• Development of V-FAST: a vision screening tool for ambulance staff

      Rowe, Fiona J.; Dent, Joseph; Allen, Frank; Hepworth, Laura R.; Bates, Rachel (2020-08)
      About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim: The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy of identifying visual impairment in hyperacute strokes were developed and evaluated. Abstract published with permission.
    • Implementation of a prealert to improve in-hospital treatment of anticoagulant-associated strokes: analysis of a prehospital pathway change in a large UK centralised acute stroke system

      Ashton, Christopher; Sammut-Powell, Camilla; Birleson, Emily; Mayoh, Duncan; Sperrin, Matthew; Parry-Jones, Adrian (2020-05-17)
      Intracerebral haemorrhage (ICH) has the worst outcomes of all stroke subtypes, with a case fatality at 1 month of 30%–40% and only 20% regaining independence.1 Improving the implementation of existing evidence-based and guideline-recommended interventions may lead to improved outcomes.2 10%–20% of acute ICH occurs in patients taking oral anticoagulants and this is associated with a high risk of early haematoma expansion.3 4 Rapid treatment to normalise coagulation reduces this risk and may improve outcomes.4 5 The first critical step in achieving this is for suspected stroke patients on anticoagulants to undergo immediate brain imaging, allowing ICH to be identified quickly and anticoagulant reversal therapy initiated. Our regional centralised acute stroke system within Greater Manchester and Eastern Cheshire serves a population of 2.85 million and although suspected stroke patients collected by ambulance <48 hours post onset are transported to a hyperacute stroke unit (HASU), only those within 4 hours of onset are prealerted. We conducted a service evaluation to determine whether an additional prealert and emergency transport for suspected stroke on anticoagulants 4–48 hours post onset facilitated rapid imaging and hence reversal of anticoagulation after ICH on HASU arrival. A proposed prealert for anticoagulant-associated suspected strokes was agreed by the Greater Manchester Stroke Operational Delivery Network and introduced on 13 March 2018. The change in practice was disseminated by the North West Ambulance Service (NWAS) to all prehospital clinicians. https://bmjopenquality.bmj.com/content/9/2/e000883. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjoq-2019-000883
    • Potential use of amiodarone to treat new-onset AF in the pre-hospital setting

      Brown, Philip (2014-08)
      Abstract published with permission. Incidence of atrial fibrillation (AF) is high, it is the most prevalent arrhythmia in the UK, Europe and the USA (Naccarelli et al, 2009; Davis et al, 2012; Dagres et al, 2013) and is associated with significant morbidity, high risk of stroke and mortality (Cottrell, 2012). Clinical guidance from the National Collaborating Centre for Chronic Conditions (NCCCC) (2006) and the National Institute for Health and Care Excellence (NICE) (2006) supports clinicians working in primary and hospital-based emergency care, but not those working in pre-hospital care. Updated guidance from NICE (2014) highlights the importance of providing rapid, personalised, evidence-based care, yet does not provide any guidance for pre-hospital clinicians responding to emergency presentations of AF. Paramedics have knowledge and experience of identifying AF, possess antiarrhythmic, anticoagulant and anti-platelet medications as part of their formulary and possess the necessary skills for obtaining intravenous access. This article reviews the national guidance and available best-evidence to provide safe treatment to patients presenting with new-onset AF and considers areas that merit further research.
    • Pre-hospital detection of post-stroke visual impairment

      Rowe, F.J.; Hepworth, L.R.; Dent, J. (2017-11)
    • Stroke knowledge and awareness: an integrative review of the evidence

      Jones, Stephanie P.; Jenkinson, Amanda J.; Leathley, Michael J.; Watkins, Caroline L. (2010-01)