Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy

Leo H. Bonati, Jörg Ederle, Joanna Dobson, on behalf of the CAVATAS Investigators are just about to have their paper Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy published on IJS Early View. They have found that there was no difference in the occurrence of death or stroke lasting >seven-days between randomization, and 30 days after treatment between the EVT arm (23/213 patients, 10·8%: 13 nonfatal strokes, 9 fatal strokes, 1 nonstroke death) and the CEA arm (24/211 patients, 11·4%: 20 nonfatal strokes, 4 nonstroke deaths), OR 0·94 (0·52–1·72). In the entire study population, length of carotid stenosis using either definition significantly predicted the safety end-point [definition 1, i.e., using length 1 where possible and otherwise length 2: area under the ROC 0·62 (0·54–70), P = 0·008; definition 2, i.e., always using length 2: area under the ROC 0·67 (0·59–0·74), P < 0·001].

Online soon.

Exploring quality markers for scientific journals

It's been a while since IJS has sent out a blog post, and as always this is because there is so much going on, rather than inaction! Our esteemed Associate Editors have been busily trawling through manuscripts and working hard to make IJS a more timely journal. New IJS Board member Atte Meretoja has been workshopping with us, for presentation at our coming Board meeting in London later this month a new set of author guidelines. As always we are working towards bettering our quality and content for the benefit of our readership, and as a journals quality markers exist in guidelines we see this as an essential area to grow and nurture, so you the authors and readers know what to expect from IJS. 

Let's focus on Transparency

1. Transparency: mistakes are inevitably made from time to time, and science, scientists and scientific processes can be flawed. Papers are peer reviewed and sometimes, undeservedly make it through to publication either innocently and therefore ignorantly, or deceitfully. 

Transparency is essential for stakeholder trust in journal quality. The internet community and stakeholders will hold accountable those who strive to evade, mislead or under-disclose. You will be publicly interrogated and your actions questioned. Discussions on ethics are becoming more globally cohesive and the excellent outcome is that authors and more importantly publishers, are more accountable and also rewarded for their behaviours. 

IJS is committed to transparency. As stroke is such a close knit community, and the reviewers and authors are very intertwined, we have not yet been in the position where we have needed to disclose a retraction, or more importantly, where we have need to retract an article.  

http://retractionwatch.wordpress.com
The author of the Retraction watch blog wrote the following article for Lab Times online 
http://www.labtimes.org/labtimes/ranking/dont/2013_03.lasso; they quote Dr Stuart Firestein from this article here http://www.wired.com/wiredscience/2012/07/firestein-science-doubt/ 'Science often traffics in doubt and readily welcomes revision. And these are precisely the attributes that make it deserving of our confidence.'  

In a recent TED talk he says “It’s farting around… in the dark.”
http://blog.ted.com/2013/02/26/celebrating-ignorance-stuart-firestein-at-ted2013/. 

So this means that explanation and transparency through retraction or in a wider sense error, is fundamentally important to quality, and a true quality marker for scientific publishing. 

This quote was found in PubMed - a standard retraction from Wiley, IJS's publisher.  

The following article from Journal of Product Innovation Management, The Impact of Aligning Product Development and Technology Licensing: A Contingency Perspective by Ulrich Lichtenthaler and Johan Frishammar, published online on 13 October 2011 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor-in-Chief, the Product Development and Management Association, and Wiley Periodicals, Inc. The retraction has been agreed to due to inconsistencies in the empirical results. Prof. Dr. Lichtenthaler has indicated that Prof. Frishammar was not responsible for any of the statistical analyses in the article and Prof. Dr. Lichtenthaler accepts sole responsibility for this article being retracted.

I invite blog readers to comment on this retraction and the process used and invoke discussion about the detail, and transparency.

Disability and stroke rehabilitation; S Mendis WHO

Dr Shanthi Mendis Chronic Disease Prevention and Management World Health Organization Geneva.

Stroke is a leading cause of acquired disability in adults. If secular trends continue it is estimated that there will be 23 million first ever strokes and 7·8 million stroke deaths in 2030 [1]. In 2008, out of 57 million global deaths, 17 million were due to cardiovascular diseases [2]. Stroke accounted for about one third of cardiovascular deaths (5·7 million deaths) and 46·6 million Disability Adjusted Life Years (DALYs) [3]. Burden of disease measured as DALYs is a composite measure of both morbidity and mortality of stroke and a good indirect indicator of the economic and social burden caused by stroke. With regard to the incidence, there has been a decline in high-income countries and a greater than 100% increase in stroke incidence in Low-and middle-income countries (LMIC) over the last four decades. Currently, the overall stroke incidence rates in LMIC exceed the level of stroke incidence seen in high-income countries, by about 20% [4]. Countries in Eastern Europe, North Asia, Central Africa, and the South Pacific have the highest stroke mortality and stroke burden [5].

