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Welsh Stroke Portfolio Studies - All

Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
BIG CACTUS

A study to assess the clinical cost effectiveness of aphasia computer treatment versus usual stimulation or attention control long term post stroke (CACTUS)
For more information please visit,https://www.sheffield.ac.uk/scharr/sections/dts/ctru/bigcactus

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Characterizing Clot Microstructure in Atrial Fibrillation and Stroke

Stroke and Atrial fibrillation especially in South Wales are major diseases resulting in a significant social and economic burden. It has long been argued that AF and stroke unfavourably alter how the blood clots, however, there is no available test that can provide a numerical description of blood clotting quality in a clinical setting. The main goal of this observational study is to validate a novel test of clot quality, fractal dimension (df) in atrial fibrillation patients with and without stroke. This study aims to determine whether these patients are more likely to produce substantially modified clots that results in poorer clot quality and how these patients respond to anti coagulation (blood thinning) therapy. To do this a baseline blood sample will be taken for 2 different groups: atrial fibrillation patients suffering a stroke and atrial fibrillation patients without stroke. These patients will then receive oral anticoagulant therapy, following which a second sample will be taken to determine whether they improve clotting quality. The results of the second blood test will be compared to the results of their matched baseline for each participant to ascertain what effect oral anticoagulation has on clotting quality.

For more information please visit,
https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/characterizing-clot-microstructure-in-atrial-fibrillation-and-stroke/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
COMPOSEd – [Exploring the Barriers to Effective CO-morbidity Management POSt-StrokE with a Focus on Hypertension and Diabetes]

COMPOSEd is a study of patients’ and healthcare professionals’ experiences and opinions of diabetes and blood pressure management after a stroke. For more information please visit: https://public-odp.nihr.ac.uk/QvAJAXZfc/opendoc.htm?document=CRNCC_Users%2FFind%20A%20Clinical%20Research%20Study.qvw&sheet=SH01&bookmark=Document%5CBM02&select=LB01,=StudyID=38049

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
CONVINCECOichichine for preventioN of vascular Inflammation in Non-CardioEmbolic stroke

This study evaluates the use of Colchicine in adults over 40 years of age who have suffered an ischaemic stroke or transient ischaemic attack NOT caused by cardiac embolism or other defined causes. Patients will be randomised to 0.5 mg/day of Colchicine plus usual care, or to usual care alone.
To investigate the efficacy of low dose colchicine (0.5mg/day) plus usual care (defined as antiplatelet, lipid-lowering, antihypertensive treatment, and appropriate lifestyle advice) compared with usual care alone to prevent non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest, hospitalization for unstable angina and vascular death after ischaemic stroke or transient ischaemic attack (TIA) not caused by cardiac embolism or other defined causes unrelated to atherosclerosis
For more information please visit,https://clinicaltrials.gov/ct2/show/NCT02898610

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Delivery of Patient Reported Health Status Questions in Stroke

A Patient Reported Outcome Measure (PROM) is a questionnaire that asks patients for their views on their own health or the impact of healthcare they have received on their health and quality of life\n\nThere is a PROM (the PROMIS-10 Global Health) and a number of extra questions that are recommended for use in people who have had a stroke by the International Consortium for Health Outcomes Measurement, but the best way of delivering these questions for stroke survivors is unknown.\n\nAt present, the NHS in England, Scotland and Wales are required to offer every stroke survivors a 6 month post stroke follow-up appointment. Currently, the information collected at this 6 month review is not from the patient’s perspective and the best method of collecting this information has not been established.\n\nThe aim of this research is to understand if there is a difference between 4 methods of administration using a grouping of Patient Reported Health Status Questions (PRHSQs) in people who have had a stroke. \n\nThe four methods of administration are: \n\n-\tFace-to-Face\n-\tTelephone\n-\tOnline\n-\tPost\nTo conduct this research study four initial Principal Investigators in 4 sites have agreed to take part. Aneurin Bevan Health Board will hold 3 sites and Cwm Taf University Health Board will hold 1 site. Between each site a sample of 808 eligible stroke survivors will be asked to take part. From these 808 people, 202 participants will be randomly assigned to each method of administration. \n\nThe study data collection will run concurrent from 1st June 2017 to 31st December 2017. \n\nThe conclusions of this research will inform the roll-out of the most appropriate method of delivering the 6 month stroke follow-up review for stroke survivors.

For more information please visit,
https://clinicaltrials.gov/ct2/show/NCT03177161

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
ELAN Early versus late initiation of direct oral anticoagulants in post-ischaemic stroke patients with non-valvular atrial fibrillation

The ELAN trial aims to estimate the net benefit of early versus late (current standard practice) initiation of direct oral anticoagulants (DOACs) in patients with acute ischaemic stroke related to atrial fibrillation.
For more information please visit,https://www.elan-trial.ch/about-the-trial/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
ENCHANTED Enhanced Control of Hypertension and Thrombolysis Stroke Study

