RESEARCH IN STROKE 1. RESEARCH FELLOWSHIPS 1.1 Dr. Jesse Dawson (Fellow)
Department of Medicine and Cardiovascular Sciences, Western Infirmary, Glasgow £64,765 over two years, awarded 2006
Aspirin resistance and microemboli: towards targeted antiplatelet treatment Aspirin prevents many recurrent strokes. However, some patients fail to respond. They show limited platelet inhibition (“aspirin resistance”), and suffer further strokes. Previously, huge studies were needed to discover whether treatment changes in such patients may reduce subsequent stroke risk. Using new ultrasound techniques the researcher(s) will investigate the link between aspirin resistance and tiny circulating blood clots. They need only small numbers of patients to see if these clots form preferentially in patients with aspirin resistance. The results may allow treatment for future patients to be chosen more reliably and thus reduce recurrent stroke.
1.2 Dr. Andrew Farrall (Fellow)
Division of Clinical Neurosciences, Western General Hospital, Edinburgh 89,500 over one year, awarded 2004
Is blood brain barrier failure the cause of cerebral “small vessel disease”? Dementia and stroke commonly cause dependency in older people, creating a major societal disease burden. Their pathologies are complex. A primary, overlooked cause may be blood brain barrier (BBB), leakiness that allows deposition of substances in blood vessel walls, then surrounding brain, with consequent damage. Sophisticated magnetic resonance (MR) brain imaging techniques promise to identify BBB leakiness: the researcher aims to image a large group of lacunar stroke and dementia patients. New insights into the underlying cause of dementia and stroke will be gained and correlated with the clinical picture. This may radically change how dementia and stroke are treated.
2. PROJECT 2.1 Drs. Miles Witham, Jacqui Sugden, Alex Doney and Professor Allan Struthers
Ninewells Hospital, Dundee £69,960 over two years, awarded December 2006
Does Vitamin D improve markers of vascular health in stroke patients? Low vitamin D levels are common among patients who have had a stroke, and this may have damaging effects on blood pressure and blood vessels. The researchers will give a single large dose of vitamin D or a placebo (dummy pill) to patients who have suffered a stroke and have low vitamin D levels. They will measure their blood pressure and markers of heart and blood vessel health eight and 16 weeks later. If vitamin D reduces blood pressure and improves markers of blood vessel health, it may reduce the risk of heart attack or a further stroke in stroke sufferers.
2.2 Professor Martin Dennis on behalf of Prediction of Stroke Outcomes Collaboration
£89,386 over two years, awarded December 2006
Development of systems to predict specific and important outcomes after stroke Patients who have had a stroke (and their families) ask their doctors many questions, including: Will I survive? Will I walk again? Will I be able to get home? The doctor answers these questions based on their experience. This project aims to develop systems that will allow patients’ outcomes to be predicted. These predictive systems will be based on the experience of many thousands of patients and will offer patients and their doctors a more accurate prognosis. This allows the patient and their doctors to choose the most appropriate treatment and care.
2.3 Ms. Gillian Baer, Dr. Lisa Salisbury, Mark Smith and Professor Martin Dennis
Queen Margaret University College, Edinburgh
£83,630 over two years, awarded December 2005
Treadmill training in sub-acute stroke rehabilitation:
A pilot multi-centre randomised controlled trial One of the main problems for people after a stroke is learning to walk again. Physiotherapists help stroke patients to walk using different exercises. A new way of teaching walking has been to use a treadmill (like a running machine found in gyms). The researchers do not know whether this is better than teaching walking on the floor. This study will look at the two different ways of teaching walking after a stroke. They will look at how long it takes to walk without help, how fast people can walk, and how far they can walk.
2.4 Professor Peter Langhorne, Professor David Stott, Julie Bernhart, David
Barer, Caroline Watkins Academic Section of Geriatric Medicine, Glasgow Royal Infirmary
£38,605 over one year, awarded December 2004
Very Early Rehabilitation or Intensive Telemetry After Stroke (VERITAS) Stroke patients have a better chance of making a good recovery if they receive care in a well-organized stroke unit. However, there are uncertainties about how best to provide such care and how best to improve on current practices. The researchers plan to carry out a pilot study exploring two key aspects of early stroke patient care (early active mobilisation and careful monitoring for other problems). At present, they do not know how best to carry out these tasks, and this study will explore whether a definitive clinical trial is possible. The potential benefits if such a trial were positive would be substantial.