At present, globally, there are about 650 million people 60 years of age and older, and by 2050, the number of people 60 years of age and older is forecast to reach two billion [6]. Ageing of populations, globalization, and urbanization are the powerful drivers of the stroke epidemic. A large proportion of strokes are preventable through population-wide control of modifiable risk factors; unhealthy diet, physical inactivity, tobacco use, and drug treatment to address hypertension, diabetes, and hyperlipidemia through a primary health-care approach [7-9].

It has been estimated that the proportion of stroke patients who are dead or dependent at six-months in the absence of interventions is about 62% [10]. A population study of follow-up of stroke survivors demonstrated that at five-years two-thirds had some neurologic impairment and disability, 22·5% had dementia, 15% were institutionalized, and 20% had experienced a recurrent stroke [11]. Poststroke disability disproportionately affects people from the poorest wealth quintiles and people in lower income countries.

Recent studies have shown that stroke-related disability may be substantially reduced by emergency treatment of acute stroke in dedicated stroke units and by appropriate management of transient ischemic attacks [12, 13]. Simple clinical scores are also available to improve prehospital diagnosis of acute stroke and risk estimation in patients with transient ischemic attacks [14]. If these tools can be incorporated in health education and physician training programs, more people will receive appropriate stroke care thereby reducing stroke related disability. Immediate access to diffusion magnetic resonance imaging, intracranial magnetic resonance angiography, and detection and management of severe carotid stenosis and atrial fibrillation can also contribute to improved outcomes. However, most of these services are not available to majority of people in LMIC [15].

For most stroke survivor's rehabilitation is essential to become economically active and to participate in civic life. Article 26, of the United Nations Convention on the Rights of Persons with Disabilities, calls for ‘appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability and full inclusion and participation in all aspects of life’[16].

In developed countries the recovery process of stroke survivors is supported with stroke rehabilitation services. These services reduce disability and increase the chances of a person returning to their own home. A five-year follow-up of a six-month cohort of all discharges in a stroke rehabilitation unit showed that 76% of those who returned home were still at home 12 months later [17]. However, even across countries in the developed world stroke care and rehabilitation need improvement in order to minimize poststroke disability [18].

The World Report on disability [19] has documented strong evidence of many barriers that restrict participation of people with disabilities. They include negative attitudes toward disability, inadequate national policies and standards, lack of provision of services, problems with services delivery, lack of accessibility to built environments and public amenities, lack of involvement of people with disabilities in decision making in matters directly affecting their lives, and inadequate financial resources to address these barriers. Importantly, evidence presented in the WHO report suggests that many of these barriers are avoidable and the disadvantages associated with disability can be overcome through appropriate policy and structural changes.

The World Disability report recommends measures to: Enable people with disability, access to all mainstream policies systems and services; Invest in specific programs and services for people with disabilities; Adopt a national disability strategy and a plan of action; Involve people with disabilities in decision making; Improve human resource capacity to address the needs of the disabled; Provide adequate funding and improve affordability; Increase public awareness, understanding of disability, and improve data collection and research on disabilities.

Implementation of the recommendations of the WHO report requires engagement of different sectors – health, education, social protection, labor, transport, and housing – and different actors – governments, civil society organizations, professionals, the private sector, and people with disabilities. The World Report on Disability recommends that countries tailor their actions to their specific contexts and that in resource-constrained settings some of the priority actions, particularly those requiring technical assistance and capacity building, be included within the framework of international cooperation.

Nordic Stroke 2013

http://www.nordicstroke2013.lt/lt/organization

International Stroke Conference; six days away

The International Stroke Conference starts in six days and we invite all attendees to update via email or through the blog and tell us and other strokologists unable to attend this exciting event, all about the newest things in stroke. 

Things of note:

Sandy Middleton from Australia will receive the Stroke article of the year award this year at the Nurses symposium. Sandy has been working on swallowing in post stroke care. IJS have had the opportunity to publish Dr Middleton many times, her presentation skills are exemplary and her science and research approach, excellent. This will be a worthwhile session.

