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Overview of current and future research opportunities in Stroke and Vascular Disease

Overview of current and future research opportunities in Stroke and Vascular Disease. David Yates who knows very little about these topics. Extended remit. Stroke and Trauma (TBI & SCI) *pathophysiology *epidemiology *systems development *cerebral protection *initial care

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Overview of current and future research opportunities in Stroke and Vascular Disease

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  1. Overview of current and future research opportunities in Stroke and Vascular Disease David Yates who knows very little about these topics

  2. Extended remit • Stroke and Trauma (TBI & SCI) *pathophysiology *epidemiology *systems development *cerebral protection *initial care *rehabilitation

  3. Large variably deprived populationSMR above average for Stroke and TBI. ?for SCI • Potential 5* SBS Inflammation & Epidemiology • National / European Trauma Database • ?Links with CV and DM databases • Interest in disability scoring • Mild TBI / Psychology / Epilepsy • Good immediate access to acute patients

  4. Colleagues consulted • Hope Fiona Lecky Mike Horan Pippa Tyrrell • Preston Aprajay Golash • Southport Clive Glass • Walton - - - - -

  5. Stroke (Pippa Tyrrell) • Basic Science collaboration with SBS • Phase three trials Both need good clinical infrastructure Problems with funding when inadequate staff to recruit patients and follow up in acute phase ?role for Intercern Clinical Trials Unit

  6. Stroke • Health Services Research - effectiveness of care pathways (GM guidelines group) - value of discharge booklet • Pain effect on rehab • Neglect; drop foot; dysphagia

  7. Stroke - Potential Co-operation • Anil Sharma - Aintree on IL1ra DMC • David Bowsher - Liverpool Pain • Ed Gamble - Liverpool Pain • Audrey Bowen (psychology)- SALT Neglect • Ed Gamble - UHSM

  8. Stroke summary • Infarct limitation • Pain • Specific complications • Pathways • Outcome analysis

  9. Injury (Aprajay Golash) • Neuronal regeneration • Reformation of synapses • Outcome measures • Link with Southport

  10. SCI Clive Glass / Bakul Soni / Pradip Sett • Incidence in NW • Outcome measures - physical & psychological (Koln group) • Optimising patient pathways (including initial care)

  11. Injury (Lecky, Hopkins, Warhurst, Carlson, Childs & Dark) • Early haemodynamic changes (systemic v. cerebral) • Inflammatory responses (+ Large scale clinical trial of MP) • Thermoregulation • Gut barrier function (systemic injury  BBB) • Mild TBI / psychology / brain markers • Epidemiology / outcome analysis • Patient pathways

  12. Links with geriatrics (Horan) • Inflammation • Metabolic consequences of stroke

  13. Other players • Arpan Guha (neuro ICU Walton) BMJ:“pre-hospital scoring system for trauma” • Others at Walton?

  14. Common themes • An acute group • Modulation of inflammation • BBB / tight junctions • Markers / early diagnosis • Patient pathways / standard setting • Outcome analysis • Large scale clinical trials

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