New resource: stroke & transient ischemic attack - management & prevention

A new provincial clinical practice guideline for stroke/tia prevention and management has now been approved and released:

Stroke and Transient Ischemic Attack – Management and Prevention

Notes:

This guideline is based on scientific evidence current as of the Effective Date [April 29, 2009].

It was developed by the Guidelines and Protocols Advisory Committee, approved by the British Columbia Medical Association and adopted by the Medical Services Commission.

It comes in a variety of formats including the full guideline, an executive summary, and resources which are contained in the appendices

 I've quickly scanned the full guideline and noted nutrition is included in these sections:

IV. Management: TIA and Stroke

Prevention of medical complications of stroke is an important aspect of patient care. There are multiple complications post-stroke, and the following list addresses some of the most serious or common complications. Early mobilization and appropriate positioning within 24 hours are associated with improved outcomes. Assess swallowing and refer to SLP/OT as appropriate

• • Serious cardiac complications - common in the first three months post-stroke
  • Depression – estimated to affect up to 1/3 of patients; assess and treat individually
  • Dysphagia/malnutrition/dehydration – optimize positioning (sitting upright in chair unless contraindicated) for meals etc.; consider enteral feeding if no oral intake for >48hrs; there is a reduction in risk of aspiration pneumonia when swallowing is managed early by a speech therapist

Appendix F: A Guide for Patients

 For additional evidence and resources on the important role of nutrition in acute stroke recovery when nutrition support is needed to prevent or correct malnutrition), please see these older posts and links to resources:

• • Research article: undernutrition & stroke outcome
  • Weight Loss After Stroke
  • Canadian Best Practice Recommendations for Stroke Care: Summary (2008)

Comments

[Sophie]

Thanks for posting these - it's always interesting to see what guidelines suggest in other countries.

It's good to see assessing and managing depression given such a high priority. I'm not sure we give it as high a priority as we should yet depression seems to impact on so many facets of people's recovery (including nutrition).

[Elaine]

Yes, I agree with you about the priority of treating depression. It has a big impact on appetite and intake -- I've observed this many times in my practice.