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After a Stroke PowerPoint PPT Presentation


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After a Stroke. www.bradfordvts.co.uk. Some Numbers. Each GP will have 4 new strokes a year to deal with. Each GP will have about 15 patients with old strokes on their list. A quarter of severely disabled people in the community are stroke patients. PHCT Tasks. Information. Support.

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After a Stroke

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After a stroke l.jpg

After a Stroke

www.bradfordvts.co.uk


Some numbers l.jpg

Some Numbers

  • Each GP will have 4 new strokes a year to deal with.

  • Each GP will have about 15 patients with old strokes on their list.

  • A quarter of severely disabled people in the community are stroke patients.

Bruce Davies


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PHCT Tasks

  • Information.

  • Support.

  • Secondary prevention.

  • Help with post stroke physical problems.

  • Treating depression.

Bruce Davies


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Patient Questions

  • Patients and their carers need information after a stroke.

  • 80% survive a stroke.

  • 50% 10 year survival.

Bruce Davies


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Disability Figures

  • 25% entirely dependant on a carer.

  • Another 30% need help with ADL.

  • <50% are fully independent.

  • 25% become depressed.

  • At 6 months 70% can walk independently but only 20% at pre stroke speed.

Bruce Davies


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Recurrence

  • 13% chance in the year after a stroke.

  • 5% per year thereafter.

  • 40% will eventually have a fatal MI.

Bruce Davies


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Secondary Prevention

  • To reduce atherosclerotic risk.

  • Based on RCP guidelines.

  • Reduce cholesterol to less than 5mmol (40% die of an MI).

  • Reduce BP, if it persists after 4 weeks post stroke. Each 5mmHg lowering of diastolic pressure reduces risk by 28%.

Bruce Davies


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Secondary Prevention

  • Target BP 140/85mmHg or 130/80 if concurrent diabetes.

  • Lifestyle advice.

  • Anti-platelet drugs.

  • Anti-coagulation if appropriate.

Bruce Davies


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Secondary Prevention

  • Hope trial- Ramipril.

  • Progress Trial - Perindopril.

  • 30% and 28 % respectively reduction in further vascular events with use of ACE.

Bruce Davies


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Social Problems

  • Driving, and the DVLA.

  • Sex.

  • Work.

  • Problems of care and carers.

Bruce Davies


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Common Physical Problems

  • Depression.

  • Emotional lability.

  • Convulsions.

  • Muscular pains – especially shoulder pain.

  • Thalamic syndrome.

  • Insomnia.

Bruce Davies


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Common Physical Problems

  • Incontinence.

  • Leg swelling.

  • Contractures.

  • Falls.

  • All of these problems are amenable to treatment.

Bruce Davies


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Carers

  • Need help.

    • Financial help.

    • Actual help.

    • Psychological help.

  • 12-25% of carers are depressed.

  • 14% give up work to care.

Bruce Davies


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Conclusion

  • A general practioners real job starts after they leave hospital and goes on for years.

  • An area for planned on-going care.

Bruce Davies


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Audit?

  • How many on anti-platelet drugs?

  • How many had BP in last year?

  • Cholesterol on target?

  • Records of functional disability?

  • Visits from PHCT?

  • Carers identifiable?

  • Services for carers?

Bruce Davies


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References

  • http://www.stroke.org.uk

  • http://www.rcplondon.ac.uk

Bruce Davies


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