***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background and Purpose — Stroke unit care is one of the most powerful interventions available to help stroke patients . There are limited data available to assess the impact of stroke units in routine clinical practice outside r and omized clinical trials . This article uses data from the 2001 to 2002 National Stroke Audit to assess the effectiveness of stroke unit care in Engl and , Wales , and Northern Irel and in delivering effective processes of care and in reducing case fatality and disability . Methods — An observational study of the organization , structure , process of care , and outcomes for stroke in 2001 . Case fatality after stroke in Engl and was compared using data from the audit and routinely collected data from the Department of Health . 240 hospitals ( 196 Trusts ) from Engl and , Wales , and Northern Irel and took part in the 2001 to 2002 National Stroke Audit , a response rate of > 95 % . These sites assessed a total of 8200 patients using the Royal College of Physicians Intercollegiate Working Party Stroke Audit Tool . Results — The availability of stroke unit care varies hugely across the country . Case fatality after stroke was higher in Trusts with least availability of stroke unit care . These differences persisted after control for case mix . The process of care was better for patients managed on stroke units compared with other setting s. Overall , the risk of death for patients who received stroke unit care was estimated to be ≈75 % that of the risk for those having no stroke unit care ( 95 % CI , 60 to 90 ) . Conclusions — Stroke unit care as provided in routine clinical practice in Engl and , Wales , and Northern Irel and reduces case fatality by ≈25 % , which is in line with the figures obtained from systematic analysis of stroke unit trial data BACKGROUND AND PURPOSE Meta-analyses of r and omized controlled trials of acute stroke care have shown care in stroke units ( SUs ) to be superior to that in conventional general medical , neurological , or geriatric wards , with reductions in early case fatality , functional outcome , and the need for long-term institutionalization . This study examined whether these results can be reproduced in clinical practice . METHODS A multicenter observational study of procedures and outcomes in acute stroke patients admitted to design ated SUs or general medical or neurological wards ( GWs ) , the study included patients of all ages with acute stroke excluding those with subarachnoid hemorrhage , who were entered into the Riks-Stroke ( Swedish national quality assessment ) data base during 1996 ( 14 308 patients in 80 hospitals ) . RESULTS Patients admitted to SUs who had lived independently and who were fully conscious on admission to the hospital had a lower case fatality than those cared for in GWs ( relative risk [ RR ] for death , 0.87 ; 95 % confidence interval [ CI ] , 0.79 to 0.96 ) and at 3 months ( RR , 0.91 ; 95 % CI , 0.85 to 0.98 ) . A greater proportion of patients cared for in an SU could be discharged home ( RR , 1.06 ; 95 % CI , 1.03 to 1.10 ) , and fewer were in long-term institutional care 3 months after the stroke ( RR , 0.94 ; 95 % CI , 0.89 to 0.99 ) . No difference was seen in outcome in patients cared for in SUs or GWs if they had impaired consciousness on admission . CONCLUSIONS The improvement in outcomes after stroke care in SUs compared with care in GWs can be reproduced in the routine clinical setting , but the magnitude of the benefit appears smaller than that reported from meta-analyses Background and Purpose — The long-term beneficial effects of stroke unit care have been proved in several r and omized trials . However , there is a question of large-scale applicability in routine clinical practice of interventions used by dedicated investigators in small r and omized trials . The objective of this study was to compare , 21/2 years after stroke , patients who had been treated in stroke units and those treated in general wards in routine clinical practice . Methods — This is a prospect i ve cohort study based on 8194 patients who were included , during the first 6 months in 1997 , in Riks-Stroke , the Swedish National Register for quality assessment of acute stroke . Two years after the event , 5189 patients were still alive and 5104 were followed up with a postal question naire to which 4038 responded . Results — Among the group of patients who were independent in activities of daily living ( ADL ) functions before the stroke , patients who were treated in stroke units were less often dependent in ADL functions , after adjustment for case mix ( OR , 0.79 ; CI , 0.66 to 0.94 ) . If they also lived at home before the stroke , then