In recent years breakthrough advances have occurred in the management of ischaemic stroke, greatly improving clinical outcomes. Along with the availability of clot retrieval for acute management of stroke there have been advances in stroke secondary prevention. The following article summarises the highlights of the talk given on the Modern Management of Stroke at the Nordoc conference in June 2019 and focuses on recent updates in the field.

Facts about stroke:

Stroke is one of Australia’s biggest killers and a leading cause of disability, killing more women than breast cancer and more men than prostate cancer (1). Even when patients survive, most suffer a disability that impedes their carrying out the activities of daily living unassisted (2). Therefore, it is of utmost importance to look for new ways and strategies to reduce the detrimental consequences of stoke.

Endovascular therapies:

One of the breakthrough advances has been the implementation of clot retrieval in the management of stroke caused by a large vessel occlusion. A series of clinical trials published in 2015 showed consistently that endovascular treatment, in combination with best practice medical treatment, was superior to the latter treatment alone for patients suffering acute occlusion of the internal carotid artery or the main stem of the proximal middle cerebral artery. The number needed to treat in most studies ranges between 3 to 7 to achieve a positive outcome and functional independence (3,4,5,6,7).

In a draft report widely described as “damning” the Australian Government’s Productivity Commission has said that mental ill-health and suicide cost the nation nearly $500 million per day - $180 billion per year – and called mental health “an add-on to the physical health system”.

Amongst a raft of recommendations, the report emphasises the need for better support for young people.

"75% of those who develop mental illness first experience symptoms before they turn 25, and mental ill-health in critical schooling and employment years has long lasting effects for not only your job prospects but many aspects of your life. Getting help early is key to prevention and better outcomes," Chair Michael Brennan said.

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The proliferation of health related apps – more than 3 million available so far, with 200 new ones being created daily - has prompted a warning that the app jungle is almost impossible for consumers to negotiate safely. Moreover, many app products are ineffective or inaccurate, thus exposing users to major health complications as well as posing a privacy risk through personal data being hacked or misused.

According to the Health Informatics Society of Australia, the peak body for the digital health community, the huge number of apps is confusing for consumers who often find it hard to decide which apps are evidence based. An app store search for diabetes apps delivers a plethora of choices that leaves most potential users uncertain and possibly feeling negative about the value of any apps in the self-management of their disease.

A study of mobile phone app usage by people with Type 2 Diabetes Mellitus (T2DM) has found that while recommended app usage improves self-management for most users only a minority of patients had practitioners involved in their app use. Further, all non-app users had never had the concept discussed with them by a health professional.

The findings of the study* were said to be “significant for GPs, nurse practitioners and allied health professionals who may integrate apps into a holistic management plan that considers strategies outside the clinical environment.”

The research team from Western Sydney University, The University of Sydney and the University Centre for Rural Health, Lismore (Dr Jane Barker and Dr Sabrina Pit) noted that better incorporation of user-centred features would enhance patient self-management, a significant factor in glycaemic control: “Self-management is considered the most important factor in ensuring well-controlled blood glucose levels (BGL) and, thereby, preventing diabetes complications. It has the potential to ease the burden on the healthcare system by encouraging patient autonomy and allowing disease monitoring outside clinical settings.”

Foetal alcohol spectrum disorder (FASD) is a lifelong condition where diffuse brain injury is caused by antenatal alcohol use. It is thought that the prevalence of foetal alcohol spectrum disorder may be as high of 2 - 4% of the Australian population. The majority of people with the disorder have not been diagnosed. They are, however, accessing their GP regularly as well as seeing other health professionals due to their multiple difficulties. The Australian diagnostic criteria for FASD are now available online.

GPs should consider FASD particularly in children, young people and young adults who have difficulties in multiple areas. People with FASD present with learning and language difficulties and they may have a present or past diagnosis of ADHD and/or Autism.