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Stroke is a common problem, being the third cause of mortality in the UK and the leading cause of adult disability with a resultant significant cost burden to the NHS and social services. The guidelines highlight the wide national variation in the implementation of evidence based practice as seen in the Stroke Association's National Survey and the Royal College of Physicians National Sentinel Audit, for instance access to stroke unit care varies between 30% and 70%. Furthermore newer therapies such as thrombolysis and alternative antiplatelet agents are becoming available for use in patients with stroke. The production of National Clinical Guidelines for Stroke is therefore timely.
This concise, well written document covers all aspects of the management of patients with stroke including service organisation, acute management issues including diagnosis and interventions, rehabilitation, longer term management issues including secondary prevention, and service evaluation. It also includes a useful section on carers and families which is supported by an information booklet. The presentation of the guidelines is extremely user-friendly with a consistent approach throughout the book with an introduction to the area, relevant guidelines and grading, a tabular presentation of the evidence which summarises the main features of the trials, and recommendations for local implementation.
It is unfortunate that no guidelines are produced for primary prevention of stroke. It is also unfortunate that there is not a consistency in grading of evidence throughout the document, for instance the use of compres-sion stockings in stroke patients acquires a grade A (level 1b) evidence, though the supporting references refer to postoperative and not stroke patients.
Overall, the guidelines are produced in a user-friendly and well referenced fashion to assist local purchasers and providers in the development of an evidence based stroke service. Furthermore the guidelines identify areas of common clinical problems where the evidence is weak—fertile ground for researchers.
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