ENCHANTED is an independent, investigator initiated, international collaborative, quasi-factorial randomised controlled trial involving a package of 2 linked comparative randomised treatment arms, which aims to address 4 key questions in patients eligible for thrombolysis in the acute phase of ischaemic stroke. (1) Does low-dose (0.6 mg/kg) intravenous (i.v.) recombinant tissue plasminogen activator (rtPA) provide equivalent benefits compared to standard-dose (0.9 mg/kg) rtPA? (2) Does intensive blood pressure (BP) lowering (130-140 mmHg systolic target) improve outcomes compared to the current guideline recommended level of BP control (180 mmHg systolic target)? (3) Does low-dose (0.6 mg/kg) intravenous (i.v.) recombinant tissue plasminogen activator (rtPA) reduce the risk of symptomatic intracerebral haemorrhage (sICH)? (4) Does the addition of intensive BP lowering to thrombolysis with rtPA reduce the risk of any intracerebral haemorrhage (ICH)?
For more information please visit,
https://clinicaltrials.gov/ct2/show/NCT01422616

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
EoLCASS: End of Life Care in Acute Stroke Setting

After a severe stroke, prognosis is often poor and consequently high quality end-of-life care is very important. Recognising that a person may be in the final phase of life is very difficult and end-of-life care conversations can be delayed. This means that peoples’ end-of-life care wishes and needs may not be identified until the very end of life. Yet at this point it may be too late address particular wishes and/or needs. The transition to end-of-life care could be eased through excellent, sensitive communication and advance care planning. At a time when life expectancy may be cut short this may improve patients’ and families’ experiences of care, enhance care quality, quality of life and family outcomes.

This study aims to understand end-of-life care in severe stoke in the stroke ward setting from the standpoint of bereaved family members of people who died before and after the introduction of an advance care planning staff training intervention. We will use face-to-face interviews with up to 16 bereaved family members of people who died in the hospital stroke ward following a severe stroke. Interviews will take place either in participants’ own homes or in the University. We hope the findings will help us to better understand bereaved families’ experiences of end-of-life care and the effect, if any, of staff training to improve advance care planning. This is important as currently we know very little about end of life care in stroke wards and the extent to which this care is consistent with UK and Welsh Government policy and guidance. This study will enable a foundation for enhancing end-of-life care in severe stroke in acute hospital settings and use of advance care planning and the new All Wales Care Decisions for the Last Days of Life guidance.

For more information please visit: https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/eolcass-end-of-life-care-in-acute-stroke-setting/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Evaluating an extended rehabilitation service for stroke patients

Stroke in Young Adults: What is the metabolic and mechanical cost of walking of working and what are the implications for rehabilitation?

This research study led by Dr Hannah Jarvis and Professor Neil Reeves from Manchester Metropolitan University and funded by the Stroke Hub Wales aims to investigate how a stroke in young adults affects the energy required to walk (known as the metabolic cost of walking) compared to able-bodied age-matched controls that have not experienced a stroke and to understand the underlying mechanisms for potential impairments in their gait pattern. This research study has captured energy expenditure, joint kinematics and kinetics during walking and quality of life of young adults who have had a stroke and compared to healthy able-bodied controls. The outcome of this research will be used to inform rehabilitation guidelines specific for younger adults following stroke. This research study is registered on the NIHR portfolio (CPMS – 39832).

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
FOCUS The effect (s) of routine administration of Fluoxetine in patients with a recent stroke

The FOCUS trial is aims to establish whether a six month course of fluoxetine, started within the first 15 days after an acute stroke, improves patients recovery over the first year. Also whether the treatment is cost effective (i.e. that any costs associated with the treatment are offset by health gains, and or reductions in healthcare and social care costs. This research aims to improve the care received by NHS patients and the use of NHS resources. Recruitment to the trial closed on the 31st March 2017. 3127 participants were recruited to the trial. The final patient and GP follow-ups for the patients recruited on the 31st March 2017 are due on 31st March 2018.
For more information please visit,
http://www.focustrial.org.uk/default.html cl.ac.uk/extrastrial/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
HeadPoST Version 2.1 Head Position in Stroke Trial

This study is an investigator-initiated and conducted, international collaborative, regionally organised, multicentre, prospective, cluster randomised, crossover, blinded outcome assessment study to compare the effectiveness of the lying flat (0°) head position with the sitting up (=30°) head position, in the first 24 hours of admission to hospital for patients with acute stroke, on the poor outcome of death or disability over the subsequent 90 days.
For more information please visit,
https://www.georgeinstitute.org/projects/head-position-in-stroke-trial-headpost

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Long-term Registry of Patients with Atrial Fibrillation UK Extension (AF-GEN-UK) Study

Given the advances in the management of atrial fibrillation (an irregular heart rhythm), especially the new medications for stroke prevention, and the availability of new European Society of Cardiology (ESC) clinical guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of atrial fibrillation. There is currently a registry collecting data on how cardiologists (specialists in conditions of the heart) manage and treat patients with atrial fibrillation in 55 countries in Europe. Data is being collected on how cardiologists in the UK manage patients with atrial fibrillation. However, in the UK, patients with atrial fibrillation are also managed by other doctors, particularly their general practitioner (GPs), accident and emergency (A&E) doctors (when admitted to hospital), stroke doctors (when atrial fibrillation is diagnosed after a stroke has occurred) and by acute medicine doctors (as atrial fibrillation is more common among people aged 65 years and older). This study will allow us to compare how patients with atrial fibrillation are managed by heart specialists (cardiologists) and other doctors (non-heart specialists). The purpose of collecting this data is to see if atrial fibrillation patients are managed in line with clinical guidelines. In this UK extension study we will recruit up to 1650 atrial fibrillation managed by GPs, cardiologists, A&E, stroke, and acute medicine doctors. Demographic (e.g. age, sex, ethnicity etc.) and clinical (e.g. other health problems, medications, operations etc.) information will be recorded at baseline and then the patient will be followed up 12 months later to see how their healthcare is managed over time. The follow-up will involve the patient visiting the hospital and/or review of their medical records and/or telephone call with the patient or their GP, according to the usual practice of the medical specialty who is managing the patient. For more information please visit https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/af-gen-uk-uk-extension-of-long-term-registry-of-atrial-fibrillation/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
LoTS2Care A longer-term care strategy for stroke – a feasibility study