they had a lower case-fatality rate 2 years after the stroke ( OR , 0.81 ; CI , 0.72 to 0.92 ) . Conclusions — Long-term beneficial effects of treatment in stroke units were shown for patients who were independent in ADL functions before the stroke . No benefits were shown for patients who were dependent on help for primary ADL before the stroke . Further studies on this group of patients with more detailed outcome measures are needed Background and Purpose — Transient ischemic attacks ( TIAs ) are warning signs of stroke . Recently , the hypothesis was raised that TIA bears a significant risk for death and dependence and requires the same complex diagnostic workup as a complete stroke . Methods — We prospect ively collected pre- and in-hospital procedures , symptoms , outcome , complications , and therapies from a representative sample of all stroke-treating hospitals ( n=82 ) in southwest Germany . Follow-up was attempted 6 months after discharge . End points were death or dependence in activities of daily living ( Barthel Index < 95 , modified Rankin Scale ( mRS ) of 3 to 6 , or institutionalization in a nursing home ) . Results — 1380 TIA patients and 3855 stroke patients entered the data base . During hospital stay , stroke incidence was 8 % for TIA patients and another 5 % within the first half-year . Similarly , for ischemic stroke ( IS ) patients these figures were 7 % and 6 % ( P>0.05 ) , respectively . Two percent of TIA patients died in hospital ( 5 % afterward ) compared with 9 % of stroke patients ( 10 % afterward , P<0.001 ) . Seventeen percent TIA compared with 38 % IS patients ( P<0.05 ) were dependent at follow-up . Whereas an estimated preexisting deficit ( mRS > 2 ) was the strongest predictor for death or disability ( baseline mRS odds ratio , 4.1 ; 95 % CI , 2.3 to 7.2 ) , admission to a stroke unit was a valid predictor for survival and independence ( odds ratio , 0.4 ; 95 % CI , 0.2 to 0.9 ) . Conclusions — These data from a large , multicenter , nonselected , observational study underscore the “ not so benign ” prognosis for TIA patients . There is a relevant individual risk of early stroke , death , or disability in TIA patients . Management and treatment strategies are similar for both TIA and acute stroke BACKGROUND AND PURPOSE Treatment of stroke patients in specialized stroke units has become more frequent , yet the effect of this treatment has not been determined . METHODS In a community-based , prospect i ve , and consecutive study of 1241 unselected acute stroke patients , we compared outcome of stroke treatment between two neighboring communities within Greater Copenhagen : the Bispebjerg community , where all acute stroke patients are treated and rehabilitated on a stroke unit , and Frederiksberg community , where all acute stroke patients are treated and rehabilitated on general neurological and medical wards . Except for the different organization of stroke treatment , the two communities and the two patient groups were comparable . Specifically , age , sex , marital status , prestroke residence , and stroke severity were not statistically different between patients treated on the stroke unit and those treated on the general neurological and medical wards . Multivariate regression analyses were used to estimate the independent influence of stroke unit treatment on outcome . RESULTS Stroke unit treatment significantly reduced in-hospital mortality ( odds ratio [ OR ] , 0.50 ; 95 % confidence interval [ CI ] , 0.34 to 0.74 ; P < .001 ) , case-fatality rate ( OR , 0.45 ; CI , 0.28 to 0.71 ; P < .001 ) , 6-month mortality ( OR , 0.57 ; CI , 0.39 to 0.82 ; P = .002 ) , 1-year mortality ( OR , 0.59 ; CI , 0.42 to 0.84 ; P = .003 ) , and discharge rate to a nursing home ( OR , 0.61 ; CI , 0.38 to 0.98 ; P = .04 ) . Discharge rate to the patient 's own home was significantly increased ( OR , 1.90 ; CI , 1.30 to 2.70 ; P < .001 ) . The length of hospital stay ( including rehabilitation ) was reduced significantly by 30 % in patients treated on the stroke unit despite their lower mortality ( P < .001 ) . The savings due to stroke unit treatment were estimated at 1313 bed-days and three places at a nursing home per 100 stroke patients . CONCLUSIONS Treatment of unselected acute stroke patients on a stroke care unit saved lives , reduced the length of hospital stay , reduced the frequency of discharge to a nursing home , and potentially reduced cost BACKGROUND Recent meta-analyses have reported a beneficial effect of stroke units compared with traditional care , both on patient survival and on dependency after one year . AIM To determine whether these results can be reproduced outside a clinical trial setting . SETTING A medium-sized general hospital . METHODS From 1993 to 1998 , all patients aged > 60 years with suspected acute stroke were allocated either to a stroke unit or general medical wards according to date of birth ( day of the month ) . Patients were identified retrospectively , using a discharge diagnosis of ICD-9 codes 431 , 434 and 436 . We assessed 30-day and 1-year survival . RESULTS In the stroke unit , 926/1128 patients survived at 30 days , vs. 905/1141 in the general medical wards ( p=0.08 ) . Beyond the first 30 days , there was no difference in survival ( p=0.27 ) . Under Cox regression analysis , there was a 20 % reduction in mortality in the stroke unit after 30 days compared with the general medical wards ( RR 0.80 , p=0.02 ) after adjusting for age , gender , stroke type and season of the year . DISCUSSION In this , the largest single-centre study to evaluate the survival benefit of a stroke unit , survival at 30 days was increased , although not significantly so . Survival at one year was unchanged We performed a prospect i ve observational study using a stroke register , case-note review and survey of carers with 6 months of follow-up in two adjacent health districts in East London . District 1 was a teaching district and had no special stroke service ; District 2 had a comprehensive stroke service comprising stroke unit , review of all stroke admissions and community follow-up . Three hundred and sixty-one consecutive patients with stroke admitted to hospital and 103 carers were surveyed at 6 months from admission using the Royal College of Physicians ( London ) Stroke Audit st and ards . We also assessed mortality , disability , perceived health , mood , and satisfaction with services 6 months after stroke , carer mood , perceived health and satisfaction with services . The st and ard of care was below that set by the Royal College of Physicians of London in both districts and there were no significant differences between the districts in age-st and ardized mortality at 1 and 6 months , Barthel score , extended ADL score , Geriatric Depression score , Nottingham Health Profile score and patient satisfaction with services at 6 months . Carer outcomes did not differ between districts . Service costs , particularly costs of rehabilitation services , were much lower in District 2 . A comprehensive district stroke service was not associated with major differences in patient outcomes or st and ards of care . This may have been because the non-r and om nature of the comparison meant that the patients differed in other ways than in the nature of treatment . Caution is needed when using these techniques in making purchasing decisions Clinical trials have demonstrated the superiority of coordinated interdisciplinary stroke unit care over conventional treatment of stroke patients on general medical wards . The evidence is so strong that several national bodies have recommended that stroke unit care be widely implemented . Translation of these research findings and care guidelines into clinical practice , however , represents a challenge for health care systems unaccustomed to managing stroke in a coordinated manner . This report describes the organization , operation and outcomes of the Acute Stroke Unit at the Queen Elizabeth II Health Sciences Centre in Halifax . By replicating and adapting the core characteristics identified in the r and omized trials , we have been able to demonstrate the effectiveness of stroke unit care in a routine clinical setting . Our experience may help facilitate the development of organized stroke care in Canada Abstract Objective : To show the influence of variations in case mix on clinical outcome indicators for patients admitted to hospital with acute stroke . Design : “ Before and after ” cohort study , with prospect i ve , consecutive identification of patients and prospect i ve follow up ; multiple logistic regression analyses to correct for case mix variations . Setting : University teaching hospital . Subjects : 216 patients with stroke identified before the introduction of an organised stroke service , and 252 patients with stroke identified after its introduction . Main outcome measures : Case fatality at 30 days and 12 months ; for survivors at 12 months , proportions of patients who were independent ( according to the Oxford h and icap scale ) and of those living at home . Results : Crude outcome data suggested that patients in the cohort identified after the introduction of the stroke service were significantly more likely to be alive , independent , and 
    Output:
    
Although these results are complicated by potential bias and heterogeneity , the observed benefit associated with stroke unit care in routine practice is comparable to that in clinical trials