Warding Off Stroke Source: Tufts University Health and Nutrition Letter. 16(4):7. June 1998. Contact: Tufts University Health and Nutrition Letter, 53 Park Place, New York, NY 10007. Summary: According to this article, deaths from stroke are increasing in America. The authors say that stroke prevention measures include such steps as smoking cessation, drinking in moderation, losing weight, controlling diabetes, eating a low-fat diet, and keeping blood pressure low. One of the most important of these, the authors claim, is weight control, since that influences many of the other factors.
Academic Periodicals covering Stroke Academic periodicals can be a highly technical yet valuable source of information on stroke. We have compiled the following list of periodicals known to publish articles relating to stroke and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on stroke published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on stroke:
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Artificial Organs. (Artif Organs) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar tificial+Organs&dispmax=20&dispstart=0
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Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. (Biomed Pharmacother) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi omedicine+&+Pharmacotherapy+=+Biomedecine+&+Pharmacotherapie &dispmax=20&dispstart=0
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Clinical and Experimental Pharmacology & Physiology. (Clin Exp Pharmacol Physiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+and+Experimental+Pharmacology+&+Physiology&dispmax=20&d ispstart=0
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Clinical Chemistry. (Clin Chem) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Chemistry&dispmax=20&dispstart=0
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Clinical Pharmacology and Therapeutics. (Clin Pharmacol Ther) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Pharmacology+and+Therapeutics&dispmax=20&dispstart=0
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Clinical Rehabilitation. (Clin Rehabil) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Rehabilitation&dispmax=20&dispstart=0
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Critical Care Medicine. (Crit Care Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cr itical+Care+Medicine&dispmax=20&dispstart=0
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Experimental Neurology. (Exp Neurol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ex perimental+Neurology&dispmax=20&dispstart=0
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Journal of Advanced Nursing. (J Adv Nurs) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Advanced+Nursing&dispmax=20&dispstart=0
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Journal of Hypertension. (J Hypertens) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Hypertension&dispmax=20&dispstart=0
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Journal of Neurology. (J Neurol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Neurology&dispmax=20&dispstart=0
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Physical Therapy. (Phys Ther) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ph ysical+Therapy&dispmax=20&dispstart=0
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Postgraduate Medical Journal. (Postgrad Med J) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medical+Journal&dispmax=20&dispstart=0
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Radiation Research. (Radiat Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ra diation+Research&dispmax=20&dispstart=0
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The Journal of Nutrition. (J Nutr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Nutrition&dispmax=20&dispstart=0
Vocabulary Builder Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH]
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Livedo: A discoloured spot or patch on the skin, commonly due to passive congestion; commonly used alone to refer to l. reticularis. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.30 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:31 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 31 See http://www.nlm.nih.gov/databases/databases.html. 30
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat stroke, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and stroke using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “stroke” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with stroke. The following is a sample result:
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·
Family Matter: A Longitudinal Study of California Caregivers of BrainImpaired Adults Source: San Francisco, CA: Family Survival Project. November 1991. 116 p.
Contact: Available from Family Survival Project. 425 Bush Street, Suite 500, San Francisco, CA 94108 (415) 434-3388. Price: $20.00. Summary: This research report describes a longitudinal study conducted between April 1988 and June 1990 in San Francisco, California, to examine changes over time in the well being, social support, service needs, and service utilization of caregivers of brain impaired persons. The report first reviews the literature, highlighting prior research on caregivers for the three diagnostic groups examined in the study: dementia (among dementias, Alzheimer's disease was the most common diagnosis); stroke; and traumatic brain injury. The report then describes the study instruments and methodology and presents findings in the following areas: 1) caregiver and patient status over time; 2) caregiver and patient characteristics and patient problem behaviors at baseline; 3) changes in caregiver well being such as stress and burden, physical health, and mental health; and 4) changes in social support and in service needs and utilization. The authors note that perhaps the most important finding of the study is that caregiver well being can improve over time in a caregiving population with relatively high baseline burden and depression levels. The authors state that the findings provide important implications for future policy, service, and research initiatives to assist family caregivers of brain-impaired adults. 93 references. ·
Differential Diagnosis of Dementing Diseases Source: Bethesda, MD: Office of Medical Application of Research, National Institutes of Health. NIH Consensus Development Conference Statement, Volume 6, Number 11, July 6-8, 1987. 27 p. Contact: Available from National Institutes of Health. Office of Medical Applications of Research, Federal Building, Room 618, 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-1143. Price: Free. Summary: This report is the result of a 1 1/2-day conference convened by the National Institute on Aging, the National Institute of Neurological and Communicative Disorders and Stroke, the National Institute of Mental health, and the NIH Office of Medical Applications of Research. Following the conference, a panel formulated this consensus statement to answer the following questions: 1) What is dementia?; 2) What are the dementing diseases, and which of them can readily arrested or reversed?; 3) What should be included in the initial evaluation of dementia?; 4) What diagnostic test should be performed, and when are these tests
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indicated?; and 5) What are the priorities for future research on diagnosing the dementias?. ·
Diagnosis and Treatment of Swallowing Disorders (Dysphagia) in Acute-Care Stroke Patients Source: Rockville, MD: Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services. July 1999. 373 p. Contact: Available from Agency for Healthcare Research and Quality (AHRQ). P.O. Box 8547, Silver Spring, MD 20907-8547. (800) 358-9295. TDD (888) 586-6340. Website: www.ahrq.gov. Price: Single copy free. AHCPR Publication Number 99-E024. Summary: About 6 million Americans over age 60 have dysphagia (swallowing difficulty) and about 300,000 to 600,000 people are affected by dysphagia resulting from neurologic disorders each year. This report was requested by the Health Care Financing Administration (HCFA), which sought an evidence based assessment of methods for diagnosing and treating swallowing disorders (dysphagia) in elderly individuals with neurologic diseases, specifically those methods associated with the services provided by speech language pathologists. The report addresses four issues: how does diagnosis of dysphagia or aspiration affect treatment courses and patient outcomes; the indications for diagnosing patients using a full bedside exam (BSE), modified barium swallow, fiberoptic endoscopy, or other instrumental exams; the choices of diagnostic technology; and when noninvasive therapy is appropriate and when feeding tubes should be used in certain patient populations. The report notes that even after an extensive literature review, available evidence on the diagnosis and treatment of dysphagia is extremely limited. Nevertheless, current data suggest that implementation of dysphagia management programs for stroke patients in the acute care setting is accompanied by a reduction in pneumonia rates. There is a clear cut need to optimize a brief initial exam that accurately detects patients with possible unsafe swallows who may therefore need more extensive testing. 11 figures. 114 tables. 319 references.
·
Health Risks of Obesity: Special Report. 2nd ed Source: Hettinger, ND: Obesity and Health, Healthy Living Institute. 1993. 190 p. Contact: Available from Obesity and Health. 402 South 14th Street, Hettinger, ND 58639. (701) 567-2845. Fax (701) 567-2443. Price: $65. Summary: This report sets forth current information on the health risks of obesity. The report is intended to help educators, policy makers, and
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health care providers deal more effectively with the complexities and dilemmas of obesity. Eleven chapters address the following topics: the health risks of obesity in the areas of heart disease, stroke, cancer, diabetes, and other related diseases; fat distribution; obesity in ethnic populations, notably the high risk of diabetes in the Native American population; early puberty; leanness and aging; the risks of losing weight; effectiveness of treatment; weight cycling; mortality and weight loss; treatment decisions; and challenges for the future. Numerous appendices present information about measuring and defining obesity and two NIH conferences. ·
Minority Health Care Contact: Office of Disease Prevention and Health Promotion, Communication Support Center, PO Box 37366, Washington, DC, 200137366, (301) 468-5960. Summary: This catalog offers a list of resource materials that can be used in support of health education. They are aimed specifically at minority audiences, some are printed in languages other than English, and they come from a variety of publication sources. They cover six minority health areas: general health; AIDS; cancer; cardiovascular disease and stroke; chemical dependency; diabetes; homicide, suicide, and unintentional injuries; and infant mortality and low birthweight. Materials for Hispanics, African Americans, Native Americans, and Asian/Pacific Islanders are included in the listings.
·
Sources of Health Materials for Asian Languages Contact: US Department of Health and Human Services, Public Health Service, Office of Minority Health Resource Center, PO Box 37337, Washington, DC, 20013-7337, (800) 444-6472, http://www.omhrc.gov. Summary: This catalog alphabetically lists sources of health educational materials for Asian and Pacific Islander populations. A cross index by subject follows. Areas covered include: cancer; AIDS; chemical dependency; heart disease and stroke; drug and alcohol abuse; infant mortality; homicide, suicide, and unintentional injuries; diabetes; and domestic violence.
·
Vascular Dementia: An Explanation of Dementia Caused by Multiple Brain Strokes Source: Tuscaloosa, AL: Dementia Education and Training Program. 1995. 10 p.
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Contact: University Supply Store. Attn: Jef Smith, PO Box 870291, Ferguson Center, Tuscaloosa, AL 35487. (800) 825-6802. Price: $2.25. Summary: This booklet for families and other lay caregivers is designed to explain dementia caused by multiple small strokes (vascular dementia). It discusses how a stroke can be caused by the hardening of arteries that supply blood to the brain; and how the resulting damage can affect the patient's memory and speech, temper and personality, and ability to understand words. The text is accompanied by color photographs of normal and clogged blood vessels, and normal and stroke-damaged brains. Ten facts about vascular dementia are listed. ·
Positron Emission Tomography: Emerging Research Opportunities in the Neurosciences Source: Bethesda, MD: National Institutes of Health. 1984. 16 p. Contact: Available from National Institute of Neurological and Communicative Disorders and Stroke. National Institutes of Health, Bethesda, MD 20892. (301) 496-4000. Price: Call for information. NIH Publication Number 84-2620. Summary: This booklet examines positron emission tomography (PET), the first imaging technique that shows ongoing metabolic activity in various regions of the brain. This technique helps scientists understand how a healthy brain works and what alterations lead to brain diseases, both neurological and psychiatric. This aspect of imaging is especially helpful in studying the effects of Alzheimer's disease on the brain. The basis of PET is a group of radioisotopes that decay and emit positrons, creating imaging capabilities. The booklet discusses PET's use for observing both healthy brains and those affected by neurological diseases, brain tumors, stroke, and dementing disease. Studies at the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) have demonstrated that a decrease in metabolism is greatest in the parietotemporal region of the brain in Alzheimer's patients. PET has many possibilities for new avenues of research into the components of brain function.
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Dystonias Source: Bethesda, MD: National Institute of Neurological Disorders and Stroke, National Institutes of Health. 1996. [5 p.]. Contact: Available from National Institute of Neurological Disorders and Stroke. Office of Scientific and Health Reports, P.O. Box 5801, Bethesda, MD 20824. (800) 352-9424 or (301) 496-5751. Price: Single copy free; bulk orders may be available. NIH Publication Number 96-717.
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Summary: This brochure, written for health professionals or educated lay persons, provides basic information about the dystonias, movement disorders in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. Written in a question and answer format, the brochure covers the symptoms of the dystonias; the classification system used to categorize the dystonias, including specific dystonia systems; the etiology of the dystonias, including genetics; when symptoms typically appear and how they progress; treatment options aimed at reducing or eliminating muscle spasms and pain, including drug therapy, botulinum toxin therapy, and surgery; and research activities in this area. The brochure concludes with the contact information for five privately support voluntary health agencies as well as that for the National Institute of Neurological Disorders and Stroke, through which readers can obtain more information. ·
Post-Stroke Rehabilitation: Assessment, Referral, and Patient Management Source: Rockville, MD: Agency for Health Care Policy and Research (AHCPR). 1995. 40 p. Contact: Available from Agency for Health Care Policy and Research (AHCPR). U.S. Department of Health and Human Services, Executive Office Center, Suite 501, 2101 East Jefferson Street, Rockville, MD 20852. AHCPR Publication Number 95-0663. Summary: This booklet contains highlights from Post-Stroke Rehabilitation, Clinical Practice Guideline No. 16, which was developed by a multidisciplinary, private-sector panel composed of health care professionals and a consumer representative. This Quick Reference Guide summarizes how a clinician might implement the panel's findings and recommendations on the overall management of stroke patients who need post-stroke rehabilitation programs or services before returning to a family or other living environment. Topics include the medical management of patients, systematic assessment and evaluation of patients throughout the acute care and rehabilitation stages, referring patients to appropriate rehabilitation programs, managing the rehabilitation process, discharging patients from rehabilitation programs, and reintegrating patients into family and community environments. The goal of the guidelines are to improve the effectiveness of rehabilitation in helping individuals with disabilities from stroke to achieve the best possible functional outcomes and quality of life. The primary focus is on the patient with hemiparesis due to a first stroke, who participates in interdisciplinary rehabilitation program. The assessment of speech and
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language disabilities is included in the patient care strategies. 3 figures. 6 tables. 21 references. ·
For a healthy nation: Returns on investment in public health Source: Washington, DC: Public Health Service, U.S. Department of Health and Human Services. ca. 1994. 49 pp. Contact: Available from Superintendent of Documents, U.S. Government Printing Office, P.O. Box 371954, Pittsburgh, PA 15250-7954. Telephone: (202) 512-1991 for public information (D.C. office) or (202) 512-1800 for ordering and publication information (D.C. office) / fax: (202) 512-1293 (public information); (202) 512-2250 (ordering) / Web site: http://www.access.gpo.gov. $4.00 includes shipping and handling; prepayment required. Summary: This report underscores the importance of public health services to the overall health of the nation. It examines factors that affect public health delivery: relationships between medical care and public health, the reduction in support for public health, and health care reform. The report reviews public health programs that achieved success by developing partnerships among national, state, and local public health agencies. Also included are case studies of programs on smoking, dental care, children's exposure to lead, vaccines for preventable diseases, reducing heart disease and stroke, preventing infant mortality, controlling the spread of sexually transmitted diseases, and reducing unintentional injuries. Developing priorities for providing future services and the role of public health in the changing health care system are discussed.