An outcomes approach to stroke care: the importance of teamwork and evidence-based nursing care

   

NS 3-Rehabilitation and Recovery: An Ongoing Process 

Presenter:

Stephanie Vaughn, Fullerton, CA the session, Clinician Driven Assessment and Supportive Interventions for Men in Caregiving Families looks very interesting and will be an interesting presentation. Good luck choosing the sessions you plan to attend from this smorgasbord of choice. Head here to plan your conference week at ISC

Biomarker Summit 2013

BIOMARKER SUMMIT 2013March 20-22, 2013 

Bringing your attention to the biomarker summit 2013 - time to register ... if you have an interest in biomarkers (and let's face it who doesn't) then IJS has recently, in our translational science edition published 

Blood biomarkers in stroke: research and clinical practice

1. William Whiteley^1,*, 
2. Yingfang Tian², 
3. Glen C. Jickling²

Keywords:

• biomarker;
• diagnosis;
• prediction;
• research;
• stroke

Blood biomarkers may have applications in stroke diagnosis, outcome prediction, or treatment. In this article, we provide a focused review on some of the methodological challenges and potential developments of biomarkers in stroke. We review the approaches to the development of a diagnostic blood marker: a candidate marker approach, marker panels, and –omics. Then we examined the role of blood markers to predict recurrent stroke and treatment response in stroke.

Speaking of blood biomarkers IJS have a gorgeous interview with Barbo Johannssen coming to iTunes soon, where she speaks on her early interest in biomarkers and blood in the 60s.

World Stroke Academy

World Stoke Academy

The World Stroke Academy is an online educational resource that can contribute to CPD/CME points and the sharing of information and knowledge. The current focus is Paediatric Stroke authored by Professor Nabil Kitchener, Dr. Gabrielle deVeber and Dr Vijeya Ganesan.

You can upload podcasts, and a well of various information, at your fingertips. We know these tools are looking great, and getting better all the time, we know the content is excellent for the best authors in stroke, but what we don't know is how you feel about it, and we'd love to hear your responses to the new look WSA.

  

IJS rehabilitation edition OUT NOW

At IJS we are often asked the question, 'why don't you have a rehabilitation section in your journal?' and we always answer that as stroke rehabilitation is such an essential part of stroke as a whole that it cannot be regulated to one simple section. With that in mind we have acquiessed to some extent and put together for our readers immediate accessibility a special themed rehabilitation edition. This is really to emphasise stroke rehabilitation in the field and not to make rehab a separate section.

When we approached the wonderful Associate Professor Julie Bernhardt and Professor Steve Cramer they were both brimming with ideas of how to pull together an edition that would bring together the most important aspects of stroke rehabilitation. They have of course done a splendid job. 

Access to IJS directly, Rehab edition is free access

Editorial

We have focused an entire edition of the International Journal of Stroke with guest editors Associate Professor Julie Bernhardt and Professor Steven Cramer on rehabilitation for a very good reason. For those of us who manage stroke patients on a regular basis, there are a number of obvious issues, which often arise. The first is that the acute stroke process is often only the beginning of what becomes a lifelong disability, the consequences which are entirely born by the individual and their families; second, while we are accumulating significant amounts of evidence-based knowledge about stroke prevention and acute therapy, there is still a paucity of evidence-based knowledge about recovery and rehabilitation.

Assembling this volume, Professors Bernhardt and Cramer have drawn together strands of information from the basic sciences, right through to the global World Health Organization perspective about rehabilitation generally. The burden of stroke during the rehabilitation phase and beyond in terms of life-years is enormous. The prolonged phase of disability for the patient and limited evidence pool to guide practitioners and families remain a sleeping giant of stroke medicine. We hope that this edition may fuel the great awakening.

Professor Geoffrey A. Donnan

Read Stroke disability and rehabilitation of stroke: World Health Organization

Festive season

The festive season specifically for those following the Gregorian calendar, has just wrapped up and we at IJS office are having a well deserved (if we may say it) break from the lovely job of putting together this wonderful journal and all its accoutrements for you the readers, the authors and the reviewers. So, if you have been watching us, and noticing our voice is a little quieter at this time of year, never fear because as this year rolls over we will be doing more, offering more, working even closer with the World Stroke Academy, which is now online; and bringing you the voices of the SSOs globally. As many of you will find tech commentators are excitedly predicating a wonderful year for eLearning. The potential for people to explore actively, on so many platforms information, debate and knowledge from experts is full of all kinds of potential.

Keep your eye on the blog, and sign up to receive our posts.

Stroke Telemedicine

http://www.youtube.com/watch?v=iQdkBKF8p5g&feature=youtu.be
Dominique Cadilhac and Chris Bladin speak about telemedicine - paper is coming soon to IJS.

IJS is experimenting with coding - have you seen this ground breaking work on fatigue with Gillian Mead and martin Dennis? Keep an eye out for more stroke and fatigue papers as this topic garners more and more attention.