Stroke Units: An Evidence Based Approach

Stroke Units: An evidence based approach......Page 1
Contents......Page 7
Authorship......Page 11
Contributors......Page 13
Foreword by Iain Chalmers......Page 15
Preface......Page 17
History of stroke unit care and its evaluation......Page 19
Early studies......Page 20
Definitions of a stroke unit......Page 21
Later developments......Page 22
The demands of evidence based practice......Page 24
Levels of evidence......Page 26
Systematic error (bias)......Page 28
Design of a reliable stroke unit trial......Page 31
Why randomised trials may not be enough......Page 32
Conduct of systematic reviews......Page 33
Sources of bias in systematic reviews......Page 35
Interpretation of systematic reviews......Page 36
Defining the intervention......Page 38
Defining the patient group......Page 39
Defining the outcomes......Page 40
Locating information from relevant trials......Page 41
Stroke unit characteristics......Page 42
Characteristics of different models of stroke unit......Page 47
What is meta-analysis?......Page 51
What is an odds ratio?......Page 52
Presentation of results......Page 53
Can the risk of death be reduced?......Page 54
Why were deaths reduced?......Page 56
Preventing death at the expense of increased dependency among survivors?......Page 58
Is the need for institutional care reduced?......Page 59
Is dependency (disability) among survivors reduced?......Page 60
What are the absolute benefits of stroke unit care?......Page 63
Subgroup analysis......Page 64
Which patients benefit?......Page 66
What kind of stroke unit is effective?......Page 67
Exploring the diversity of stroke unit trials......Page 68
What general policies should be applied?......Page 69
Methods of economic analysis......Page 74
Costs of stroke......Page 75
Potential costs......Page 77
Measuring costs and benefits......Page 78
Economic “balance sheet”......Page 80
Implications of the analysis......Page 82
Evidence based stroke care......Page 84
Comprehensive stroke services......Page 85
Stroke ward or mobile stroke team?......Page 86
Acute or rehabilitation unit?......Page 87
In which department should the unit be established?......Page 88
What staff are needed?......Page 89
Stroke unit size......Page 90
Duration of stay......Page 91
Communication: Multidisciplinary team......Page 92
Care pathways......Page 93
Overcoming resistance to change......Page 96
Current state of knowledge......Page 98
Outstanding questions......Page 99
Appendix: Descriptions of stroke unit care......Page 102
Glossary of terms......Page 111
References......Page 118
Index......Page 127