The NLM Gateway32 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.33 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
32 33
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researchers, librarians, students, and, increasingly, patients, their families, and the public.34 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “stroke” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 348136 Books / Periodicals / Audio Visual 2576 Consumer Health 294 Meeting Abstracts 2575 Other Collections 100 Total 353681
HSTAT35 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.36 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.37 Simply search by “stroke” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 35 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 36 The HSTAT URL is http://hstat.nlm.nih.gov/. 37 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) 34
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Coffee Break: Tutorials for Biologists38 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.39 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.40 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 38 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 39 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 40 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
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Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Stroke With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to stroke. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).41 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “stroke” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
41
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report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for stroke: ·
Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like Episodes Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?540000
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Occipital Calcifications, Familial, with Hemorrhagic Leukoencephalopathy, Arterial Dysplasia, and Dementia Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?605714
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Stroke Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601367
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Stroke, Susceptibility To, 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?606799
Strokes,
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-
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Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html ·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “stroke” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database42 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database43 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 43 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 42
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the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “stroke” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in stroke (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · The Behavioral Neurology of White Matter by Christopher M. Filley; Paperback - 279 pages; 1st edition (September 15, 2001), Oxford University Press; ISBN: 019513561X; http://www.amazon.com/exec/obidos/ASIN/019513561X/icongroupinterna
· The Cerebellum and Its Disorders by Mario-Ubaldo Manto, Massimo Pandolfo; Hardcover - 1st edition (January 2002), Cambridge University Press; ISBN: 0521771560; http://www.amazon.com/exec/obidos/ASIN/0521771560/icongroupinterna · Clinical Neurology by David A. Greenberg, et al; Paperback - 390 pages; 5th edition (February 9, 2002), Appleton & Lange; ISBN: 0071375430; http://www.amazon.com/exec/obidos/ASIN/0071375430/icongroupinterna · Clinical Neurology for Psychiatrists by David M. Kaufman; Hardcover 670 pages, 5th edition (January 15, 2001), W. B. Saunders Co.; ISBN: 0721689957; http://www.amazon.com/exec/obidos/ASIN/0721689957/icongroupinterna
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· Comprehensive Neurology by Roger N. Rosenberg (Editor), David E. Pleasure (Editor); 1280 pages, 2nd edition (April 1998), Wiley-Liss; ISBN: 0471169587; http://www.amazon.com/exec/obidos/ASIN/0471169587/icongroupinterna · Emergent and Urgent Neurology by William J. Weiner (Editor), Lisa M. Shulman (Editor); Hardcover - 571 pages; 2nd edition (January 15, 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 0397518579; http://www.amazon.com/exec/obidos/ASIN/0397518579/icongroupinterna · Neurology in Clinical Practice: Volume I: Principles of Diagnosis and Management, Volume II: The Neurological Disorders (2-Volume Set, Includes a 12-Month Subscription to the Online Edition) by W. G. Bradley, et al; Hardcover - 2413 pages, 3rd edition, Vol 1-2 (January 15, 2000), Butterworth-Heinemann; ISBN: 0750699736; http://www.amazon.com/exec/obidos/ASIN/0750699736/icongroupinterna · Neuroscience: Exploring the Brain by Mark F. Bear, et al; Hardcover - 855 pages, 2nd edition (January 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0683305964; http://www.amazon.com/exec/obidos/ASIN/0683305964/icongroupinterna · Office Practice of Neurology by Martain A. Samuels, Steven F. Feske; Hardcover, Churchill Livingstone; ISBN: 0443065578; http://www.amazon.com/exec/obidos/ASIN/0443065578/icongroupinterna · Patient-Based Approaches to Cognitive Neuroscience by Martha J. Farah (Editor), Todd E. Feinberg (Editor); Paperback - 425 pages (April 3, 2000), MIT Press; ISBN: 0262561239; http://www.amazon.com/exec/obidos/ASIN/0262561239/icongroupinterna · Principles of Neural Science by Eric R. Kandel (Editor), et al; Hardcover 1414 pages, 4th edition (January 5, 2000), McGraw-Hill Professional Publishing; ISBN: 0838577016; http://www.amazon.com/exec/obidos/ASIN/0838577016/icongroupinterna · Review Manual for Neurology in Clinical Practice by Karl E. Misulis, et al; Paperback, Butterworth-Heinemann Medical; ISBN: 0750671920; http://www.amazon.com/exec/obidos/ASIN/0750671920/icongroupinterna
Vocabulary Builder Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH]
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Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Orofacial: Of or relating to the mouth and face. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU]
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CHAPTER 10. DISSERTATIONS ON STROKE Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to stroke. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Stroke ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to stroke. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with stroke: ·
A Comparison of a Standard Neurological Assessment Tool to a Stroke Scale for Detecting Symptomatic Cerebral Vasospasm by Doerksen, Kathryn Joyce; Mn from The University of Manitoba (canada), 2001, 172 pages http://wwwlib.umi.com/dissertations/fullcit/MQ57532
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·
A Comparison of Cardiac Output and Stroke Volume in Phase Iii Cardiac Patients and Healthy Adults by Tuncel, Fehmi, Edd from Oklahoma State University, 1989, 62 pages http://wwwlib.umi.com/dissertations/fullcit/9004043
·
A Description of the Vertical Integration of Acute and Post-acute Care and Its Impact on Patients with Stroke in California, 1997 to 1998 by Zingmond, David Scott; Phd from University of California, Los Angeles, 2002, 243 pages http://wwwlib.umi.com/dissertations/fullcit/3040215
·
A Descriptive Study of Educational, Counseling, and Support Group Services Received and Needed by Spouses of Stroke Survivors (counselors) by Albert, Sharon Feld, Phd from University of Denver, 1996, 155 pages http://wwwlib.umi.com/dissertations/fullcit/9632548
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to stroke is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with stroke and related conditions.
Researching Your Medications 275
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with stroke. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for stroke. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of stroke. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-touse public sources.
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Your Medications: The Basics44 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of stroke. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with stroke take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for stroke. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
44
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 277
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for stroke). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for stroke. One such source is the
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United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.45 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of stroke. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to stroke: Amlodipine ·
Systemic - U.S. Brands: Norvasc http://www.nlm.nih.gov/medlineplus/druginfo/amlodipinesyste mic202670.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
45
Researching Your Medications 279
Amlodipine and Benazepril ·
Systemic - U.S. Brands: Lotrel http://www.nlm.nih.gov/medlineplus/druginfo/amlodipineand benazeprilsystemi203634.html
Androgens ·
Systemic - U.S. Brands: Andro L.A. 200; Androderm; AndroGel 1%; Android; Android-F; Andronate 100; Andronate 200; Andropository 200; Andryl 200; Delatest; Delatestryl; Depotest; Depo-Testosterone; Everone 200; Halotestin; ORETON Methyl; TCypionate; Testamone 100; Testaqua; Te http://www.nlm.nih.gov/medlineplus/druginfo/androgenssyste mic202036.html
Angiotensin-Converting Enzyme (Ace) Inhibitors ·
Systemic - U.S. Brands: Accupril; Aceon; Altace; Capoten; Lotensin; Mavik; Monopril; Prinivil; Univasc; Vasotec 4; Zestril http://www.nlm.nih.gov/medlineplus/druginfo/angiotensinconv ertingenzymeace202044.html
Angiotensin-Converting Hydrochlorothiazide ·
Enzyme
(Ace)
Inhibitors
and
Systemic - U.S. Brands: Accuretic; Capozide; Lotensin HCT; Prinzide; Uniretic; Vaseretic; Zestoretic http://www.nlm.nih.gov/medlineplus/druginfo/angiotensinconv ertingenzymeace202045.html
Beta-Adrenergic Blocking Agents ·
Systemic - U.S. Brands: Betapace; Blocadren; Cartrol; Corgard; Inderal; Inderal LA; Kerlone; Levatol; Lopressor; Normodyne; Sectral; Tenormin; Toprol-XL; Trandate; Visken; Zebeta http://www.nlm.nih.gov/medlineplus/druginfo/betaadrenergicb lockingagentssy202087.html
Beta-Adrenergic Blocking Agents and Thiazide Diuretics ·
Systemic - U.S. Brands: Corzide 40/5; Corzide 80/5; Inderide; Inderide LA; Lopressor HCT; Tenoretic 100; Tenoretic 50; Timolide 10-25; Ziac http://www.nlm.nih.gov/medlineplus/druginfo/betaadrenergicb lockingagentsan202088.html
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Botulinum Toxin Type A ·
Parenteral-Local - U.S. Brands: Botox http://www.nlm.nih.gov/medlineplus/druginfo/botulinumtoxint ypeaparenterall202608.html
Calcium Channel Blocking Agents ·
Systemic - U.S. Brands: Adalat; Adalat CC; Calan; Calan SR; Cardene; Cardizem; Cardizem CD; Cardizem SR; Dilacor-XR; DynaCirc; Isoptin; Isoptin SR; Nimotop; Plendil; Procardia; Procardia XL; Vascor; Verelan http://www.nlm.nih.gov/medlineplus/druginfo/calciumchannel blockingagentssy202107.html
Candesartan ·
Systemic - U.S. Brands: Atacand http://www.nlm.nih.gov/medlineplus/druginfo/candesartansyst emic203598.html
Carvedilol ·
Systemic - U.S. Brands: Coreg http://www.nlm.nih.gov/medlineplus/druginfo/carvedilolsyste mic203636.html
Clonidine ·
Systemic - U.S. Brands: Catapres; Catapres-TTS http://www.nlm.nih.gov/medlineplus/druginfo/clonidinesystem ic202152.html
Clonidine and Chlorthalidone ·
Systemic - U.S. Brands: Combipres http://www.nlm.nih.gov/medlineplus/druginfo/clonidineandchl orthalidonesyst202153.html
Clopidogrel ·
Systemic - U.S. Brands: Plavix http://www.nlm.nih.gov/medlineplus/druginfo/clopidogrelsyste mic203403.html
Researching Your Medications 281
