Stroke Care—a Practical Manual

Abstract

Twenty years ago patients with a stroke were put to bed in the far corner of the medical ward. They were the last patients to be seen on ward rounds and when they were seen their learned doctors would shake their head and say—`not much to be done here I'm afraid'. But 20 years can make a lot of difference. Today nearly all affected patients have a computerized tomography scan (many within 48 hours of admission) and a growing number are cared for on dedicated stroke units. The case for a subspecialty of stroke medicine is gaining universal acceptance. And with this progress a number of textbooks on stroke have started to appear. But this book is the first pocket manual to come out—that I am aware of. It is written for all health professionals who care for stroke patients and aims to give practical advice. In that regard the text is refreshing: the authors tell you what to do in a range of circumstances that occur in stroke care. Supporters of the Plain English Campaign will like its direct style. When possible the authors back up their statements with evidence; but there are many areas in stroke medicine where there is poor or no evidence. More often than not it can be difficult to apply evidence to the patient in front of you with their particular set of problems. The authors overcome this problem by citing guidelines or their own experience or what they feel to be the most practical advice that they can give. Many pocket books give you the bare minimum but this one has useful chapters on managing difficult decisions and on terminal care. There is much written about how these issues relate to cancer but not a great deal on how they relate to stroke—this is one of the strengths of the book. But a weakness is that the legal guidelines that the authors cite hold sway only in England and Wales—Scottish readers beware. The book also suffers somewhat from repetition: some problems such as deep vein thromboses and positioning arise again and again and there is a limited amount of evidence based advice that you can give about them. Also the chapter on preventing stroke and other vascular events could perhaps best sit as the first chapter rather than the second last. Advances in the treatment of stroke have not always kept pace with advances in prevention and giving more prominence to primary and secondary prevention would perhaps reflect this more strongly. These are fairly minor quibbles. If you are a consultant or a registrar and you care for stroke patients, then this excellent pocket book is a great place to learn new knowledge or brush up your existing skills. A few years ago many thought that the rise of PDAs would herald the death of the pocket handbook but this one shows that they still have an important place.