This feasibility study is the 5th of five work streams funded by an NIHR Programme Grant to develop and evaluate key aspects of a replicable system of longer-term service delivery ‘care strategy’. The emphasis is on improving quality of life by addressing unmet needs and enhancing participation. In previous workstreams, work has focused on development of an intervention, to be delivered by community-based staff, called ‘New Start’
For more information please visit,
https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/longer-term-support-for-stroke-survivors-and-their-carers/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
MORe PREcISE – MORbidity PRevalence Estimate In StrokE (Morbidity Prevalence Estimate at six months, following a Stroke: A Cohort Study)

Waiting for information

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
National Institute for Health Research BioResource – Rare Diseases

For more information please visit

https://bioresource.nihr.ac.uk/rare-diseases/rare-diseases/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Neurofeedback for functional motor recovery after stroke.

Waiting on information

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
PASTA Paramedic Acute Stroke Treatment Assessment

Paramedic Acute Stroke Treatment Assessment – This research study is a clinical trial to determine whether a Paramedic Acute Stroke Treatment Assessment (PASTA) pathway can speed up access to emergency stroke treatments, especially thrombolysis treatment, and so improve recovery after stroke. Participants receive either usual emergency stroke care or the additional PASTA pathway.
For more information please visit,
https://research.ncl.ac.uk/pasta/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
PLORAS Predicting Language Outcome and Recovery After Stroke

PLORAS is a research project looking at recovery of language difficulties after stroke (aphasia).
Aim: to give future stroke survivors a prediction about their aphasia recovery.
For more information please visit,
http://www.ucl.ac.uk/ploras

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
R4VAD Rate, risks and routes to reduce vascular dementia

For more information please visit,https://www.nottingham.ac.uk/research/groups/stroke/clinical-stroke-trials/index.aspx

https://www.ed.ac.uk/clinical-sciences/edinburgh-imaging/research/themes-and-topics/body-systems/brain-nervous-system/stroke/r4vad

 

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Real-time functional magnetic resonance imaging (fMRI) neurofeedback for functional motor recovery after stroke.

For more information please visit: https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/neurofeedback-for-functional-motor-recovery-after-stroke/

Publication link: https://www.ncbi.nlm.nih.gov/pubmed/27213774

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
RESTART Restart or stop antithrombotics randomised trial.

Restart or stop antithrombotics randomised trial. For adults surviving spontaneous (non-traumatic) intracerebral haemorrhage (ICH) who had taken and antithrombotic (ie anticoagulant or antiplatelet) drug for the prevention of vaso-occlusive disease before ICH, does a policy of starting antiplatelet therapy result in a beneficial net reduction of all serious vascular events over two years compared with a policy of avoiding antiplatelet therapy?
For more information please visit,
http://restarttrial.org/default.html

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
RIGHT-2 Rapid intervention with glyceryl trinitrate in hypertensive stroke trial

Rapid intervention with glyceryl trinitrate in hypertensive stroke trial – assessment of safety and efficacy of transdermal GTN, and the feasibility of a multicentre ambulance-based stroke trial
For more information please visit,
http://right-2.ac.uk/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
RIVER Registry – RIVaroxaban Evaluation in Real life setting

To discover outcomes of patients treated with Rivaroxaban with atrial fibrillation with at least one additional investigator-determined risk factor for stroke in real-life practice. For more information please visit,
https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/river-registry-rivaroxaban-evaluation-in-real-life-setting/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Rospective, open-label study of andexanet alfa in patients receiving a factor xa inhibitor who have acute major bleeding (annexa-4)

In patients receiving a factor Xa inhibitor who are experiencing an acute major bleed, the objectives of this study are to demonstrate the decrease in anti-fXa activity and to evaluate hemostatic efficacy following andexanet treatment. Form ore information please visit http://www.phri.ca/research-study/annexa-4/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Start or STop Anticoagulants Randomised Trial (SoSTART) after spontaneous intracranial haemorrhage

Bleeding within the skull, also known as brain haemorrhage, affects 3 million people in the world each year.

One in five people who survive brain haemorrhage have an irregular heart rhythm called ‘atrial fibrillation’, which puts them at risk of stroke and other blood clots.

Blood-thinning medicines, known as ‘anticoagulant’ drugs, are used in everyday clinical practice to protect people with atrial fibrillation from developing blood clots. However, these drugs also increase the risk of bleeding and are usually stopped when the brain haemorrhage occurs.