Dantrolene ·
Systemic - U.S. Brands: Dantrium http://www.nlm.nih.gov/medlineplus/druginfo/dantrolenesyste mic202181.html
Dipyridamole and Aspirin ·
Systemic - U.S. Brands: Aggrenox http://www.nlm.nih.gov/medlineplus/druginfo/dipyridamolean daspirinsystemic500072.html
Dipyridamole Therapeutic ·
Systemic - U.S. Brands: Persantine http://www.nlm.nih.gov/medlineplus/druginfo/dipyridamoleth erapeuticsystemi202624.html
Diuretics, Loop ·
Systemic - U.S. Brands: Bumex; Edecrin; Lasix; Myrosemide http://www.nlm.nih.gov/medlineplus/druginfo/diureticsloopsys temic202205.html
Diuretics, Potassium-Sparing ·
Systemic - U.S. Brands: Aldactone; Dyrenium; Midamor http://www.nlm.nih.gov/medlineplus/druginfo/diureticspotassi umsparingsyste202206.html
Diuretics, Potassium-Sparing, and Hydrochlorothiazide ·
Systemic - U.S. Brands: Aldactazide; Dyazide; Maxzide; Moduretic; Spirozide http://www.nlm.nih.gov/medlineplus/druginfo/diureticspotassi umsparingandhy202207.html
Diuretics, Thiazide ·
Systemic - U.S. Brands: Aquatensen; Diucardin; Diulo; Diuril; Enduron; Esidrix; Hydro-chlor; Hydro-D; HydroDIURIL; Hydromox; Hygroton; Metahydrin; Microzide; Mykrox; Naqua; Naturetin; Oretic; Renese; Saluron; Thalitone; Trichlorex 10; Zaroxolyn http://www.nlm.nih.gov/medlineplus/druginfo/diureticsthiazid esystemic202208.html
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Doxazosin ·
Systemic - U.S. Brands: Cardura http://www.nlm.nih.gov/medlineplus/druginfo/doxazosinsyste mic202629.html
Enalapril and Felodipine ·
Systemic - U.S. Brands: Lexxel http://www.nlm.nih.gov/medlineplus/druginfo/enalaprilandfelo dipinesystemic203638.html
Eprosartan ·
Systemic - U.S. Brands: Teveten http://www.nlm.nih.gov/medlineplus/druginfo/eprosartansyste mic500044.html
Ergoloid Mesylates ·
Systemic - U.S. Brands: Gerimal; Hydergine http://www.nlm.nih.gov/medlineplus/druginfo/ergoloidmesylat essystemic202215.html
Guanabenz ·
Systemic - U.S. Brands: Wytensin http://www.nlm.nih.gov/medlineplus/druginfo/guanabenzsyste mic202271.html
Guanadrel ·
Systemic - U.S. Brands: Hylorel http://www.nlm.nih.gov/medlineplus/druginfo/guanadrelsyste mic202272.html
Guanethidine ·
Systemic - U.S. Brands: Ismelin http://www.nlm.nih.gov/medlineplus/druginfo/guanethidinesys temic202273.html
Guanfacine ·
Systemic - U.S. Brands: Tenex http://www.nlm.nih.gov/medlineplus/druginfo/guanfacinesyste mic202275.html
Researching Your Medications 283
Heparin ·
Systemic - U.S. Brands: Calciparine; Liquaemin http://www.nlm.nih.gov/medlineplus/druginfo/heparinsystemic 202280.html
Hydralazine and Hydrochlorothiazide ·
Systemic - U.S. Brands: Apresazide http://www.nlm.nih.gov/medlineplus/druginfo/hydralazineand hydrochlorothiaz202286.html
Indapamide ·
Systemic - U.S. Brands: Lozol http://www.nlm.nih.gov/medlineplus/druginfo/indapamidesyst emic202296.html
Irbesartan ·
Systemic - U.S. Brands: Avapro http://www.nlm.nih.gov/medlineplus/druginfo/irbesartansyste mic203379.html
Laxatives ·
Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/laxativesoral202 319.html
Losartan ·
Systemic - U.S. Brands: Cozaar http://www.nlm.nih.gov/medlineplus/druginfo/losartansystemi c202767.html
Losartan and Hydrochlorothiazide ·
Systemic - U.S. Brands: Hyzaar http://www.nlm.nih.gov/medlineplus/druginfo/losartanandhyd rochlorothiazide203639.html
284 Stroke
Mecamylamine ·
Systemic - U.S. Brands: Inversine http://www.nlm.nih.gov/medlineplus/druginfo/mecamylamines ystemic202340.html
Methyldopa ·
Systemic - U.S. Brands: Aldomet http://www.nlm.nih.gov/medlineplus/druginfo/methyldopasyst emic202359.html
Methyldopa and Thiazide Diuretics ·
Systemic - U.S. Brands: Aldoclor; Aldoril http://www.nlm.nih.gov/medlineplus/druginfo/methyldopaand thiazidediuretics202360.html Minoxidil ·
Systemic - U.S. Brands: Loniten http://www.nlm.nih.gov/medlineplus/druginfo/minoxidilsyste mic202373.html
Nisoldipine ·
Systemic - U.S. Brands: Sular http://www.nlm.nih.gov/medlineplus/druginfo/nisoldipinesyste mic203431.html
Prazosin ·
Systemic - U.S. Brands: Minipress http://www.nlm.nih.gov/medlineplus/druginfo/prazosinsystemi c202475.html
Prazosin and Polythiazide ·
Systemic - U.S. Brands: Minizide http://www.nlm.nih.gov/medlineplus/druginfo/prazosinandpol ythiazidesystemi202476.html
Rauwolfia Alkaloids ·
Systemic - U.S. Brands: Harmonyl; Raudixin; Rauval; Rauverid; Serpalan; Wolfina http://www.nlm.nih.gov/medlineplus/druginfo/rauwolfiaalkaloi dssystemic202503.html
Researching Your Medications 285
Rauwolfia Alkaloids and Thiazide Diuretics ·
Systemic - U.S. Brands: Demi-Regroton; Diupres; Diurigen with Reserpine; Diutensen-R; Enduronyl; Enduronyl Forte; Oreticyl; Oreticyl Forte; Rauzide; Regroton http://www.nlm.nih.gov/medlineplus/druginfo/rauwolfiaalkaloi dsandthiazided202504.html
Reserpine, Hydralazine, and Hydrochlorothiazide ·
Systemic - U.S. Brands: Cam-Ap-Es; Cherapas; Ser-A-Gen; Seralazide; Ser-Ap-Es; Serpazide; Tri-Hydroserpine; Unipres http://www.nlm.nih.gov/medlineplus/druginfo/reserpinehydral azineandhydroch202506.html
Salicylates ·
Systemic - U.S. Brands: Acuprin 81; Amigesic; Anacin Caplets; Anacin Maximum Strength; Anacin Tablets; Anaflex 750; Arthritis Pain Ascriptin; Arthritis Pain Formula; Arthritis Strength Bufferin; Arthropan; Aspergum; Aspirin Regimen Bayer Adult Low Dose; Aspirin Regimen Bayer R http://www.nlm.nih.gov/medlineplus/druginfo/salicylatessyste mic202515.html
Sildenafil ·
Systemic - U.S. Brands: Viagra http://www.nlm.nih.gov/medlineplus/druginfo/sildenafilsystem ic203533.html Telmisartan ·
Systemic - U.S. Brands: Micardis http://www.nlm.nih.gov/medlineplus/druginfo/telmisartansyste mic203710.html
Terazosin ·
Systemic - U.S. Brands: Hytrin http://www.nlm.nih.gov/medlineplus/druginfo/terazosinsystem ic202546.html
Ticlopidine ·
Systemic - U.S. Brands: Ticlid http://www.nlm.nih.gov/medlineplus/druginfo/ticlopidinesyste mic202637.html
286 Stroke
Torsemide ·
Systemic - U.S. Brands: Demadex http://www.nlm.nih.gov/medlineplus/druginfo/torsemidesyste mic202740.html
Trandolapril and Verapamil ·
Systemic - U.S. Brands: Tarka http://www.nlm.nih.gov/medlineplus/druginfo/trandolapriland verapamilsystem203641.html
Valsartan ·
Systemic - U.S. Brands: Diovan http://www.nlm.nih.gov/medlineplus/druginfo/valsartansystem ic203478.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html.46
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
46
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 287
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with stroke--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat stroke or potentially create deleterious side effects in patients with stroke. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense.
288 Stroke
Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with stroke. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with stroke. The FDA warns patients to watch out for47: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
47
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
Researching Your Medications 289
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Current Therapy in Neurologic Disease by Richard T. Johnson, et al; Hardcover - 457 pages, 6th edition (January 15, 2002), Mosby-Year Book; ISBN: 0323014720; http://www.amazon.com/exec/obidos/ASIN/0323014720/icongroupinterna · Emerging Pharmacological Tools in Clinical Neurology by MedPanel Inc. (Author); Digital - 66 pages, MarketResearch.com; ISBN: B00005RBN8; http://www.amazon.com/exec/obidos/ASIN/B00005RBN8/icongroupinter na · Goodman & Gilman’s The Pharmacological Basis of Therapeutics by Joel G. Hardman (Editor), Lee E. Limbird; Hardcover - 1825 pages, 10th edition (August 13, 2001), McGraw-Hill Professional Publishing; ISBN: 0071354697; http://www.amazon.com/exec/obidos/ASIN/0071354697/icongroupinterna · Neurology and General Medicine by Michael J. Aminoff (Editor), Hardcover - 992 pages, 3rd edition (March 15, 2001), Churchill Livingstone; ISBN: 0443065713; http://www.amazon.com/exec/obidos/ASIN/0443065713/icongroupinterna · Neurology and Medicine by Hughes Perkins; Hardcover - 415 pages, 1st edition (December 15, 1999), B. M. J. Books; ISBN: 0727912240; http://www.amazon.com/exec/obidos/ASIN/0727912240/icongroupinterna · Pharmacological Management of Neurological and Psychiatric Disorders by S. J. Enna (Editor), et al; Hardcover - 736 pages, 1st edition, McGrawHill Professional Publishing; ISBN: 0070217645; http://www.amazon.com/exec/obidos/ASIN/0070217645/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also
290 Stroke
increase nitrogen and water retention and stimulate skeletal growth. [NIH] Botulinum Toxin Type A: A neurotoxin produced by Clostridium botulinum. When consumed in contaminated food it can cause paralysis and death. In its purified form, it has been used in the treatment of blepharospasm and strabismus. [NIH] Dantrolene: Skeletal muscle relaxant that acts by interfering with excitationcontraction coupling in the muscle fiber. It is used in spasticity and other neuromuscular abnormalities. Although the mechanism of action is probably not central, dantrolene is usually grouped with the central muscle relaxants. [NIH]
Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH] Guanethidine: An antihypertensive agent that acts by inhibiting selectively transmission in post-ganglionic adrenergic nerves. It is believed to act mainly by preventing the release of norepinephrine at nerve endings and causes depletion of norepinephrine in peripheral sympathetic nerve terminals as well as in tissues. [NIH] Guanfacine: A centrally acting antihypertensive agent. The drug lowers both systolic and diastolic blood pressure by activating the central nervous system alpha-2 adrenoreceptors, which results in reduced sympathetic outflow leading to reduced vascular tone. Its adverse reactions include dry mouth, sedation, and constipation. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Mecamylamine: A nicotinic antagonist that is well absorbed from the gastrointestinal tract and crosses the blood-brain barrier. Mecamylamine has been used as a ganglionic blocker in treating hypertension, but, like most ganglionic blockers, is more often used now as a research tool. [NIH] Methyldopa: An alpha-2 adrenergic agonist that has both central and peripheral nervous system effects. Its primary clinical use is as an antihypertensive agent. Before its alpha-adrenergic actions became clear, methyldopa was thought to act by inhibiting decarboxylation of dopa leading to depletion of norepinephrine or by conversion to and release as the
Researching Your Medications 291
false transmitter alpha-methylnorepinephrine. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Rauwolfia Alkaloids: Alkaloids from Rauwolfia serpentina Benth and other species. The prototype is reserpine, which is a depleter of catecholamines and serotonin from the sympathetic postganglionic fibers and brain areas. They have been used in hypertension and psychoses despite their wide range of potentially adverse effects. [NIH] Reserpine: An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse effects limit its clinical use. [NIH] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH]
Researching Alternative Medicine 293
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to stroke. Finally, at the conclusion of this chapter, we will provide a list of readings on stroke from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?48 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 48
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?49 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
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Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.50
50
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Stroke Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for stroke. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “stroke” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
NIH Consensus Conference: Acupuncture Source: JAMA. Journal of the American Medical Association. 280(17): 1518-1524. November 4, 1998.
