Alive, able and at home: stroke unit care offers better outcomes than alternatives

Key message: people who have a stroke are more likely to be alive, be at home and be independent after a year if they are cared for in a stroke unit

We probably all know someone who’s had a stroke, which is now the second leading cause of death and the third most common cause of disability worldwide. Many of us have followed broadcaster Andrew Marr’s progress in the wake of the stroke he had, aged 53, earlier this year and his wife, Jackie Ashley, caught the attention of many with her recent Guardian blog on their experience of this devastating event. She deemed the NHS to be “wonderful, wonderful, wonderful” and paid tribute to the health professionals who helped get her husband back on his feet, but pointed to the void in support offered by community services after intensive and generally excellent care in hospital. Not all hospital care is equal either, of course, and the type of care offered in hospital after acute stroke can make all the difference to whether, and how well, the person recovers.

Can ‘red flags’ help clinicians diagnose vertebral fracture in patients with low-back pain?

Key message:  Based on the small number of studies included in this review, the use of many red flags to screen for vertebral fracture is not supported by the available evidence.

Many people suffer from low-back pain (LBP) and, whilst it is second only to the common cold as a cause of lost working days and can be pretty disabling, for most it is not caused by serious underlying disease. But how can clinicians identify the 1% to 5% of patients presenting with LBP who do have underlying disease (vertebral fracture, malignancy, infection or inflammatory disease) needing further investigation and treatment?

How best to prevent falls in older people in care homes and hospitals remains unclear despite large body of evidence

Key message: In care facilities, amongst people with low levels of vitamin D, vitamin D supplementation reduces the rate of falls. Evidence on other strategies to prevent falls in hospitals and care facilities is inconclusive.