But when patients recover from brain haemorrhage, they and their doctors are often uncertain about whether to start or stop these drugs to prevent further clots occurring, or whether to avoid them in case they increase the risk of brain haemorrhage happening again.

Investigators want to find out whether starting or not starting an anticoagulant drugs is better for those patients.

A network of hospital doctors, nurses, and other staff will identify people who survive brain haemorrhage and have atrial fibrillation. If a patient and their doctor are uncertain about whether to start an anticoagulant drug, they may invite the patient to participate.

In the pilot phase, investigators aim to recruit at least 60 participants to determine the feasibility of recruiting the target sample size of at least 800 participants in the main phase of the trial.

Investigators will follow-up all participants for at least one year to determine whether prescribing an anticoagulant drug reduces the occurrence of all serious vascular events like heart attack, stroke compared with a policy of avoiding oral anticoagulant. For more information please visit: https://clinicaltrials.gov/ct2/show/NCT03153150

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Stroke In Young Adults

Stroke in Young Adults: What is the metabolic and mechanical cost of walking of working and what are the implications for rehabilitation?

This research study led by Dr Hannah Jarvis and Professor Neil Reeves from Manchester Metropolitan University and funded by the Stroke Hub Wales aims to investigate how a stroke in young adults affects the energy required to walk (known as the metabolic cost of walking) compared to able-bodied age-matched controls that have not experienced a stroke and to understand the underlying mechanisms for potential impairments in their gait pattern. This research study has captured energy expenditure, joint kinematics and kinetics during walking and quality of life of young adults who have had a stroke and compared to healthy able-bodied controls. The outcome of this research will be used to inform rehabilitation guidelines specific for younger adults following stroke. This research study is registered on the NIHR portfolio (CPMS – 39832).

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Stroke Peer Support and Coaching

Waiting for information

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
STROLLERS Stroke Life and Leisure Research Survey

Waiting for information

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
TICH2 Tranexamic acid for IntraCerebral Haemorrhage

When someone has a stroke caused by bleeding into the brain (haemorrhagic stroke) permanent brain damage can occur and result in long-term disability. There is also a chance that the bleeding can increase, which may cause worse disability or be life threatening. This happens in approximately 20-30% of haemorrhagic stroke patients. At present there is no available treatment that is effective at reducing the bleeding in the brain and improving the recovery. In this trial, we want to test whether it is possible to give a drug (tranexamic acid) to people in the first few hours after a haemorrhagic stroke. We hope that we will be able to show that giving the drug may reduce the chances of dying and being left with disability after a haemorrhagic stroke. In this trial, the treatment we are testing is a drug, tranexamic acid, which encourages blood to clot to stop the bleeding. Continued or increased bleeding into the brain (haematoma expansion) is not uncommon in the first hours and days following a haemorrhagic stroke and increases the risk of the patient not recovering fully and being left with some disability. Stopping the bleeding in the first hours and days after stroke with medicine might help patients to recover better. Tranexamic acid is a tried and tested drug in other medical conditions that acts quickly to help the blood to clot and stop bleeding but is not given routinely after stroke. The aim of this study is to assess what effect tranexamic acid has on how people recover after a haemorrhagic stroke.
For more information please visit http://tich-2.org/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
TIME – Treatment in Morning Versus Evening

Treatment in Morning versus Evening (TIME) is a study to compare the treatment for high blood pressure using hypertensive drugs given in the evening with the usual morning medication. This is done using an online system to record any side effects or changes due to the change in their medication. This automated system has worked well in our initial phase of this study with good patient response. Record-linkage to hospitalisations and deaths will be carried out and events monitored. Heart attack, stroke or death will be recorded and analysed to see if the timing of the medication has any impact. For more information please visit: https://www.bhf.org.uk/research-projects/treatment-in-the-morning-versus-evening-time-study

Publication link: https://www.ncbi.nlm.nih.gov/pubmed/29169373

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Trajectories of Outcome in Neurological Conditions: Quality of Life (QoL) and neurological disease – Phase 2 Demographics and Clinical Info

Quality of Life (QoL) for people with disabling neurological conditions is affected by a range of factors, which have received considerable previous research attention. However clinicians’ knowledge could be enhanced by two areas of additional enquiry. For more information please visit: https://wessexhealthlines.nhs.uk/health-lines/researchline/studies-list/trajectories_of_outcome_in_neurological_conditions_quality_of_life_qol_and_neurological_disease_-_phase_2_demographics_and_clini1/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Trajectories of Outcome in Neurological Conditions: Quality of Life (QoL) and neurological disease Sub- Phase 3 Consent and questionnaire

Quality of Life (QoL) for people with disabling neurological conditions is affected by a range of factors, which have received considerable previous research attention. However clinicians’ knowledge could be enhanced by two areas of additional enquiry. For more information please visit:https://wessexhealthlines.nhs.uk/health-lines/researchline/studies-list/trajectories_of_outcome_in_neurological_conditions_quality_of_life_qol_and_neurological_disease_sub-_phase_3_consent_and_questio/

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Welsh Stroke Portfolio Studies (Closed)

Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
BIG CACTUS

A study to assess the clinical cost effectiveness of aphasia computer treatment versus usual stimulation or attention control long term post stroke (CACTUS)
For more information please visit,https://www.sheffield.ac.uk/scharr/sections/dts/ctru/bigcactus

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Delivery of Patient Reported Health Status Questions in Stroke

A Patient Reported Outcome Measure (PROM) is a questionnaire that asks patients for their views on their own health or the impact of healthcare they have received on their health and quality of life\n\nThere is a PROM (the PROMIS-10 Global Health) and a number of extra questions that are recommended for use in people who have had a stroke by the International Consortium for Health Outcomes Measurement, but the best way of delivering these questions for stroke survivors is unknown.\n\nAt present, the NHS in England, Scotland and Wales are required to offer every stroke survivors a 6 month post stroke follow-up appointment. Currently, the information collected at this 6 month review is not from the patient’s perspective and the best method of collecting this information has not been established.\n\nThe aim of this research is to understand if there is a difference between 4 methods of administration using a grouping of Patient Reported Health Status Questions (PRHSQs) in people who have had a stroke. \n\nThe four methods of administration are: \n\n-\tFace-to-Face\n-\tTelephone\n-\tOnline\n-\tPost\nTo conduct this research study four initial Principal Investigators in 4 sites have agreed to take part. Aneurin Bevan Health Board will hold 3 sites and Cwm Taf University Health Board will hold 1 site. Between each site a sample of 808 eligible stroke survivors will be asked to take part. From these 808 people, 202 participants will be randomly assigned to each method of administration. \n\nThe study data collection will run concurrent from 1st June 2017 to 31st December 2017. \n\nThe conclusions of this research will inform the roll-out of the most appropriate method of delivering the 6 month stroke follow-up review for stroke survivors.

For more information please visit,
https://clinicaltrials.gov/ct2/show/NCT03177161

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
ENCHANTED Enhanced Control of Hypertension and Thrombolysis Stroke Study

ENCHANTED is an independent, investigator initiated, international collaborative, quasi-factorial randomised controlled trial involving a package of 2 linked comparative randomised treatment arms, which aims to address 4 key questions in patients eligible for thrombolysis in the acute phase of ischaemic stroke. (1) Does low-dose (0.6 mg/kg) intravenous (i.v.) recombinant tissue plasminogen activator (rtPA) provide equivalent benefits compared to standard-dose (0.9 mg/kg) rtPA? (2) Does intensive blood pressure (BP) lowering (130-140 mmHg systolic target) improve outcomes compared to the current guideline recommended level of BP control (180 mmHg systolic target)? (3) Does low-dose (0.6 mg/kg) intravenous (i.v.) recombinant tissue plasminogen activator (rtPA) reduce the risk of symptomatic intracerebral haemorrhage (sICH)? (4) Does the addition of intensive BP lowering to thrombolysis with rtPA reduce the risk of any intracerebral haemorrhage (ICH)?
For more information please visit,
https://clinicaltrials.gov/ct2/show/NCT01422616

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
EoLCASS: End of Life Care in Acute Stroke Setting

After a severe stroke, prognosis is often poor and consequently high quality end-of-life care is very important. Recognising that a person may be in the final phase of life is very difficult and end-of-life care conversations can be delayed. This means that peoples’ end-of-life care wishes and needs may not be identified until the very end of life. Yet at this point it may be too late address particular wishes and/or needs. The transition to end-of-life care could be eased through excellent, sensitive communication and advance care planning. At a time when life expectancy may be cut short this may improve patients’ and families’ experiences of care, enhance care quality, quality of life and family outcomes.

This study aims to understand end-of-life care in severe stoke in the stroke ward setting from the standpoint of bereaved family members of people who died before and after the introduction of an advance care planning staff training intervention. We will use face-to-face interviews with up to 16 bereaved family members of people who died in the hospital stroke ward following a severe stroke. Interviews will take place either in participants’ own homes or in the University. We hope the findings will help us to better understand bereaved families’ experiences of end-of-life care and the effect, if any, of staff training to improve advance care planning. This is important as currently we know very little about end of life care in stroke wards and the extent to which this care is consistent with UK and Welsh Government policy and guidance. This study will enable a foundation for enhancing end-of-life care in severe stroke in acute hospital settings and use of advance care planning and the new All Wales Care Decisions for the Last Days of Life guidance.

For more information please visit: https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/eolcass-end-of-life-care-in-acute-stroke-setting/

ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Evaluating an extended rehabilitation service for stroke patients

Stroke in Young Adults: What is the metabolic and mechanical cost of walking of working and what are the implications for rehabilitation?

This research study led by Dr Hannah Jarvis and Professor Neil Reeves from Manchester Metropolitan University and funded by the Stroke Hub Wales aims to investigate how a stroke in young adults affects the energy required to walk (known as the metabolic cost of walking) compared to able-bodied age-matched controls that have not experienced a stroke and to understand the underlying mechanisms for potential impairments in their gait pattern. This research study has captured energy expenditure, joint kinematics and kinetics during walking and quality of life of young adults who have had a stroke and compared to healthy able-bodied controls. The outcome of this research will be used to inform rehabilitation guidelines specific for younger adults following stroke. This research study is registered on the NIHR portfolio (CPMS – 39832).

ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
FOCUS The effect (s) of routine administration of Fluoxetine in patients with a recent stroke

The FOCUS trial is aims to establish whether a six month course of fluoxetine, started within the first 15 days after an acute stroke, improves patients recovery over the first year. Also whether the treatment is cost effective (i.e. that any costs associated with the treatment are offset by health gains, and or reductions in healthcare and social care costs. This research aims to improve the care received by NHS patients and the use of NHS resources. Recruitment to the trial closed on the 31st March 2017. 3127 participants were recruited to the trial. The final patient and GP follow-ups for the patients recruited on the 31st March 2017 are due on 31st March 2018.
For more information please visit,
http://www.focustrial.org.uk/default.html cl.ac.uk/extrastrial/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
HeadPoST Version 2.1 Head Position in Stroke Trial

This study is an investigator-initiated and conducted, international collaborative, regionally organised, multicentre, prospective, cluster randomised, crossover, blinded outcome assessment study to compare the effectiveness of the lying flat (0°) head position with the sitting up (=30°) head position, in the first 24 hours of admission to hospital for patients with acute stroke, on the poor outcome of death or disability over the subsequent 90 days.
For more information please visit,
https://www.georgeinstitute.org/projects/head-position-in-stroke-trial-headpost

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Long-term Registry of Patients with Atrial Fibrillation UK Extension (AF-GEN-UK) Study

Given the advances in the management of atrial fibrillation (an irregular heart rhythm), especially the new medications for stroke prevention, and the availability of new European Society of Cardiology (ESC) clinical guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of atrial fibrillation. There is currently a registry collecting data on how cardiologists (specialists in conditions of the heart) manage and treat patients with atrial fibrillation in 55 countries in Europe. Data is being collected on how cardiologists in the UK manage patients with atrial fibrillation. However, in the UK, patients with atrial fibrillation are also managed by other doctors, particularly their general practitioner (GPs), accident and emergency (A&E) doctors (when admitted to hospital), stroke doctors (when atrial fibrillation is diagnosed after a stroke has occurred) and by acute medicine doctors (as atrial fibrillation is more common among people aged 65 years and older). This study will allow us to compare how patients with atrial fibrillation are managed by heart specialists (cardiologists) and other doctors (non-heart specialists). The purpose of collecting this data is to see if atrial fibrillation patients are managed in line with clinical guidelines. In this UK extension study we will recruit up to 1650 atrial fibrillation managed by GPs, cardiologists, A&E, stroke, and acute medicine doctors. Demographic (e.g. age, sex, ethnicity etc.) and clinical (e.g. other health problems, medications, operations etc.) information will be recorded at baseline and then the patient will be followed up 12 months later to see how their healthcare is managed over time. The follow-up will involve the patient visiting the hospital and/or review of their medical records and/or telephone call with the patient or their GP, according to the usual practice of the medical specialty who is managing the patient. For more information please visit https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/af-gen-uk-uk-extension-of-long-term-registry-of-atrial-fibrillation/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
LoTS2Care A longer-term care strategy for stroke – a feasibility study

This feasibility study is the 5th of five work streams funded by an NIHR Programme Grant to develop and evaluate key aspects of a replicable system of longer-term service delivery ‘care strategy’. The emphasis is on improving quality of life by addressing unmet needs and enhancing participation. In previous workstreams, work has focused on development of an intervention, to be delivered by community-based staff, called ‘New Start’
For more information please visit,
https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/longer-term-support-for-stroke-survivors-and-their-carers/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Neurofeedback for functional motor recovery after stroke.

Waiting on information

ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
PASTA Paramedic Acute Stroke Treatment Assessment

Paramedic Acute Stroke Treatment Assessment – This research study is a clinical trial to determine whether a Paramedic Acute Stroke Treatment Assessment (PASTA) pathway can speed up access to emergency stroke treatments, especially thrombolysis treatment, and so improve recovery after stroke. Participants receive either usual emergency stroke care or the additional PASTA pathway.
For more information please visit,
https://research.ncl.ac.uk/pasta/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Real-time functional magnetic resonance imaging (fMRI) neurofeedback for functional motor recovery after stroke.

For more information please visit: https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/neurofeedback-for-functional-motor-recovery-after-stroke/

Publication link: https://www.ncbi.nlm.nih.gov/pubmed/27213774

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
RESTART Restart or stop antithrombotics randomised trial.

Restart or stop antithrombotics randomised trial. For adults surviving spontaneous (non-traumatic) intracerebral haemorrhage (ICH) who had taken and antithrombotic (ie anticoagulant or antiplatelet) drug for the prevention of vaso-occlusive disease before ICH, does a policy of starting antiplatelet therapy result in a beneficial net reduction of all serious vascular events over two years compared with a policy of avoiding antiplatelet therapy?
For more information please visit,
http://restarttrial.org/default.html

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
RIGHT-2 Rapid intervention with glyceryl trinitrate in hypertensive stroke trial

Rapid intervention with glyceryl trinitrate in hypertensive stroke trial – assessment of safety and efficacy of transdermal GTN, and the feasibility of a multicentre ambulance-based stroke trial
For more information please visit,
http://right-2.ac.uk/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
RIVER Registry – RIVaroxaban Evaluation in Real life setting

To discover outcomes of patients treated with Rivaroxaban with atrial fibrillation with at least one additional investigator-determined risk factor for stroke in real-life practice. For more information please visit,
https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/river-registry-rivaroxaban-evaluation-in-real-life-setting/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Rospective, open-label study of andexanet alfa in patients receiving a factor xa inhibitor who have acute major bleeding (annexa-4)

