GEP Medicine in Society Handbook 2019/20
The Medicine in Society unit is the clinical contact module in Year 1 of the GEP course. Students will spend 12 days in primary care and 13 days in seconday care during the year.
5. Secondary Care Themed Days
5.3. Day 4 Theme: Stroke
Introduction – Cerebrovascular disease is a major cause of chronic disability and death within the western world. It is the third largest killer of adults within the UK, accounting for ~60,000 deaths annually, and it is estimated that the NHS spends 4% of its total budget on the care of stroke patients.
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Challenge Box: How may stroke manifest clinically? Why is stroke so common in the East End of London? What single intervention would you make to reduce the incidence of stroke in the East End? |
Stroke is a multifactorial condition crossing primary care, public health, hospital and institutional care. It affects all ages, with a total incidence of 114/100,000. The incidence doubles with every decade over the age of 55 years-old with 75% of strokes occurring in the over 65s. There is a recurrence rate of 7 -10%, with the greatest risk in the first year after the initial episode. The hospital admission of patients with stroke provides a key insight into the workings of an ‘expert’ multidisciplinary team, as well as the shortcomings of non-specialist areas in dealing with such a complicated condition. This placement should give you an overview of the management of stroke patients within a typical District General Hospital.
Learning Issues
- Compare the care of the stroke patients you have seen today in the various settings.
- What are the features of good rehabilitation common to these settings?
- What are the activities of daily living (ADL) assessed by the MDT?
- What is the role of the doctor in the care of the stroke patient in the
(a) acute setting (b) rehabilitation setting?
- List the secondary risk factors which should be addressed on admission of stroke patients?
- List three drugs that such patients may be on.
Learning tasks
- · Record the ADLs of a patient and your MDT recommendations
- · What is meant by FAST?
- · What is the difference between hyper-acute, acute and rehabilitation stroke care?
- · Where are these services offered in East London?
References
NICE guidelines for the management of stroke:
UK Stroke Statistics:
