Online character simulation - avoiding research misconduct

http://ori.hhs.gov/TheLab/

In "The Lab: Avoiding Research Misconduct," you become the lead characters in an interactive movie and make decisions about integrity in research that can have long-term consequences. The simulation addresses Responsible Conduct of Research topics such as avoiding research misconduct, mentorship responsibilities, handling of data, responsible authorship, and questionable research practices.

It's a great online interactive idea - we would be interested to hear your thoughts?
 

Long-term risk of recurrent stroke in young cryptogenic stroke patients with and without patent foramen ovale

Abstract

Background: Among patients with a patent foramen ovale and cryptogenic ischemic stroke, the long-term prognosis is unclear.

Aims: This study aims to estimate the recurrence rate in young cryptogenic stroke patients with and without patent foramen ovale.

Methods: One hundred eighty-six cryptogenic stroke patients (aged 18 to 45 years) were prospectively followed up for up to five years. They were divided into two groups according to the echocardiographic presence of patent foramen ovale. All patients received aspirin (100 mgs per day) for secondary prevention.

Results: Mean age was 32.3 (SD 7.9) years. During the mean follow up of 66 months five patients with patent foramen ovale had a recurrent strokes compared with 11 patients without patent foramen ovale. The average annual rate of recurrent cerebral ischemia was 1.1% and 1.6% for patients with and without patent foramen ovale respectively. The recurrence rate did not increase with the presence of patent foramen ovale, atrial septal aneurysm or other variables. More than 60% of the reported cases achieved a good functional outcome.
 
Conclusions: Young patients with cryptogenic ischemic stroke with and without patent foramen ovale have a low recurrence rate in a long-term follow-up and most present a favorable outcome. Patent foramen ovale with or without atrial septal aneurysm did not increase the risk of recurrence.

Discoveries need dollars

Last week the Australian government announced they will be slicing 400 million dollars off NHMRC funding in the coming budget. Of course, it goes without saying that a loss of 400 million dollars to the Australian medical research community means lost jobs, defunded projects and ultimately the loss of lives and quality of life for Australians. In terms of CVD in the Australian community, in our cities we are well funded and stroke fatality is in decline; however, the vast land mass that is this enormous island has extreme health disparity. Remote populations in cities as large as Broome on Australia's west coast have access to one part-time GP; options like telemedicine are imperative in these communities but the funding behind these concepts must be continued. It is common knowledge among stroke practitioners that neuro-protectants are as yet ineffectual in humans, but animal model testing has shown possibilities of protection. Imagine a world where a potential stroke could be avoided all together; this is only possible with continued trial funding. Sex, depression, dementia and rehabilitation post stroke are burgeoning ares of study, these clinical and observational studies have enough difficulty in clinically dominant environments receiving funding for best practice trials. In Melbourne, the new amalgamated Florey Neuroscience Institute has two fabulous purpose built buildings,  state of the art labs and collaborations with some of the best practitioners in the field of stroke. What was the point of the government funding these amazing spaces if there is a thinning stream of research outcomes, does it make it worth the communities money, because ultimately in every respect that's who pays for this enormous budget cut.

What's coming up in April on IJS Early view

Predictors of mobility after stroke: a systematic review

Craig, Louise  Wu, Olivia; Bernhardt, Julie; Langhorne, Peter Abstract Regaining post stroke mobility is considered a primary goal of the stroke patient in early rehabilitation. The ability to predict the recovery of post stroke mobility is of great clinical importance, providing information to healthcare professionals, patients and their families. We conducted a systematic review aimed at identifying the baseline factors, assessed within one week of stroke onset that are predictive of, or associated with, the recovery of mobility within 30 days post stroke. A comprehensive search strategy was applied to all major electronic databases to identify potentially relevant studies. Included in the review were two studies that evaluated the predictive value of baseline factors by developing a prognostic model, and three studies that assessed baseline factors that were associated with the outcome by univariate analysis. Walking was the most commonly assessed mobility outcome; age, the severity of paresis, reduced leg power, presence of hemianopia, size of brain lesion and type of stroke were shown to be predictive or associated with walking within 30 days post stroke.  This review has identified potential predictors of the recovery of mobility post stroke. There is a need to explore and validate these predictors in other patient cohorts and consider additional factors believed to be associated with mobility. The recovery of mobility other than walking also needs investigation. In order to move prognostic research in stroke forward a collaborative approach in the collecting and sharing of data is recommended

International Stroke Conference 2011

The International Stroke Conference is on again this time in Los Angeles; (it's always in the US). We have briefly summarized a few of the presentations so far - it's worth checking out the excellent ISC Science News site. 


ER evaluation of TIA
Devin Brown
The ongoing unanswerable question is 'what is a TIA?' I love the link to this slide TIA is a mini stroke?  from a talk by Devin Brown on ER evaluation of TIA.  Dr Brown suggests in her slides that the AHA guidelines and an etiology hunt can find TIA, which will indicate a coming stroke. She warn that to miss TIA is to miss an opportunity window 



Drip and Ship Thrombolytic Therapy
Jennifer Cohn, MSN, CNRN, Indiana University Health Presentation slides
This presentation is to open discussion of the development of partnerships with emergent stroke ready hospitals.
What a great idea - I wonder how this would work, or if it could work in the developing world?


SWALLOW-3D, a Simple 2-minute Bedside Screening Test, Detects Dysphagia in Acute Stroke Patients With High Sensitivity When Validated Against Video-Fluoroscopy
Jeff Edmiaston, Washington University in St. Louis Presentation slides
Certainly an interesting presentation; however, some factors seem to missing which makes the study less than comprehensive; though a great possible screening tool - IJS looks forward to gathering further information on this study.