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Summary: This journal article presents the findings of the consensus conference on acupuncture, sponsored by the Office of Alternative Medicine and the Office of Medical Applications of Research, National Institutes of Health. The purpose of the conference was to provide clinicians, patients, and the general public with a reliable assessment of the use and effectiveness of acupuncture for a variety of conditions. A multidisciplinary panel evaluated evidence presented by experts and in the scientific literature, and developed a consensus statement addressing five issues: the efficacy of acupuncture compared with placebo or sham acupuncture, the place of acupuncture in clinical practice, the biological effects of acupuncture, the integration of acupuncture into the health care system, and directions for future research. The panel concluded that many of the efficacy studies of acupuncture provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls. However, promising results have emerged showing the efficacy of acupuncture for adult postoperative and chemotherapy nausea and vomiting, and in postoperative dental pain. In other conditions such as addiction, stroke rehabilitation, headache, menstrual cramps, fibromyalgia, myofascial pain, osteoarthritis, tennis elbow, low back pain, carpal tunnel syndrome, and asthma, acupuncture may be useful as an adjunct treatment, an acceptable alternative, or part of a comprehensive management plan. This article has 66 references. ·
Acupuncture: A Review of Its History, Theories, and Indications Source: Southern Medical Journal. 91(12): 1121-1125. December 1998. Summary: This journal article reviews the literature on the history, techniques, physiology, indications, adverse effects, and limitations of acupuncture. It describes six approaches to acupuncture that commonly are used in the United States: traditional Chinese medicine acupuncture, French energetics, Korean hand acupuncture, five element theory, auricular acupuncture, and myofascially-based acupuncture. It reviews neurophysiologic theories of the action of acupuncture; methodological difficulties in acupuncture research; and studies supporting the efficacy of acupuncture as a treatment for various pain syndromes, nausea, asthma, addiction, and stroke. It also identifies some of the adverse effects related to acupuncture which have been reported, and highlights studies suggesting that acupuncture may have only limited use. Finally, one of the authors describes his own personal and clinical experience with acupuncture. The article has 43 references.
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National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to stroke and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “stroke” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to stroke: ·
A framework for care during the stroke experience. Author(s): Brauer DJ, Schmidt BJ, Pearson V. Source: Rehabil Nurs. 2001 May-June; 26(3): 88-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12035694&dopt=Abstract
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A pilot study to investigate the combined use of botulinum neurotoxin type a and functional electrical stimulation, with physiotherapy, in the treatment of spastic dropped foot in subacute stroke. Author(s): Johnson CA, Wood DE, Swain ID, Tromans AM, Strike P, Burridge JH. Source: Artificial Organs. 2002 March; 26(3): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11940029&dopt=Abstract
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A preliminary investigation of Tanakan in the treatment of hypertensive arteriosclerosis and stroke in rats. Author(s): Fang Y, Huang R, Zhang Y, Lin J, Li J. Source: Chin Med J (Engl). 2000 May; 113(5): 425-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11776097&dopt=Abstract
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A randomized efficacy and feasibility study of imagery in acute stroke. Author(s): Page SJ, Levine P, Sisto S, Johnston MV. Source: Clinical Rehabilitation. 2001 June; 15(3): 233-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11386392&dopt=Abstract
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A randomized, controlled, a single-blind trial of supplementation after acute stroke. Author(s): Gariballa SE, Parker SG, Taub N, Castleden CM.
nutritional
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Source: Jpen J Parenter Enteral Nutr. 1998 September-October; 22(5): 3159. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9739036&dopt=Abstract ·
A systematic review of vinpocetine therapy in acute ischaemic stroke. Author(s): Bereczki D, Fekete I. Source: European Journal of Clinical Pharmacology. 1999 July; 55(5): 34952. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10456483&dopt=Abstract
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Activity, participation, and quality of life 6 months poststroke. Author(s): Mayo NE, Wood-Dauphinee S, Cote R, Durcan L, Carlton J. Source: Archives of Physical Medicine and Rehabilitation. 2002 August; 83(8): 1035-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12161823&dopt=Abstract
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Acupuncture and stroke rehabilitation. Author(s): Shiflett SC. Source: Stroke; a Journal of Cerebral Circulation. 2001 August; 32(8): 1934-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11486131&dopt=Abstract
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Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial. Author(s): Johansson BB, Haker E, von Arbin M, Britton M, Langstrom G, Terent A, Ursing D, Asplund K. Source: Stroke; a Journal of Cerebral Circulation. 2001 March; 32(3): 70713. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11239191&dopt=Abstract
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Acute traumatic stroke: a case of bow hunter's stroke in a child. Author(s): Duval EL, Van Coster R, Verstraeten K. Source: European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine. 1998 June; 5(2): 259-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9846257&dopt=Abstract
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Advances in the management of dysphagia caused by stroke. Author(s): Miller RM, Chang MW. Source: Phys Med Rehabil Clin N Am. 1999 November; 10(4): 925-41, X. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10573716&dopt=Abstract
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An observational study of the Stroke Association family support organizer service. Author(s): Harding J, Lincoln NB. Source: Clinical Rehabilitation. 2000 June; 14(3): 315-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10868727&dopt=Abstract
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Anti-hypercholesterolaemia, antioxidant activity and free radical scavenger effects of traditional Chinese medicine prescriptions used for stroke. Author(s): Lin CC, Yen FL, Hsu FF, Lin JM. Source: The Journal of Pharmacy and Pharmacology. 2000 November; 52(11): 1387-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11186247&dopt=Abstract
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Antioxidants prevent depletion of [Mg2+]i induced by alcohol in cultured canine cerebral vascular smooth muscle cells: possible relationship to alcohol-induced stroke. Author(s): Li W, Zheng T, Altura BT, Altura BM. Source: Brain Research Bulletin. 2001 July 1; 55(4): 475-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11543947&dopt=Abstract
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Antiphospholipid antibodies, ischemic stroke in young adults, and calcium supplementation: a hypothesis. Author(s): Newmark J, Newmark HL, Marden LA. Source: Mil Med. 2000 June; 165(6): 489-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10870370&dopt=Abstract
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Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Author(s): Geiger RA, Allen JB, O'Keefe J, Hicks RR.
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Source: Physical Therapy. 2001 April; 81(4): 995-1005. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11276182&dopt=Abstract ·
Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Author(s): Langhammer B, Stanghelle JK. Source: Clinical Rehabilitation. 2000 August; 14(4): 361-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10945420&dopt=Abstract
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Can pure oxygen prevent stroke damage? Author(s): Buchan AM. Source: Critical Care Medicine. 2000 August; 28(8): 3101-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10966313&dopt=Abstract
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Can the site of brain lesion predict improved motor function after lowTENS treatment on the post-stroke paretic arm? Author(s): Sonde L, Bronge L, Kalimo H, Viitanen M. Source: Clinical Rehabilitation. 2001 October; 15(5): 545-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11594644&dopt=Abstract
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Can we exploit event-related potentials for retraining language after stroke? Author(s): Cobianchi A, Giaquinto S. Source: Disability and Rehabilitation. 2000 June 15; 22(9): 427-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10894207&dopt=Abstract
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Caring and expressions of spirituality by urban caregivers of people with stroke in African American families. Author(s): Pierce LL. Source: Qualitative Health Research. 2001 May; 11(3): 339-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11339078&dopt=Abstract
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Caring for carers coping with stroke. Author(s): Exall K, Johnston H.
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Source: Nurs Times. 1999 March 17-23; 95(11): 50-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10349015&dopt=Abstract ·
Cerebral effects of a single dose of intravenous vinpocetine in chronic stroke patients: a PET study. Author(s): Szakall S, Boros I, Balkay L, Emri M, Fekete I, Kerenyi L, Lehel S, Marian T, Molnar T, Varga J, Galuska L, Tron L, Bereczki D, Csiba L, Gulyas B. Source: Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging. 1998 October; 8(4): 197-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9780850&dopt=Abstract
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Cervical manipulation and risk of stroke. Author(s): Kapral MK, Bondy SJ. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2001 October 2; 165(7): 907-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11599330&dopt=Abstract
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Chinese elderly patients' perceptions of their rehabilitation needs following a stroke. Author(s): Lui MH, MacKenzie AE. Source: Journal of Advanced Nursing. 1999 August; 30(2): 391-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10457241&dopt=Abstract
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Chiropractic manipulation and stroke. Author(s): Rosner AL. Source: Stroke; a Journal of Cerebral Circulation. 2001 September; 32(9): 2207-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11546921&dopt=Abstract
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Chiropractic manipulation and stroke: a population-based case-control study. Author(s): Rothwell DM, Bondy SJ, Williams JI.
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Source: Stroke; a Journal of Cerebral Circulation. 2001 May; 32(5): 105460. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11340209&dopt=Abstract ·
Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Author(s): Cauraugh J, Light K, Kim S, Thigpen M, Behrman A. Source: Stroke; a Journal of Cerebral Circulation. 2000 June; 31(6): 1360-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10835457&dopt=Abstract
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Chronotherapy with active vitamin D3 in aged stroke-prone spontaneously hypertensive rats, a model of osteoporosis. Author(s): Tsuruoka S, Nishiki K, Sugimoto K, Fujimura A. Source: European Journal of Pharmacology. 2001 October 5; 428(2): 28793. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11675047&dopt=Abstract
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Clinical trial of electrical acupuncture on hemiplegic stroke patients. Author(s): Wong AM, Su TY, Tang FT, Cheng PT, Liaw MY. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1999 March-April; 78(2): 117-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10088585&dopt=Abstract
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Comparison of the content of two physiotherapy approaches for stroke. Author(s): van Vliet PM, Lincoln NB, Robinson E. Source: Clinical Rehabilitation. 2001 August; 15(4): 398-414. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11518441&dopt=Abstract
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Continuity and discontinuity: the quality of life following stroke. Author(s): Secrest JA, Thomas SP. Source: Rehabil Nurs. 1999 November-December; 24(6): 240-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10754917&dopt=Abstract
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Dietary fiber, psyllium, attenuates salt-accelerated hypertension in stroke-prone spontaneously hypertensive rats. Author(s): Obata K, Ikeda K, Yamasaki M, Yamori Y.
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Source: Journal of Hypertension. 1998 December; 16(12 Pt 2): 1959-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9886883&dopt=Abstract ·
Differences in stroke subtypes among natives and caucasians in Boston and Buenos Aires. Author(s): Saposnik G, Caplan LR, Gonzalez LA, Baird A, Dashe J, Luraschi A, Llinas R, Lepera S, Linfante I, Chaves C, Kanis K, Sica RE, Rey RC. Source: Stroke; a Journal of Cerebral Circulation. 2000 October; 31(10): 2385-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11022068&dopt=Abstract
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Does acupuncture have additional value to standard poststroke motor rehabilitation? Author(s): Sze FK, Wong E, Yi X, Woo J. Source: Stroke; a Journal of Cerebral Circulation. 2002 January; 33(1): 18694. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11779909&dopt=Abstract
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Effect of ipriflavone on bone in elderly hemiplegic stroke patients with hypovitaminosis D. Author(s): Sato Y, Kuno H, Kaji M, Saruwatari N, Oizumi K. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1999 September-October; 78(5): 457-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10493456&dopt=Abstract
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Effect of perindopril on cerebral and renal perfusion in stroke patients with carotid disease. Author(s): Walters MR, Bolster A, Dyker AG, Lees KR. Source: Stroke; a Journal of Cerebral Circulation. 2001 February; 32(2): 473-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11157185&dopt=Abstract
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Effect of transcutaneous electrical nerve stimulation (TENS) on Barthel Activities of Daily Living (ADL) index score following stroke. Author(s): Tekeoglu Y, Adak B, Goksoy T.
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Source: Clinical Rehabilitation. 1998 August; 12(4): 277-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9744663&dopt=Abstract ·
Effectiveness of acupuncture for stroke: a systematic review. Author(s): Park J, Hopwood V, White AR, Ernst E. Source: Journal of Neurology. 2001 July; 248(7): 558-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11517996&dopt=Abstract
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Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients. Author(s): Gosman-Hedstrom G, Claesson L, Klingenstierna U, Carlsson J, Olausson B, Frizell M, Fagerberg B, Blomstrand C. Source: Stroke; a Journal of Cerebral Circulation. 1998 October; 29(10): 2100-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9756589&dopt=Abstract
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Effects of ashwagandha in a rat model of stroke. Author(s): Adams JD Jr, Yang J, Mishra LC, Singh BB. Source: Alternative Therapies in Health and Medicine. 2002 SeptemberOctober; 8(5): 18-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12233797&dopt=Abstract
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Effects of Choto-san on hemorheological factors and vascular function in stroke-prone spontaneously hypertensive rats. Author(s): Yang Q, Goto H, Shimada Y, Kita T, Shibahara N, Terasawa K. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 March; 9(2): 93-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11995955&dopt=Abstract
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Effects of guggul in a rat model of stroke. Author(s): Adams JD Jr, Klaidman LK, Mishra L, Singh BB. Source: Alternative Therapies in Health and Medicine. 2002 July-August; 8(4): 20-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12126167&dopt=Abstract
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Electrical stimulation for preventing and treating post-stroke shoulder pain. Author(s): Price CI, Pandyan AD. Source: Cochrane Database Syst Rev. 2000; (4): Cd001698. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11034725&dopt=Abstract
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Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review. Author(s): Price CI, Pandyan AD. Source: Clinical Rehabilitation. 2001 February; 15(1): 5-19. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11237161&dopt=Abstract
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Electromyographic (EMG) biofeedback in the comprehensive treatment of central pain and ataxic tremor following thalamic stroke. Author(s): Edwards CL, Sudhakar S, Scales MT, Applegate KL, Webster W, Dunn RH. Source: Applied Psychophysiology and Biofeedback. 2000 December; 25(4): 229-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11218924&dopt=Abstract
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Evaluation of the volunteer stroke service in Scotland. Author(s): Smith RG, McLeod I, Clark DH. Source: Health Bull (Edinb). 1997 September; 55(5): 285-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11769105&dopt=Abstract
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Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients: a review. Author(s): Woldag H, Hummelsheim H. Source: Journal of Neurology. 2002 May; 249(5): 518-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12021939&dopt=Abstract
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Fatal heatstroke in a young woman with previously undiagnosed Hashimoto's thyroiditis. Author(s): Siegler RW.
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Source: J Forensic Sci. 1998 November; 43(6): 1237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9846404&dopt=Abstract ·
Financial analysis of chronic transfusion for stroke prevention in sickle cell disease. Author(s): Wayne AS, Schoenike SE, Pegelow CH. Source: Blood. 2000 October 1; 96(7): 2369-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11001885&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to Stroke; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:
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·
General Overview Stroke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Stroke.htm Stroke Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/ stroke.html Stroke Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stro kecc.html Stroke, Transient Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Stro keTransientcc.html
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Alternative Therapy Acupuncture Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Acu puncturecm.html Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 663,00.html
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Biofeedback Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 675,00.html Chelation therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 679,00.html Chiropractic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Chir opracticcm.html Dance therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 687,00.html Feldenkrais Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 695,00.html Hemi-Sync Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Massage therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 716,00.html
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Music therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 719,00.html Traditional Chinese medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10085,00.html ·
Chinese Medicine Anxixiang Alternative names: Benzoin; Anxixiang (An Xi Xiang); Benzoinum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Baifuzi Alternative names: Giant Typhonium Rhizome; Rhizoma Typhonii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Bingpian Alternative names: Borneol; Bingpian (Bing Pi An); Borneolum Syntheticum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Chansu Alternative names: Toad Venom; Venenum Bufonis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Dannanxing Alternative names: Bile Arisaema; Dannanxing (Dan Nan Xing); Arisaema Cum Bile Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
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Fuzi Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Hongling San Alternative names: Hongling Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Hongling%20Sa n&mh=10&sb=---&view_records=View+Records Jixuecao Alternative names: Asiatic Pennywort Herb; Herba Centellae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Niuhuang Alternative names: Cow-bezoar; Calculus Bovis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Qishe Alternative names: Long-noded Pit Viper; Qishe (Qi She); Agkistrodon Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shexiang Alternative names: Musk; Moschus Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shixiang Fansheng Wan Alternative names: Shixiang Fansheng Pills; Shixiang Fansheng Wan (Shi Xiang Fan Sheng Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shixiang%20Fan sheng%20Wan&mh=10&sb=---&view_records=View+Records
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Suhexiang Alternative names: Storax; Styrax Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Suhexiang Wan Alternative names: Suhexiang Pills; Suhexiang Wan
(Su He Xiang Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Suhexiang%20 Wan&mh=10&sb=---&view_records=View+Records Tiannanxing Alternative names: Jackinthepulpit Tuber; Rhizoma Arisaematis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Wushaoshe Alternative names: Black-tail Snake; Zaocys Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhuru Alternative names: Bamboo Shavings; Caulis Bambusae in Taeniam Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhuyazao Alternative names: Chinese Honeylocust Abnormal Fruit; Fructus Gleditsiae Abnormalis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ ·
Herbs and Supplements ALA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Al phaLinolenicAcidALAcs.html
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Allium sativum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Garlicch. html Alpha-Linolenic Acid (ALA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Al phaLinolenicAcidALAcs.html Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Al phaLipoicAcidcs.html Alpha-lipoic acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10002,00.html Amino acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10003,00.html Angelica sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQu aich.html
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Antioxidants Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10004,00.html Aortic Glycosaminoglycans Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000096.html Aspirin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Aspirin.htm Astragalus mem Alternative names: Huang-Qi; Astragalus membranaceus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Beta-Carotene Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000104.html Beta-carotene Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10103,00.html Betaine Alternative names: Trimethylglycine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Be tainecs.html
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Brewer's Yeast Alternative names: Nutritional Yeast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br ewersYeastcs.html Brewer's Yeast Alternative names: Nutritional Yeast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/BrewersYeastcs.html Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GreenTe ach.html Chamomile, German Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileGermanch.html Chinese Angelica Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQu aich.html Clopidogrel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Clopidogrel.htm
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Coenzyme Q Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 768,00.html Coleus Alternative names: Coleus forskohlii Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Coleus.htm Corydalis Alternative names: Corydalis turtschaninovii, Corydalis yanhusuo Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Corydalis.htm Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQu aich.html Dehydroepiandrosterone (DHEA) Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DHEA.htm Dipyridamole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Dipyridamole.htm
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Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQu aich.html Ephedra (Ma huang) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 777,00.html Fennel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Fennel.htm Fiber Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Fi bercs.html Flavonoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 782,00.html German Chamomile Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileGermanch.html
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Ginkgo Alternative names: Ginkgo biloba Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Ginkgo Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsg-i.htm Ginkgo biloba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 788,00.html Grape seed extract Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 793,00.html Green Tea Alternative names: Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GreenTe ach.html Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 798,00.html Matricaria recutita Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileGermanch.html
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Melatonin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 804,00.html Methionine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Methionine.htm Nonsteroidal Anti-Inflammatory Drugs Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000310.html Phenylpropanolamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Phenylpropanolamin e.htm Phosphatidylserine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000222.html Phosphatidylserine (PS) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 813,00.html SAMe (S-adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 818,00.html Siberian ginseng Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 821,00.html
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Tang Kuei Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/DongQu aich.html Taurine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000196.html Thiazide Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Thiazide_Diuretics.ht m Ticlopidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ticlopidine.htm Tocotrienols Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Tocotrienols.htm Trimethylglycine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Be tainecs.html Warfarin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Warfarin.htm
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative and Complementary Treatment in Neurologic Illness by Michael I. Weintraub (Editor); Paperback - 288 pages (March 23, 2001), Churchill Livingstone; ISBN: 0443065586; http://www.amazon.com/exec/obidos/ASIN/0443065586/icongroupinterna · Radical Healing: Integrating the World’s Great Therapeutic Traditions to Create a New Transformative Medicine by Rudolph Ballentine, M.D., Linda Funk (Illustrator); Paperback - 612 pages; Reprint edition (March 14, 2000), Three Rivers Press; ISBN: 0609804847; http://www.amazon.com/exec/obidos/ASIN/0609804847/icongroupinterna · The Review of Natural Products by Facts and Comparisons (Editor); CdRom edition (January 2002), Facts & Comparisons; ISBN: 1574391453; http://www.amazon.com/exec/obidos/ASIN/1574391453/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium
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of the heart. [EU] Benzoin: A white crystalline compound prepared by condensation of benzaldehyde in potassium cyanide and used in organic syntheses. [NIH] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an Nacetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3linkages consisting of either N-acetylglucosamine or N-acetylgalactosamine. [NIH]
Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after
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prolonged activity. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Thrombocytosis: Increased numbers of platelets in the peripheral blood. [EU] Urinary: Pertaining to the urine; containing or secreting urine. [EU]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with stroke. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with stroke may be given different recommendations. Some recommendations may be directly related to stroke, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of stroke. We will then show you how to find studies dedicated specifically to nutrition and stroke.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:51 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
51
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
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RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?52
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”53 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.54 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 53 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 54 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 52
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the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Stroke The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.55 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
55
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periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “stroke” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on stroke: ·
Alcohol and ischemic stroke. Author(s): University Hospital, Medical Policlinic, Zurich, Switzerland. Source: Suter, P M Vetter, W Nutr-Revolume 1999 October; 57(10): 310-4 0029-6643
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Better stroke prevention. Source: Ornato, J P Health-News. 2001 April; 7(4): 1-2 1081-5880
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Block a stroke with better nutrition. Source: Mihalik, M. Prevention (USA). (August 1987). volume 39(8) page 24-28. fruits diet potassium circulatory disorders mortality prevention vegetables 0032-8006
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Effect of vitamin E, vitamin C, and beta-carotene on stroke risk. Author(s): Medical Policlinic, University Hospital, Zurich, Switzerland. Source: Suter, P M Nutr-Revolume 2000 June; 58(6): 184-7 0029-6643
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Fruits and vegetables and the risk of stroke. Source: Feldman, E B Nutr-Revolume 2001 January; 59(1 Pt 1): 24-7 00296643
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Getting enough calcium may reduce stroke risk in women. Source: Anonymous Mayo-Clin-Health-Lett. 2000 January; 18(1): 4 07416245
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Heart lines. But...vitamin supplements do not reduce stroke risk. Source: Anonymous Harv-Heart-Lett. 1999 September; 10(1): 7 1051-5313
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I am undergoing treatment for hypertension and have been taking 200 mg of vitamin E daily for the past few years. I read that even lower doses might raise my risk of having a hemorrhagic stroke. Is this true? Source: Goldfinger, S E Harv-Health-Lett. 1999 January; 24(3): 3 10521577
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Male pattern obesity as a risk predictor for coronary heart disease, stroke and death. Source: Nutrition-reviews (USA). (February 1985). volume 43(2) page 4446. heart diseases overweight risk forecasting circulatory disorders mortality 0029-6643
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Stroke. Preemptive strikes. Source: Anonymous Harv-Health-Lett. 2000 April; 25(6): 1-3 1052-1577
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The effects of potassium, magnesium, calcium, and fiber on risk of stroke. Author(s): Medical Policlinic, University Hospital, Zurich, Switzerland. Source: Suter, P M Nutr-Revolume 1999 March; 57(3): 84-8 0029-6643
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The influence of aging and nutrition on the occurrence of cerebrovascular diseases. Author(s): National Cardiovascular Center, Osaka, Japan Source: Sawada, T. Nutrition-reviews (USA). (December 1992). volume 50(12) page 413-418. japan diet aging circulatory disorders 0029-6643
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Whole grain intake and risk of ischemic stroke in women. Author(s): Epidemiology Program, Jean Mayer USDA Human Nutrition Research Center at Tufts University, Boston, MA 02111, USA. Source: McKeown, N M Jacques, P Nutr-Revolume 2001 May; 59(5): 14952 0029-6643
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Whole grains cut stroke risk. Source: Anonymous Health-News. 2000 November; 6(11): 5 1081-5880
The following information is typical of that found when using the “Full IBIDS Database” when searching using “stroke” (or a synonym): ·
Acute stroke management in the local general hospital. Author(s): Department of Neurology, Friedrich-Alexander Universitaet Erlangen-Nurnberg, Erlangen, Germany.
[email protected] Source: Handschu, R Garling, A Heuschmann, P U Kolominsky Rabas, P L Erbguth, F Neundorfer, B Stroke. 2001 April; 32(4): 866-70 1524-4628
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Alcohol, stroke and coronary heart disease. Are there anti-oxidants and pro-oxidants in alcoholic beverages that might influence the development of atherosclerotic cardiovascular disease? Author(s): Department of Medicine and Western Australian Heart Research Institute, University of Western Australia, Perth, Australia.
[email protected] Source: Puddey, I B Croft, K D Neuroepidemiology. 1999; 18(6): 292-302 0251-5350
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Atrial fibrillation, anticoagulation, and stroke. Author(s): Division of Cardiovascular Diseases, Lankenau Hospital and Medical Research Center, Wynnewood, Pennsylvania 19096, USA. Source: Morley, J Marinchak, R Rials, S J Kowey, P Am-J-Cardiol. 1996 January 25; 77(3): 38A-44A 0002-9149
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Calcium antagonists for acute ischemic stroke. Author(s): Dept of Neurology, Academical Medical Center, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ.
[email protected] Source: Horn, J Limburg, M Cochrane-Database-Syst-Revolume 2000; (2): CD001928 1469-493X
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Cobalt-55 positron emission tomography in recurrent ischaemic stroke. Author(s): PET Centre UZ/RUG, University Hospital, Gent, Belgium.