2.5 Dr. Dilys Freeman, Allan Gaw, Ian Ford, Ian Greer, Professors Lowe and Stott
Developmental Medicine, Glasgow Royal Infirmary
£86,334 over one year, awarded December 2004
Risk factors for the development of incident venous thrombotic events in the
Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) Blood clots in the leg and lungs can lead to serious infirmity or even death. Currently, it is difficult to predict who might develop these clots. This research project plans to use the samples and data collected from a very large population study, during which over 100 older individuals developed a blood clot. The researchers will look at lifestyle factors, blood levels of proteins and compounds involved in clotting, fat metabolism, inflammation and blood vessel function, and also variation at their genes, in order to find a simple test which would help predict who develops blood clots.
DCN X-Ray, Western General Hospital, Edinburgh
£33,537 over two years, awarded December 2003
VERITAS: A trial of cerebral angioplasty for symptomatic vasospasm after
aneurysmal subarachnoid haemorrhage Brain haemorrhage caused by rupture of a blister (or aneurysm) on a brain artery affects 5,000 people annually in the UK. It most commonly occurs in middle age. Narrowing of the arteries supplying the brain – a condition called vasospasm – frequently complicates the brain haemorrhage. Two thirds of those affected by symptomatic vasospasm die or are left disabled. It is possible to dilate the narrowed arteries within the head to improve the blood supply using a special type of balloon – a procedure called angioplasty. Angioplasty may substantially reduce the risk of death/disability, but needs to be tested in a proper trial.
2.7 Professor Peter Langhorne, Graham Ellis, Jonathon Mant and Lynn Legg
Academic Section of Geriatric Medicine, Glasgow Royal Infirmary
£53,701 over two years, awarded December 2003
An exploration of the role and impact of Stroke Liaison Worker services Specialist stroke nurses (or stroke liaison worker) services have been used in a variety of ways to help stroke patients and their families overcome difficulties at home, and to provide information and support. Although patients and carers usually appreciate such services, there is limited research evidence about their impact in other areas. The researchers plan to examine all the available information about stroke nurse services to establish the best way to provide such services for the benefit of patients and carers.
COMMISSIONED/ACTION RESEARCH PROJECTS
3.1 Professors Peter Langhorne, David Stott and Lynn Legg
Academic Section of Geriatric Medicine, Glasgow Royal Infirmary £64,983 over two years, awarded 2006
Developing the next generation of rehabilitation trials
Rehabilitation provides one of the main treatment options for people who have had a stroke. If improvements are to be made on current care, it is important that high quality research is carried out into new rehabilitation treatments. However, such research requires a lot of planning and preparation. The researchers propose to review all existing trials of stroke rehabilitation, identify priority areas for future research, and assist the development of several research trials.
3.2 Dr. Gillian Mead et al
University of Edinburgh, Royal Infirmary, Edinburgh £46,516 over two years, awarded 2005 An evaluation of telemedicine for “brain attacks”
The deliver of optimum care to patients with stroke (e.g. clot-busting drugs) depends on 24-hour, 7-days a week, availability of stroke specialists. Currently, geographical barriers mean that stroke patients do not always see a specialist quickly, especially those admitted to remote hospitals. Video links (telemedicine) between the patient and an expert stroke specialist will enable the stroke specialist to speak to and examine a patient and the brain scans remotely at any time of day or night. This project will determine whether telemedicine improves patient care and is acceptable to patients, carers and their doctors.
3.3 NHS Highland, Managed Clinical Network
£35,000 over nine months, awarded 2004 Speech and language therapy services in remote and rural areas Current gaps in speech and language therapy across many of Scotland’s rural and remote areas are having a significant impact on the consistency and quality of care that can be delivered to stroke patients. A more holistic and strategic approach to addressing the problem in the longer term is required. This proposal is to pilot and evaluate a way of using scarce available resources in more innovative ways for the benefit of patients. Although the practical components will be piloted in the Highlands, the findings will be applicable across Scotland, particularly in remote and rural settings.
Do a pregnancy test before starting clomipheneMultiple births occur. Clomiphene has causedeven if your period seems normal. There is aone set of quadruplets, five triplets, andpossibility of birth defects if clomiphene is takenuncounted twins in 36 years in my practice. while you are pregnant and possibly if taken theSide effects such as mood swings, hot flashes,Take one prenat
Self Medication Order for Benadryl Only The administration of medication to a child during the before and after school SACC Program will be permitted only when the child’s physician certifies in writing that the administration of medication during the before and after school SACC Program is essential to the health of the child and may be self-administered by the child safely. The parent/g