In patients receiving a factor Xa inhibitor who are experiencing an acute major bleed, the objectives of this study are to demonstrate the decrease in anti-fXa activity and to evaluate hemostatic efficacy following andexanet treatment. Form ore information please visit http://www.phri.ca/research-study/annexa-4/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Stroke Peer Support and Coaching

Waiting for information

ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
TICH2 Tranexamic acid for IntraCerebral Haemorrhage

When someone has a stroke caused by bleeding into the brain (haemorrhagic stroke) permanent brain damage can occur and result in long-term disability. There is also a chance that the bleeding can increase, which may cause worse disability or be life threatening. This happens in approximately 20-30% of haemorrhagic stroke patients. At present there is no available treatment that is effective at reducing the bleeding in the brain and improving the recovery. In this trial, we want to test whether it is possible to give a drug (tranexamic acid) to people in the first few hours after a haemorrhagic stroke. We hope that we will be able to show that giving the drug may reduce the chances of dying and being left with disability after a haemorrhagic stroke. In this trial, the treatment we are testing is a drug, tranexamic acid, which encourages blood to clot to stop the bleeding. Continued or increased bleeding into the brain (haematoma expansion) is not uncommon in the first hours and days following a haemorrhagic stroke and increases the risk of the patient not recovering fully and being left with some disability. Stopping the bleeding in the first hours and days after stroke with medicine might help patients to recover better. Tranexamic acid is a tried and tested drug in other medical conditions that acts quickly to help the blood to clot and stop bleeding but is not given routinely after stroke. The aim of this study is to assess what effect tranexamic acid has on how people recover after a haemorrhagic stroke.
For more information please visit http://tich-2.org/

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Welsh Stroke Portfolio Studies (Open)

Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Characterizing Clot Microstructure in Atrial Fibrillation and Stroke

Stroke and Atrial fibrillation especially in South Wales are major diseases resulting in a significant social and economic burden. It has long been argued that AF and stroke unfavourably alter how the blood clots, however, there is no available test that can provide a numerical description of blood clotting quality in a clinical setting. The main goal of this observational study is to validate a novel test of clot quality, fractal dimension (df) in atrial fibrillation patients with and without stroke. This study aims to determine whether these patients are more likely to produce substantially modified clots that results in poorer clot quality and how these patients respond to anti coagulation (blood thinning) therapy. To do this a baseline blood sample will be taken for 2 different groups: atrial fibrillation patients suffering a stroke and atrial fibrillation patients without stroke. These patients will then receive oral anticoagulant therapy, following which a second sample will be taken to determine whether they improve clotting quality. The results of the second blood test will be compared to the results of their matched baseline for each participant to ascertain what effect oral anticoagulation has on clotting quality.

For more information please visit,
https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/characterizing-clot-microstructure-in-atrial-fibrillation-and-stroke/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
COMPOSEd – [Exploring the Barriers to Effective CO-morbidity Management POSt-StrokE with a Focus on Hypertension and Diabetes]

COMPOSEd is a study of patients’ and healthcare professionals’ experiences and opinions of diabetes and blood pressure management after a stroke. For more information please visit: https://public-odp.nihr.ac.uk/QvAJAXZfc/opendoc.htm?document=CRNCC_Users%2FFind%20A%20Clinical%20Research%20Study.qvw&sheet=SH01&bookmark=Document%5CBM02&select=LB01,=StudyID=38049

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
CONVINCECOichichine for preventioN of vascular Inflammation in Non-CardioEmbolic stroke

This study evaluates the use of Colchicine in adults over 40 years of age who have suffered an ischaemic stroke or transient ischaemic attack NOT caused by cardiac embolism or other defined causes. Patients will be randomised to 0.5 mg/day of Colchicine plus usual care, or to usual care alone.
To investigate the efficacy of low dose colchicine (0.5mg/day) plus usual care (defined as antiplatelet, lipid-lowering, antihypertensive treatment, and appropriate lifestyle advice) compared with usual care alone to prevent non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest, hospitalization for unstable angina and vascular death after ischaemic stroke or transient ischaemic attack (TIA) not caused by cardiac embolism or other defined causes unrelated to atherosclerosis
For more information please visit,https://clinicaltrials.gov/ct2/show/NCT02898610

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
ELAN Early versus late initiation of direct oral anticoagulants in post-ischaemic stroke patients with non-valvular atrial fibrillation

The ELAN trial aims to estimate the net benefit of early versus late (current standard practice) initiation of direct oral anticoagulants (DOACs) in patients with acute ischaemic stroke related to atrial fibrillation.
For more information please visit,https://www.elan-trial.ch/about-the-trial/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
MORe PREcISE – MORbidity PRevalence Estimate In StrokE (Morbidity Prevalence Estimate at six months, following a Stroke: A Cohort Study)

Waiting for information

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
National Institute for Health Research BioResource – Rare Diseases

For more information please visit

https://bioresource.nihr.ac.uk/rare-diseases/rare-diseases/

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
PLORAS Predicting Language Outcome and Recovery After Stroke

PLORAS is a research project looking at recovery of language difficulties after stroke (aphasia).
Aim: to give future stroke survivors a prediction about their aphasia recovery.
For more information please visit,
http://www.ucl.ac.uk/ploras

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
R4VAD Rate, risks and routes to reduce vascular dementia

For more information please visit,https://www.nottingham.ac.uk/research/groups/stroke/clinical-stroke-trials/index.aspx

https://www.ed.ac.uk/clinical-sciences/edinburgh-imaging/research/themes-and-topics/body-systems/brain-nervous-system/stroke/r4vad

 

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Start or STop Anticoagulants Randomised Trial (SoSTART) after spontaneous intracranial haemorrhage

Bleeding within the skull, also known as brain haemorrhage, affects 3 million people in the world each year.