South African Stroke Guidelines article in IJS inbox

The South African Guideline for the Management of Ischaemic Stroke and TIA: Recommendations for a resource constrained health care setting JUST ARRIVED IN IJS inbox; very excited - an excellent piece from Alan Bryer and co. (Bryer A, Connor MD, Haug P, Cheyip B, Staub H, Tipping B, Duim B, Pinkney-Atkinson V).

OBJECTIVE

Stroke is a leading cause of death and disability in South Africa. As in other developing countries, an increase in the burden of stroke is predicted as the population is undergoing a rapid epidemiological transition with increased exposure to, and development of, stroke risk factors, together with aging of the population.

Most published stroke guidelines emanate from developed countries that have more comprehensive stroke services and resources available for their citizens. Such guidelines are therefore not always applicable to countries with limited resources.

The objective of the South African Stroke Guideline  was to develop realistic and appropriate recommendations within the current South African context of a resource constrained health care system.

Stroke resources in Indonesia - coming to Early view

Stroke resources in Indonesia are limited; however, there has been demand to include nonbiomedical practitioners in stroke care. This paper will present a snapshot of available non-biomedical stroke ‘services’ used by stroke survivors in two subdistricts of Aceh, Indonesia. Data were collected through interviews, observations, focus groups and vignettes with stroke survivors and their carers. All practitioners discussed and demonstrated an understanding and approach to stroke treatment with multiple layers of influence, predominantly, education, religion and culture. There were a number of areas of overlap between the two categories; some of these influences were also evident in the biomedical practitioners.

Emotional stress can change brain function

The Journal of Neuroscience has recently published 'Emotional stress can change brain function' a fascinating study the researchers found that a five-minute exposure to the odor of a predator produced the insertion of receptors containing GluR2 at the connections (synapses) between nerve cells in the brain 

Early view - How to cite an Early View article.

We decided earlier this year to embark on 'Early View' as a way to expedite the publication of our ever increasing manuscript pile. We realize that authors want their manuscripts published as soon as possible; for grants and funding; to increase personal citations, and to share important information with the stroke community. Early View is now online. This means that once the reviewer and revision process is complete and your manuscript has been accepted, we'll copyedit, and make a proof. Once you approve the article will be placed online and can be cited.


Early View articles may not yet be allocated to a print edition, meaning that they do not yet have volume, issue or page numbers, therefore Early View articles cannot be cited in the traditional way. They are given a Digital Object Identifier (DOI), which allows the article to be cited and tracked before it is allocated to an issue. When you cite an article that is not yet published in print but is  published on Early View, you may do so by citing the DOI. After print publication, the DOI remains valid and can continue to be used to cite and access the article.

Sneak peek - what's coming to print in IJS this year!

“Better wear out sheets than shoes” A Survey of 202 Stroke Professionals´ Early Mobilisation Practices and Concerns

Monica Skarin1, Julie Bernhardt2, Anna Sjo¨ holm1, Michael Nilsson1, and Thomas Linden1

Background Stroke unit care improves the outcome for patients.

One component responsible for this may be that

patients are mobilised earlier and more intensively. An ongoing

randomised controlled trial is investigating the potential

benefits of early mobilisation, but currently there is

limited evidence for the practice. Therefore, current practices

may be driven by historical precedent and/or clinical opinion,

and varying approaches to mobilisation are likely. This study

aims to examine different health professionals’ concerns

regarding early mobilisation in acute stroke. In this study,

early mobilisation was defined as frequent out of bed activities

within the first 24 h after stroke onset.

Methods A nine-item anonymous questionnaire exploring

benefits and harms with early mobilisation after stroke was

used during interviews of stroke care professionals attending

the annual Australasian stroke conference in 2008.

Results The survey was completed by 202 professionals,

representing 38% of all conference attendees. 65% were

females, 50% under 40-years old, 46% worked in acute stroke

and 31% in rehabilitation. Thirty-five percent were nurses,

26% medical doctors, 19% physiotherapists and 12% occupational

therapists. Two-thirds had o10-years experience with

stroke. Sixty percent of the surveyed professionals had concerns

about early mobilisation and there were significantly

more professionals concerned about early mobilisation for

haemorrhagic (59%) than ischaemic (23%) stroke patients.

Conclusion Our study shows that most clinicians had concerns

in relation to early mobilisation of stroke patients and

more clinicians had concerns for haemorrhagic than for

ischaemic stroke. The evidence underlying these concerns is

shallow.

WSC Seoul Korea

http://www.world-stroke.org/education_webcasts.asp

The World Stroke Organization host the World Stroke Congress every two years; this year in Seoul, Korea. The meeting attendance is projected at over 3000 attendees - many of those from Korea. The program has been quite varied, as you would expect from a global conference. I understand that the WSO has a no rejection policy which is a wonderful way to be inclusive. There was some mention among some groups that this may lower the quality of the meeting, this remains to be seen but there is such a great presence and support from so many excellent strokologists at the actual meeting the quality of the meeting will be maintained and developed in others way - the ESC turned 20 this year so still early days yet!  The International Journal of Stroke held their Editorial Board meeting on Friday the 15th with excellent attendance and celebratory champagne. The outcome of the meeting was to continue to develop our successful ideas and innovations which have made us quite a hit with our readership and our publisher!

Padma Gunaratne receiving the World Stroke Day Award for Sri Lanka from Bo Norrving President of the Wold Stroke Organization.