[email protected] Source: De Reuck, J Santens, P Keppens, J De Bleecker, J Strijckmans, K Goethals, P Lemahieu, I Korf, J Clin-Neurol-Neurosurg. 1999 March; 101(1): 15-8 0303-8467
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Gene-environment interaction in hypertension, stroke and atherosclerosis in experimental models and supportive findings from a world-wide cross-sectional epidemiological survey: a WHO-cardiac study. Author(s): WHO Collaborating Center for Research on Primary Prevention of Cardiovascular Diseases, Izumo, Japan. Source: Yamori, Y Nara, Y Mizushima, S Murakami, S Ikeda, K Sawamura, M Nabika, T Horie, R Clin-Exp-Pharmacol-Physiol-Suppl. 1992; 2043-52 0143-9294
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Genetics of stroke in rats. Source: Kolchinsky, A Surg-Neurol. 1999 July; 52(1): 17-8 0090-3019
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Getting enough calcium may reduce stroke risk in women. Source: Anonymous Mayo-Clin-Health-Lett. 2000 January; 18(1): 4 07416245
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Glucose and insulin therapy in acute stroke; why delay further? Author(s): Department of Geriatric Medicine, Medical School, University of Newcastle, Newcastle upon Tyne, UK. Source: Scott, J F Gray, C S O'Connell, J E Alberti, K G QJM. 1998 July; 91(7): 511-5 1460-2725
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Interventions for deliberately altering blood pressure in acute stroke. Blood pressure in Acute Stroke Collaboration (BASC). Author(s): Division of Stroke Medicine, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, Nottinghamshire, UK, NG5 1PB.
[email protected] Source: Anonymous Cochrane-Database-Syst-Revolume 2000; (2): CD000039 1469-493X
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Prostacyclin and analogues for acute ischaemic stroke. Author(s): Division of Stroke Medicine, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, Nottinghamshire, UK, NG5 1PB.
[email protected]
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Source: Bath, P M Bath, F J Cochrane-Database-Syst-Revolume 2000; (2): CD000177 1469-493X ·
Role of insulin resistance associated with compensatory hyperinsulinemia in ischemic stroke. Author(s): Division of Atherosclerosis, Metabolism, and Clinical Nutrition, National Cardiovascular Center, Osaka, Japan. Source: Shinozaki, K Naritomi, H Shimizu, T Suzuki, M Ikebuchi, M Sawada, T Harano, Y Stroke. 1996 January; 27(1): 37-43 0039-2499
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to Stroke; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Folic_Acid.htm Folic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB9FolicAcidcs.html Folic acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 887,00.html
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Riboflavin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB2Riboflavincs.html Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B12.htm Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB2Riboflavincs.html Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B6.htm Vitamin B9 (Folic Acid) Alternative names: Folate, Folic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB9FolicAcidcs.html Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_E.htm
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Vitamin E Alternative names: Alpha-Tocopherol, Beta-Tocopherol, D-AlphaTocopherol, Delta-Tocopherol, Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Vitamin E Alternative names: Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminEcs.html Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html Vitamin E Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 906,00.html ·
Minerals Alpha-Tocopherol Alternative names: Vitamin E Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminEcs.html Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html
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Beta-Tocopherol Alternative names: Vitamin E Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminEcs.html Beta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Chromium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C hromiumcs.html Creatine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Creatinecs.html Creatine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Cr eatinecs.html D-Alpha-Tocopherol Alternative names: Vitamin E Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminEcs.html
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D-Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Delta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Delta-Tocopherol Alternative names: Vitamin E Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminEcs.html Folate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB9FolicAcidcs.html Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Gamma-Tocopherol Alternative names: Vitamin E Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminEcs.html
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Lecithin and choline Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10040,00.html Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Magnesium.htm Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/M agnesiumcs.html Magnesium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000202.html Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 890,00.html Phosphocreatine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Cr eatinecs.html Phosphocreatine Alternative names: Creatine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Creatinecs.html
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Potassium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Potassium.htm Potassium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/P otassiumcs.html Potassium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10086,00.html Quercetin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000226.html Selenium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Se leniumcs.html Selenium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10055,00.html Vinpocetine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10065,00.html
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·
Food and Diet Artichoke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Artichoke.htm Avocado Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Avocado.htm Beets Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Beets.htm Bluefish Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Bluefish.htm Bok Choy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Bok_Choy.ht m Broccoli Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Broccoli.htm Brussels Sprouts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Brussels_Spro uts.htm Cabbage Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cabbage.htm
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Cauliflower Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cauliflower.ht m Chicory Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Chicory.htm Cod Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cod.htm Collards Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Collards.htm Dandelion Greens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Dandelion_Gr eens.htm Garlic Alternative names: Allium sativum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Garlicch. html Garlic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000164.html Hypertension Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypertension.htm
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Jerusalem Artichoke Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Jerusalem_Art ichoke.htm Kohlrabi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kohlrabi.htm Kombu Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kombu.htm Mullet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Mullet.htm Mustard Greens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Mustard_Gree ns.htm Nutritional Yeast Alternative names: Brewer's Yeast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/BrewersYeastcs.html Nutritional Yeast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br ewersYeastcs.html
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Omega-3 fatty acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 992,00.html Omega-6 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/O mega6FattyAcidscs.html Parsnips Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Parsnips.htm Perch Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Perch.htm Pike Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Pike.htm Porcini Mushrooms Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Porcini_Mush rooms.htm Radishes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Radishes.htm Rockfish Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Rockfish.htm
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Romaine Lettuce Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Romaine_Lett uce.htm Rutabagas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Rutabagas.htm Tilefish Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Tilefish.htm Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Water.htm Winter Squash Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Winter_Squas h.htm Yams Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Yams.htm
Vocabulary Builder Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU]
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Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cobalt: A trace element that is a component of vitamin B12. It has the atomic symbol Co, atomic number 27, and atomic weight 58.93. It is used in nuclear weapons, alloys, and pigments. Deficiency in animals leads to anemia; its excess in humans can lead to erythrocytosis. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Intestinal: Pertaining to the intestine. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 351
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.56
56
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):57 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
57
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
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·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
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·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 359
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with stroke faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.58 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
58Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
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Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
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Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
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Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
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plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
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Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
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Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
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Discuss all current treatments a consumer may be undergoing.
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Discuss all risks, nontreatment.
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Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
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Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
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Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
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Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 363
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.59
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”60 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 60 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 59
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
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Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
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Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
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Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.61 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.62 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 62 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 61
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3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
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contact information on how to find more in-depth information about Medicaid.63
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 369
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.64 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:65 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
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Your Rights and Insurance 371
Vocabulary Builder Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Audiometry: The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Cardiogenic: Originating in the heart; caused by abnormal function of the heart. [EU] Cerebral Angiography: Radiography of the vascular system of the brain after injection of a contrast medium. [NIH] Comatose: Pertaining to or affected with coma. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the
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choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU]
Online Glossaries 373
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to stroke and keep them on file. The NIH, in particular, suggests that patients with stroke visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Stroke Arrhythmias Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001101.htm Atherosclerosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000171.htm Stroke Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000726.htm Stroke secondary to atherosclerosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000738.htm Stroke secondary to cardiogenic embolism Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000735.htm Stroke secondary to carotid dissection Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000732.htm Stroke secondary to carotid stenosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000751.htm Stroke secondary to cocaine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000743.htm Stroke secondary to FMD Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001400.htm Stroke secondary to syphilis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000728.htm
Online Glossaries 375
·
Signs & Symptoms for Stroke Abnormal lack of sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003219.htm Abnormal sensations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Agitated Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Apathy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Aphasia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003204.htm Arrhythmia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm Behavior, unusual or strange Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003255.htm Changes in vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Coma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm
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Comatose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Consciousness changes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Contractures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003185.htm Decreased sensation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Decreased vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Drooling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003048.htm Drooping of one eyelid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003035.htm Eye lid drooping Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003035.htm Eye movements, uncontrollable Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003037.htm
Online Glossaries 377
Eyelid drooping Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003035.htm Facial pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003027.htm Facial paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003028.htm Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Headaches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm High blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003082.htm Hoarseness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003054.htm Inability to sleep Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003210.htm
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Inability to speak Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003204.htm Incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Leg pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003182.htm Lethargic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Loss of coordination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003198.htm Loss of memory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003257.htm Loss of movement Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Loss of sensation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Movement, dysfunctional Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003203.htm Movement, uncontrollable Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003201.htm
Online Glossaries 379
Movement, unpredictable - jerky Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003196.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle spasticity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Neck pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003025.htm Nosebleeds Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003106.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Restlessness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm
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Seizures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Sleepy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Splinter hemorrhages Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003283.htm Stuporous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Swallowing difficulties Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003115.htm Sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Tinnitus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003043.htm Tongue problems Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003047.htm Vertigo Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm
Online Glossaries 381
Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm ·
Diagnostics and Tests for Stroke ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm Angiography of the head Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003799.htm Audiometry Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003341.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm Carotid duplex Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003774.htm Cerebral angiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003799.htm Cholesterol levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003492.htm Cocaine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003578.htm
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CPK isoenzymes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003504.htm CSF (cerebrospinal fluid) examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003625.htm CSF collection Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003428.htm CSF VDRL test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003623.htm CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm Dialysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003421.htm Dopamine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003561.htm Doppler ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003775.htm Duplex/Doppler ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003442.htm ECG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm
Online Glossaries 383
Echocardiogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm Electrocardiogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Evoked response audiometry Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003926.htm Head CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003786.htm Head CT scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003786.htm Head MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003791.htm Head MRI scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003791.htm LDH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003471.htm LDH isoenzymes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003499.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm
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MRI of head Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003791.htm Osmolality Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003463.htm Platelet aggregation test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003669.htm Platelets Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003647.htm Pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm Serum (blood) VDRL Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003515.htm Serum lipids Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003491.htm Toxicology screen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003578.htm Triglycerides Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003493.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm
Online Glossaries 385
Visual field Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003879.htm Visual fields Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003879.htm ·
Nutrition for Stroke Cholesterol Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002472.htm Fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Fats Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Lipids Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Saturated fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm
·
Surgery and Procedures for Stroke Carotid endarterectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002951.htm Gastrostomy tube Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002937.htm
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Valve replacement Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002954.htm ·
Background Topics for Stroke Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Aspiration Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002216.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Blood clot Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Blood clots Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Cardiovascular Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002310.htm Central nervous system Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002311.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm
Online Glossaries 387
Clot Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Contraindications Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002314.htm Emboli Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Embolism Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Embolus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Fractures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm Heart disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000147.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm
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Kidney disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000457.htm Neurologic deficit Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002267.htm Peripheral Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002273.htm Power of attorney Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001908.htm Renal Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002289.htm Retina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002291.htm Safety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001931.htm Smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm Stimuli Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002309.htm Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm
Online Glossaries 389
Thrombus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Unconscious Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000022.htm Vasoconstriction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002338.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 391
STROKE GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Agnosia: Loss of the ability to comprehend the meaning or recognize the importance of various forms of stimulation that cannot be attributed to impairment of a primary sensory modality. Tactile agnosia is characterized by an inability to perceive the shape and nature of an object by touch alone, despite unimpaired sensation to light touch, position, and other primary sensory modalities. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU]
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Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anoxia: A total lack of oxygen; often used interchangeably with hypoxia to mean a reduced supply of oxygen to the tissues. [EU] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU]
Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins,
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etc. [EU] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antiepileptic: An agent that combats epilepsy. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Aphasia: Defect or loss of the power of expression by speech, writing, or signs, or of comprehending spoken or written language, due to injury or disease of the brain centres. [EU] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriography: Roentgenography of arteries after injection of radiopacque material into the blood stream. [EU] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Asparaginase: A hydrolase enzyme that converts L-asparagine and water to L-aspartate and NH3. EC 3.5.1.1. [NIH] Aspiration: The act of inhaling. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atrial: Pertaining to an atrium. [EU]
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Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Audiometry: The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Autopsy: Postmortem examination of the body. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Beauty: Characteristics or attributes of persons or things which elicit pleasurable feelings. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any H-isomer. [NIH] Benzoin: A white crystalline compound prepared by condensation of benzaldehyde in potassium cyanide and used in organic syntheses. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bilateral: Having two sides, or pertaining to both sides. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Botulinum Toxin Type A: A neurotoxin produced by Clostridium botulinum. When consumed in contaminated food it can cause paralysis and death. In its purified form, it has been used in the treatment of blepharospasm and strabismus. [NIH] Bradykinesia: Abnormal slowness of movement; sluggishness of physical and mental responses. [EU] Bronchitis: Inflammation of one or more bronchi. [EU]
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Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Calcification: The process by which organic tissue becomes hardened by a deposit of calcium salts within its substance. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiac: Pertaining to the heart. [EU] Cardiogenic: Originating in the heart; caused by abnormal function of the heart. [EU] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]
Caspases: A family of intracellular cysteine endopeptidases. They play a key role in inflammation and mammalian apoptosis. They are specific for aspartic acid at the P1 position. They are divided into two classes based on the lengths of their N-terminal prodomains. Caspases-1,-2,-4,-5,-8, and -10 have long prodomains and -3,-6,-7,-9 have short prodomains. EC 3.4.22.-. [NIH]
Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Causal: Pertaining to a cause; directed against a cause. [EU]
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Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Angiography: Radiography of the vascular system of the brain after injection of a contrast medium. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]
Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chronic: Persisting over a long period of time. [EU] Coagulation: 1. the process of clot formation. 2. in colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. in surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cobalt: A trace element that is a component of vitamin B12. It has the atomic symbol Co, atomic number 27, and atomic weight 58.93. It is used in nuclear weapons, alloys, and pigments. Deficiency in animals leads to anemia; its excess in humans can lead to erythrocytosis. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is
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thought to involve inhibition of dopamine uptake. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Collapse: 1. a state of extreme prostration and depression, with failure of circulation. 2. abnormal falling in of the walls of any part of organ. [EU] Comatose: Pertaining to or affected with coma. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constriction: The act of constricting. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: The prevention of conception or impregnation. [EU] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH] Criterion: A standard by which something may be judged. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH]
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Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Dantrolene: Skeletal muscle relaxant that acts by interfering with excitationcontraction coupling in the muscle fiber. It is used in spasticity and other neuromuscular abnormalities. Although the mechanism of action is probably not central, dantrolene is usually grouped with the central muscle relaxants. [NIH]
Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act
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directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Dreams: A series of thoughts, images, or emotions occurring during sleep which are dissociated from the usual stream of consciousness of the waking state. [NIH] Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Electrocardiography: The making of graphic records of the variations in electrical potential caused by electrical activity of the heart muscle and detected at the body surface, as a method for studying the action of the heart muscle. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly
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involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH]
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Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter. [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gadolinium: Gadolinium. An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Gait: Manner or style of walking. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestures: Movement of a part of the body for the purpose of communication. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an Nacetylated hexosamine in a characteristic repeating disaccharide unit. The
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repeating structure of each disaccharide involves alternate 1,4- and 1,3linkages consisting of either N-acetylglucosamine or N-acetylgalactosamine. [NIH]
Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH] Guanethidine: An antihypertensive agent that acts by inhibiting selectively transmission in post-ganglionic adrenergic nerves. It is believed to act mainly by preventing the release of norepinephrine at nerve endings and causes depletion of norepinephrine in peripheral sympathetic nerve terminals as well as in tissues. [NIH] Guanfacine: A centrally acting antihypertensive agent. The drug lowers both systolic and diastolic blood pressure by activating the central nervous system alpha-2 adrenoreceptors, which results in reduced sympathetic outflow leading to reduced vascular tone. Its adverse reactions include dry mouth, sedation, and constipation. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematoma: tissue. [NIH]
An extravasation of blood localized in an organ, space, or
Hemiplegia: Paralysis of one side of the body. [EU] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatitis: Inflammation of the liver. [EU] Herpes:
Any inflammatory skin disease caused by a herpesvirus and
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characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpesviridae: A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. There are three subfamilies based on biological characteristics: alphaherpesvirinae, betaherpesvirinae, and gammaherpesvirinae. [NIH] Hibernation: The dormant state in which some animal species pass the winter. It is characterized by narcosis and by sharp reduction in body temperature and metabolic activity and by a depression of vital signs. It is a natural physiological process in many warm-blooded animals. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Hobbies: Leisure activities engaged in for pleasure. [NIH] Homicide: The killing of one person by another. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hospices: Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family. [NIH] Hydrocephalus: A condition marked by dilatation of the cerebral ventricles, most often occurring secondarily to obstruction of the cerebrospinal fluid pathways, and accompanied by an accumulation of cerebrospinal fluid within the skull; the fluid is usually under increased pressure, but occasionally may be normal or nearly so. It is typically characterized by enlargement of the head, prominence of the forehead, brain atrophy, mental deterioration, and convulsions; may be congenital or acquired; and may be of sudden onset (acute h.) or be slowly progressive (chronic or primary b.). [EU]
Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH]
Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.)
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or be associated with other primary diseases (secondary h.). [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypovitaminosis: A condition due to a deficiency of one or more essential vitamins. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunization: The induction of immunity. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infertility:
The diminished or absent ability to conceive or produce an
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offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interindividual: Occurring between two or more individuals. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestinal: Pertaining to the intestine. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Kinetic: Pertaining to or producing motion. [EU] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH]
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Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Livedo: A discoloured spot or patch on the skin, commonly due to passive congestion; commonly used alone to refer to l. reticularis. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of
Glossary 407
tumours. [EU] Mecamylamine: A nicotinic antagonist that is well absorbed from the gastrointestinal tract and crosses the blood-brain barrier. Mecamylamine has been used as a ganglionic blocker in treating hypertension, but, like most ganglionic blockers, is more often used now as a research tool. [NIH] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methyldopa: An alpha-2 adrenergic agonist that has both central and peripheral nervous system effects. Its primary clinical use is as an antihypertensive agent. Before its alpha-adrenergic actions became clear, methyldopa was thought to act by inhibiting decarboxylation of dopa leading to depletion of norepinephrine or by conversion to and release as the false transmitter alpha-methylnorepinephrine. [NIH] Mime: Facial expression. (NOT: mimicry = adaptation for survival in which an organism takes on the semblance another organism or a non-living object.) [EU] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH]
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Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Nephropathy: Disease of the kidneys. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at
Glossary 409
nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nimodipine: A calcium channel blockader with preferential cerebrovascular activity. It has marked cerebrovascular dilating effects and lowers blood pressure. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Orofacial: Of or relating to the mouth and face. [EU] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Paraplegia: Paralysis of the legs and lower part of the body. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular,
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intraspinal, intrasternal, intravenous, etc. [EU] Parietal: 1. of or pertaining to the walls of a cavity. 2. pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perindopril: An angiotensin-converting enzyme inhibitor. It is used in patients with hypertension and heart failure. [NIH] Phagocytosis: Endocytosis of particulate material, such as microorganisms or cell fragments. The material is taken into the cell in membrane-bound vesicles (phagosomes) that originate as pinched off invaginations of the plasma membrane. Phagosomes fuse with lysosomes, forming phagolysosomes in which the engulfed material is killed and digested. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Plasminogen: The inactive precursor of plasmin (=enzyme that catalyses the hydrolysis of peptide bonds at the carbonyl end of lysine or arginine residues). [EU] Pneumonia: Inflammation of the lungs with consolidation. [EU] Postmenopausal: Occurring after the menopause. [EU] Postmenopause: The physiological period following the menopause, the permanent cessation of the menstrual life. Since in the United States the age of the menopause ranges between 48 and 55 years, generally conceived as middle age, the postmenopause often refers to women considerably older. [NIH]
Postoperative: Occurring after a surgical operation. [EU] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of
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heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Prothrombin: Factor II. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures
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the descending cortico-spinal and cortico-bulbar tracts. Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alpha-adrenergic neurotransmission. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]
Rauwolfia Alkaloids: Alkaloids from Rauwolfia serpentina Benth and other species. The prototype is reserpine, which is a depleter of catecholamines and serotonin from the sympathetic postganglionic fibers and brain areas. They have been used in hypertension and psychoses despite their wide range of potentially adverse effects. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH]
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Reserpine: An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse effects limit its clinical use. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU]
Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rhizopus: A genus of zygomycetous fungi of the family Mucoraceae, order mucorales, a common saprophyte and facultative parasite of mature fruits and vegetables. It may cause cerebral mycoses in diabetes and cutaneous infection in severely burned patients. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Salicylates: The salts, esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and antiinflammatory activities by inhibiting prostaglandin synthesis. [NIH] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH]
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Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Shame: An emotional attitude excited by realization of a shortcoming or impropriety. [NIH] Shunt: 1. to turn to one side; to divert; to bypass. 2. a passage or anastomosis between two natural channels, especially between blood vessels. Such structures may be formed physiologically (e.g. to bypass a thrombosis) or they may be structural anomalies. 3. a surgically created anastomosis; also, the operation of forming a shunt. [EU] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sotalol: An adrenergic beta-antagonist that is used in the treatment of lifethreatening arrhythmias. [NIH] Spastic: 1. of the nature of or characterized by spasms. 2. hypertonic, so that the muscles are stiff and the movements awkward. 3. a person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH]
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Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Thalamus: Either of two large, ovoid masses, consisting chiefly of grey substance, situated one on each side of and forming part of the lateral wall of the third ventricle. It is divided into two major parts : dorsal and ventral, each of which contains many nuclei. [EU] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermoregulation: Heat regulation. [EU] Thrombocytosis: Increased numbers of platelets in the peripheral blood. [EU] Thromboembolism: Obstruction of a blood vessel with thrombotic material carried by the blood stream from the site of origin to plug another vessel. [EU] Thrombolytic: 1. dissolving or splitting up a thrombus. 2. a thrombolytic
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agent. [EU] Thrombophlebitis: formation. [EU]
Inflammation of a vein associated with thrombus
Thrombosis: The formation, development, or presence of a thrombus. [EU] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Ticlopidine: Ticlopidine is an effective inhibitor of platelet aggregation. The drug has been found to significantly reduce infarction size in acute myocardial infarcts and is an effective antithrombotic agent in arteriovenous fistulas, aorto-coronary bypass grafts, ischemic heart disease, venous thrombosis, and arteriosclerosis. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Tremor: An involuntary trembling or quivering. [EU] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponintropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or
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treatment of infectious diseases. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Ventilation: 1. in respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. in psychiatry, verbalization of one's emotional problems. [EU] Ventricular: Pertaining to a ventricle. [EU] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Zygomycosis: Infection in humans and animals caused by fungi in the class Zygomycetes. It includes mucormycosis and entomophthoramycosis. The latter is a tropical infection of subcutaneous tissue or paranasal sinuses
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caused by fungi in the order Entomophthorales. Phycomycosis, closely related to zygomycosis, describes infection with members of Phycomycetes, an obsolete classification. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
420 Stroke
INDEX A Acetaminophen....................................176 Adrenergic ....21, 142, 290, 291, 399, 402, 407, 410, 412, 414 Aerobic ................................................108 Agnosia..............................32, 37, 71, 391 Amiodarone .................................106, 107 Anabolic .................................................25 Analgesic .....188, 190, 291, 391, 404, 413 Anastomosis ............................58, 79, 414 Anatomical.............................73, 224, 394 Anemia .......19, 34, 35, 80, 126, 132, 349, 396, 415 Anesthesia.........46, 71, 75, 112, 392, 399 Aneurysm ..............14, 22, 30, 40, 72, 392 Angiography ..................................17, 381 Angioplasty ....................46, 113, 131, 171 Anoxia....................................................37 Antiarrhythmic......................107, 140, 391 Antibody.........................74, 156, 157, 397 Anticoagulants ...................27, 28, 53, 215 Antidepressant.......................................32 Antihypertensive ....... 290, 291, 402, 404, 407, 413 Antioxidant...................................180, 302 Antithrombotic................................80, 416 Anxiety...................31, 113, 202, 324, 405 Aorta ......................................................22 Aphasia.......32, 57, 58, 59, 146, 148, 153, 202, 203, 215, 224, 226, 247 Arrhythmia .............72, 107, 140, 392, 393 Arterial ....14, 23, 72, 73, 76, 80, 129, 165, 166, 171, 231, 239, 240, 392, 393, 403, 415 Arteries ..... 11, 13, 14, 15, 17, 18, 22, 23, 25, 26, 29, 30, 49, 51, 62, 72, 73, 74, 116, 117, 121, 127, 170, 259, 393, 397 Arteriography ...................................17, 18 Asparaginase.........................................25 Aspiration...............................61, 154, 257 Asymptomatic ......................149, 165, 166 Atrial ...21, 22, 27, 28, 52, 69, 72, 81, 106, 107, 128, 140, 159, 172, 176, 210, 391, 393, 417 Atrium ................21, 22, 73, 323, 393, 394 Atrophy ........148, 150, 190, 265, 266, 403 Audiometry ..........................................383 Auditory .................................63, 187, 188 Auricular ..............................................299 Autopsy..................................................11
B Barium................................................. 257 Beauty................................................... 26 Benzodiazepines ................ 128, 141, 401 Bereavement ...................................... 216 Bilateral ............................................... 187 Biochemical......................... 168, 189, 402 Biopsy ........................................... 78, 410 Bradykinesia ....................................... 148 Bronchitis .................................... 204, 208 Buccal ................. 162, 188, 219, 395, 406 C Calcification................................... 22, 159 Capsules ............................................. 331 Carbohydrate ...... 189, 218, 330, 401, 402 Cardiac....... 22, 69, 80, 98, 107, 140, 142, 150, 212, 324, 335, 392, 400, 412, 413, 414 Cardiogenic......................................... 374 Cardiology........................................... 158 Cardiomyopathy.................................... 62 Cardiopulmonary .......................... 89, 212 Cardiovascular ...... 71, 85, 89, 108, 130, 149, 204, 206, 211, 214, 216, 245, 246, 248, 258, 334, 391 Carotene ............................. 182, 316, 333 Caspases .............................................. 35 Cataract ...................................... 270, 395 Catheter .......................... 29, 75, 129, 399 Cerebellum............................................ 32 Cerebrospinal ............... 15, 190, 382, 403 Cerebrovascular .... 4, 11, 17, 25, 26, 55, 57, 68, 78, 116, 149, 154, 166, 167, 211, 214, 215, 334, 409 Chemotherapy .................................... 299 Choline................................................ 342 Coagulation..... 81, 87, 163, 372, 416, 417 Cocaine......................................... 25, 374 Cognition............................................... 31 Collapse .............................................. 212 Conduction.................................. 371, 394 Confusion.................... 12, 16, 55, 75, 398 Constriction ............. 25, 77, 233, 405, 417 Contraceptive...................................... 206 Coronary ...... 68, 80, 123, 124, 125, 172, 174, 207, 210, 212, 245, 333, 334, 416 Cortex .. 32, 114, 119, 128, 148, 186, 251, 371, 400 Creatine .............................. 181, 189, 397 Criterion ...................................... 165, 167 Cytokines ...................................... 35, 117
Index 421
Cytotoxic ................................................17 D Dantrolene ...................................290, 398 Dementia ....... 27, 54, 55, 129, 146, 147, 148, 149, 150, 151, 152, 222, 238, 256, 259 Dentists................................................215 Dextroamphetamine ............................115 Diarrhea...............................................328 Diastolic ...................20, 76, 290, 402, 403 Diffusion.......................................169, 178 Disorientation...........................56, 75, 399 Dizziness .........................12, 16, 372, 417 Dreams ................................................227 Dysarthria ........................32, 35, 202, 247 Dysphagia................32, 61, 225, 257, 302 Dystonia.................................59, 148, 260 Dystrophy ........................59, 86, 226, 265 E Echocardiography................................158 Edema ...............................17, 37, 98, 411 Elasticity ................................................14 Electrocardiography...............................69 Electromyography................109, 114, 305 Emphysema.........................................204 Endarterectomy ..... 17, 29, 46, 48, 49, 51, 69, 131, 231, 385 Endoscopy...........................................257 Enzyme.......21, 73, 75, 78, 191, 324, 393, 397, 400, 410, 412 Epidemiological .............46, 124, 177, 335 Exogenous...........................182, 189, 400 Extracellular.........................................157 Extraction.............................................106 Extrapyramidal.....................................148 Extremity..............................................167 F Facial .......................37, 58, 203, 371, 400 Fatigue...................72, 114, 160, 228, 393 Fibrillation ....... 21, 27, 28, 52, 69, 72, 81, 106, 107, 128, 172, 176, 210, 334, 393, 417 Fibrinolysis...........................................163 Fibrinolytic ...........................................163 Flumazenil ...........................................128 Fluorescence .......................175, 189, 401 G Gadolinium ..................................113, 118 Gait ......................107, 108, 120, 148, 186 Genotype .............................................146 Gestures ............................35, 59, 61, 202 Ginseng ...............................................321 Glucose ......190, 204, 210, 213, 218, 227, 228, 246, 401, 405 Glycine.........................................197, 198 Glycosylation .......................................157
H Habitual............................................... 245 Hematology........................................... 90 Hematoma .......................................... 153 Hemiplegia ........ 31, 35, 41, 104, 146, 179 Hemorrhage . 4, 14, 15, 17, 24, 25, 28, 29, 30, 33, 157, 162, 165, 166, 171, 196 Heparin ......................................... 28, 172 Hepatitis ................................................ 64 Herpes .......................................... 76, 403 Hibernation............................................ 37 Hobbies............................................... 152 Hormonal ................................ 33, 34, 213 Hormones 23, 74, 80, 191, 289, 392, 397, 412, 414 Hospices ............................................... 90 Hydrocephalus .................................... 153 Hypercholesterolemia ......................... 151 Hypertrophy . 22, 159, 210, 291, 324, 409, 411 Hypothermia.......................... 37, 173, 240 Hypothyroidism ................... 153, 190, 404 Hypovitaminosis.................................. 306 Hypoxia ................................... 37, 72, 392 I Ibuprofen............................................. 176 Idiopathic............................... 76, 211, 403 Immunization ................................ 79, 414 Impotence ........................... 216, 227, 229 Incontinence ....................................... 216 Indicative................. 16, 80, 190, 408, 415 Induction ..................... 218, 289, 392, 404 Infarction .... 4, 12, 13, 17, 46, 80, 81, 126, 129, 130, 131, 151, 159, 162, 164, 165, 166, 171, 172, 192, 412, 416, 417 Infertility............................................... 216 Inflammation .... 26, 36, 73, 126, 164, 233, 251, 395, 405, 413 Infusion ............................... 102, 103, 128 Insulin....... 173, 190, 204, 218, 228, 246, 335, 336, 401, 405 Interindividual...................................... 168 Intestinal.............. 141, 189, 328, 395, 402 Ischemia..... 4, 13, 91, 157, 170, 174, 192, 213, 412 K Ketoacidosis ....................................... 228 L Larynx ................................................. 226 Lipid ..... 23, 77, 146, 190, 349, 396, 405, 406 Lipoprotein .............. 23, 77, 146, 210, 406 Livedo ................................................. 239 Lobe ...................................... 78, 148, 410 Locomotor ........................................... 107 Lubrication .................................. 199, 406
422 Stroke
Lupus ...................................................216 M Malformation..............................14, 22, 26 Malignant .............................................207 Manic .....................................................86 Membrane ....15, 191, 233, 324, 371, 405, 409, 410, 413 Menopause................33, 34, 78, 141, 410 Mental .......16, 30, 31, 32, 59, 74, 75, 140, 150, 152, 188, 190, 191, 256, 293, 296, 362, 394, 397, 398, 400, 403, 404, 411 Mentors................................................165 Methyldopa ..................................290, 407 Minocycline..........................................173 Mobility ..................86, 108, 223, 229, 302 Modulator.............................................198 Molecular .......28, 53, 76, 140, 164, 172, 191, 199, 254, 263, 264, 391, 392, 402, 412 Monocytes .............................................35 Myosin .................................175, 192, 416 N Nausea ................................................299 Necrosis...............................164, 192, 412 Nephropathy ................................227, 228 Neural ..............................37, 78, 329, 409 Neuromuscular .....59, 109, 168, 225, 290, 305, 398 Neuronal ................................37, 148, 157 Neurons ....14, 74, 78, 148, 157, 190, 198, 233, 396, 406, 408, 409 Neurosurgery...................................40, 50 Niacin...................................................329 Nicotine................................................229 Nimodipine.............................................28 Nitrogen .......................................290, 392 O Ocular ..................................................231 Opiate ....................................................28 Osmolality....................................371, 409 Osteoarthritis .......................................299 Osteoporosis ...............................246, 305 Overdose .............................................329 P Palliative ........................................98, 403 Paralysis .....10, 11, 31, 35, 78, 86, 89, 91, 98, 119, 192, 290, 371, 377, 394, 400, 409, 411, 414 Paraplegia .............................................86 Parietal ....................................32, 78, 410 Parkinsonism .......................148, 190, 406 Paroxysmal..............................69, 72, 393 Pelvic ...................................................181 Percutaneous ........................................46 Perindopril ...........................................306 Phagocytosis .......................................158
Pharmacologic ...................... 71, 210, 392 Plasminogen ... 28, 70, 102, 156, 163, 177 Pneumonia.................................. 154, 257 Postmenopausal ..... 34, 48, 130, 131, 134 Postmenopause .......................... 141, 410 Postoperative ................................ 58, 299 Postural............................................... 148 Potassium .. 142, 160, 197, 198, 290, 324, 330, 333, 334, 394, 399, 412 Predisposition ............................... 19, 228 Preeclampsia ........................................ 87 Prevalence ...... 19, 21, 22, 154, 159, 162, 166, 167, 206, 211, 213 Progestogen ....................................... 131 Prolapse.............................................. 159 Proportional................. 159, 164, 371, 409 Proteins...... 36, 45, 46, 74, 173, 189, 199, 328, 330, 397, 402, 409 Prothrombin .................................. 47, 163 Psychiatric............... 27, 31, 148, 150, 259 Psychiatry ..................... 79, 192, 411, 417 Puberty................................................ 258 Pulse ............................. 52, 110, 112, 114 Q Quadriplegia ........................... 86, 98, 411 Quinidine............................................. 107 R Ramipril............................................... 178 Receptor .... 141, 156, 157, 164, 197, 198, 401 Recombinant....................................... 156 Recurrence ........... 15, 149, 150, 165, 166 Reflex.................................................. 110 Regeneration ...................................... 208 Reperfusion................. 157, 192, 198, 412 Resuscitation ................................ 89, 212 Retina.................................. 233, 349, 413 Retinopathy................................. 227, 228 Riboflavin ............................................ 328 Rigidity ................................ 148, 191, 410 S Sedentary.............. 26, 120, 228, 246, 249 Seizures ............ 35, 78, 79, 211, 410, 413 Senna.......................................... 291, 414 Septum.................................... 22, 79, 414 Serum ..... 23, 79, 165, 167, 290, 399, 414 Shame................................................. 222 Shunt................................. 22, 47, 79, 414 Skull .............. 17, 110, 112, 113, 190, 403 Sotalol ......................................... 106, 107 Spastic ................................ 192, 300, 414 Spectrum............................................... 41 Stenosis .... 13, 14, 17, 18, 22, 24, 29, 46, 49, 51, 52, 69, 103, 131, 170, 374 Steroid......................................... 191, 412 Stomach.............................................. 174
Index 423
Subacute .............................108, 183, 300 Subarachnoid ..............15, 24, 28, 29, 162 Subclinical .............................79, 158, 413 Symptomatic.....51, 52, 80, 106, 117, 165, 166, 170, 211, 415 Symptomatology..................................146 Systemic ..........72, 81, 128, 171, 393, 417 Systolic ...20, 76, 150, 151, 206, 290, 402, 403 T Thalamus...............................................33 Thalassemia ..........................................64 Thermal .......................................189, 398 Thermoregulation ................................328 Thromboembolism...............................126 Thrombolytic ...... 17, 53, 68, 80, 198, 239, 415 Thrombosis...13, 79, 80, 81, 87, 156, 414, 416, 417 Thrombus ..............80, 142, 372, 415, 416 Thyroxine.............................................330 Ticlopidine ...............................27, 45, 122 Tolerance.............174, 213, 228, 246, 416 Tomography ....... 16, 118, 124, 151, 197, 259, 335
Toxicity.......................................... 36, 153 Transcutaneous .................. 188, 301, 306 Transfusion ................. 132, 165, 166, 309 Tremor ................ 148, 191, 265, 308, 410 Troponin.............................. 176, 192, 416 U Urinary ........................ 218, 291, 404, 411 V Vaccine ....................................... 251, 391 Vaginal ........................................ 199, 406 Vasoconstriction ................................. 229 Veins ....................................... 13, 87, 121 Ventilation ........................... 172, 192, 417 Ventricular..... 22, 140, 159, 210, 231, 391 Vertebral ................................. 11, 26, 181 Vertigo......................................... 372, 417 Viral....................................... 26, 251, 405 Viruses ........................ 141, 252, 403, 416 Viscosity................................................ 25 W Warfarin ...... 28, 47, 48, 52, 103, 134, 170 Withdrawal .......................................... 171 Z Zebrafish ............................................... 36 Zygomycosis ............................... 193, 418
424 Stroke
Index 425
426 Stroke