One in five people who survive brain haemorrhage have an irregular heart rhythm called ‘atrial fibrillation’, which puts them at risk of stroke and other blood clots.

Blood-thinning medicines, known as ‘anticoagulant’ drugs, are used in everyday clinical practice to protect people with atrial fibrillation from developing blood clots. However, these drugs also increase the risk of bleeding and are usually stopped when the brain haemorrhage occurs.

But when patients recover from brain haemorrhage, they and their doctors are often uncertain about whether to start or stop these drugs to prevent further clots occurring, or whether to avoid them in case they increase the risk of brain haemorrhage happening again.

Investigators want to find out whether starting or not starting an anticoagulant drugs is better for those patients.

A network of hospital doctors, nurses, and other staff will identify people who survive brain haemorrhage and have atrial fibrillation. If a patient and their doctor are uncertain about whether to start an anticoagulant drug, they may invite the patient to participate.

In the pilot phase, investigators aim to recruit at least 60 participants to determine the feasibility of recruiting the target sample size of at least 800 participants in the main phase of the trial.

Investigators will follow-up all participants for at least one year to determine whether prescribing an anticoagulant drug reduces the occurrence of all serious vascular events like heart attack, stroke compared with a policy of avoiding oral anticoagulant. For more information please visit: https://clinicaltrials.gov/ct2/show/NCT03153150

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Stroke In Young Adults

Stroke in Young Adults: What is the metabolic and mechanical cost of walking of working and what are the implications for rehabilitation?

This research study led by Dr Hannah Jarvis and Professor Neil Reeves from Manchester Metropolitan University and funded by the Stroke Hub Wales aims to investigate how a stroke in young adults affects the energy required to walk (known as the metabolic cost of walking) compared to able-bodied age-matched controls that have not experienced a stroke and to understand the underlying mechanisms for potential impairments in their gait pattern. This research study has captured energy expenditure, joint kinematics and kinetics during walking and quality of life of young adults who have had a stroke and compared to healthy able-bodied controls. The outcome of this research will be used to inform rehabilitation guidelines specific for younger adults following stroke. This research study is registered on the NIHR portfolio (CPMS – 39832).

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
STROLLERS Stroke Life and Leisure Research Survey

Waiting for information

ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
TIME – Treatment in Morning Versus Evening

Treatment in Morning versus Evening (TIME) is a study to compare the treatment for high blood pressure using hypertensive drugs given in the evening with the usual morning medication. This is done using an online system to record any side effects or changes due to the change in their medication. This automated system has worked well in our initial phase of this study with good patient response. Record-linkage to hospitalisations and deaths will be carried out and events monitored. Heart attack, stroke or death will be recorded and analysed to see if the timing of the medication has any impact. For more information please visit: https://www.bhf.org.uk/research-projects/treatment-in-the-morning-versus-evening-time-study

Publication link: https://www.ncbi.nlm.nih.gov/pubmed/29169373

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Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Trajectories of Outcome in Neurological Conditions: Quality of Life (QoL) and neurological disease – Phase 2 Demographics and Clinical Info

Quality of Life (QoL) for people with disabling neurological conditions is affected by a range of factors, which have received considerable previous research attention. However clinicians’ knowledge could be enhanced by two areas of additional enquiry. For more information please visit: https://wessexhealthlines.nhs.uk/health-lines/researchline/studies-list/trajectories_of_outcome_in_neurological_conditions_quality_of_life_qol_and_neurological_disease_-_phase_2_demographics_and_clini1/

ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Project Summary ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Trajectories of Outcome in Neurological Conditions: Quality of Life (QoL) and neurological disease Sub- Phase 3 Consent and questionnaire

Quality of Life (QoL) for people with disabling neurological conditions is affected by a range of factors, which have received considerable previous research attention. However clinicians’ knowledge could be enhanced by two areas of additional enquiry. For more information please visit:https://wessexhealthlines.nhs.uk/health-lines/researchline/studies-list/trajectories_of_outcome_in_neurological_conditions_quality_of_life_qol_and_neurological_disease_sub-_phase_3_consent_and_questio/

ABMUHB ABUHB BCUHB CAVUHB CTUHB HDHB PTHB WAST
Key
ABMUHB - Abertawe Bro Morgannwg University Health Board
ABUHB - Aneurin Bevan University Health Board
BCUHB – Betsi Cadwaladr University Health Board
CAVUHB – Cardiff and Vale University Health Board
CTUHB –Cwm Taf University Health Board
HDHB – Hywel Dda Health Board
PTHB – Powys Teaching Health Board
WAST – Welsh Ambulance Service Trust