An examination of the role of the sports and exercise medicine specialist in Ireland- from epidemiology to treatment

The expansion of the specialty of sports and exercise medicine (SEM) is a relatively recent development in the medical community and the role of the SEM specialist continues to evolve and develop. The SEM specialist is ideally placed to care for all aspects of physical activity not only in athletes but also in the general population. As an advocate for physical activity the SEM specialist plays a broad role in advising safe effective sports and recreation participation; screening for disease related to sports participation; examining and contributing to the evidence behind treatment strategies and evaluating any potential negative impact of sports injury prevention measures. In this thesis I will demonstrate the breadth of the role the Sports and Exercise Medicine Specialist from epidemiology to in-depth examination of treatment strategies. In Chapter 2, I examined the epidemiology of sports and recreation related injury (SRI) in Ireland, an area that has previously been poorly studied. We report on 3,172 SRI (14% of total presentations) presentations to the ED over 6 months. Paediatric patients (4-16 yrs) were over represented comprising 39.9% of all SRI presentation compared to 16% of total ED presentations and 18% of the general population. These injuries were serious (32% fractures) and though 49% of injuries occurred during organised competition/practice, 41.5% occurred during recreation-most often at home. In Chapter 3, I examined risk factors associated with hand injury in hurling. The previous chapter highlighted the importance of a firm evidence base underpinning treatment strategies. When measures to improve welfare are introduced not only must potential benefits be measured, so too must potential unwanted adverse outcomes. In this study I examined a cohort of adult hurlers who had presented to the ED with a hurling related injury in order to highlight the variables associated with hand injury in this population. I found the athletes who wore a helmet were far more likely (OR 3.15 95% CI (1.51-6.56) p= 0.002) to suffer a hand injury than athletes who did not. Very few of those interviewed (4.9%) used hand protection compared to 65% who used helmet and faceguard. The introduction of the helmet and faceguard in hurling has undeniably decreased the incidence of head and face injury in hurling. However in tandem with this intervention several observational studies have demonstrated an increase in the occurrence of hurling related hand injuries. This study highlights the importance of being cognisant of unanticipated or unintended consequences when implementing a new treatment or intervention. In Chapter 4, I examined the role of population screening as applied to sport and exercise. This is a controversial area –cardiac screening in the exercising population has been the subject of much debate. Specifically I define the prevalence of exercise induced bronchoconstriction (EIB) using a specifically designed sports specific field-testing protocol. In this study I found almost a third (29%) of a full international professional rugby squad had confirmed asthma or EIB, as compared with 12-15% of the general population. Despite regular medical screening, 5 ‘new’ untreated cases (12%) were elicited by the challenge test and in the group already on treatment for asthma/EIB; over 50% still displayed EIB. In Chapter 5, I examined the evidence supporting current treatment options for iliotibial band friction syndrome (ITBFS). The practice of sports medicine has traditionally been ‘eminence based’ rather than ‘evidence based’. This may be problematic as some of these practices are based upon flawed principles- for example the treatment of iliotibial band friction syndrome (ITBFS). In this chapter, using cadaveric and biomechanical studies I expand upon the growing base of evidence clarifying the anatomy and biomechanics of the area-thereby re-examining the principles on which current treatments are based. The role of the SEM specialist is broad; we chose to examine specific examples of some of the roles that they execute. An understanding of the epidemiology of SRI presenting to the ED has implications for individual patients, sports governing bodies and health resource utilisation. Population screening is an important tool in health promotion and disease prevention in the general population. Screening in SEM may have similar less well-recognised benefits. The SEM specialist needs to be conversant in screening for medical conditions concerning physical activity. A comprehensive understanding of the pathophysiology of a disease is required for its diagnosis and treatment. Due to the ongoing evolution of SEM many treatments are eminence-based rather than evidence‐based practice. Continued re-examination of the fundamentals of current practice is essential. An awareness of potential unwanted side effects is essential prior to the introduction of any new treatment or intervention. The SEM specialist is ideally placed to advise sports governing bodies on these issues prior to and during their implementation.

Occurrence and Function of Hoogsteen Base Pairs in Nucleic Acids

Nucleic acids (DNA and RNA) play essential roles in the central dogma of biology for the storage and transfer of genetic information. The unique chemical and conformational structures of nucleic acids – the double helix composed of complementary Watson-Crick base pairs, provide the structural basis to carry out their biological functions. DNA double helix can dynamically accommodate Watson-Crick and Hoogsteen base-pairing, in which the purine base is flipped by ~180° degrees to adopt syn rather than anti conformation as in Watson-Crick base pairs. There is growing evidence that Hoogsteen base pairs play important roles in DNA replication, recognition, damage or mispair accommodation and repair. Here, we constructed a database for existing Hoogsteen base pairs in DNA duplexes by a structure-based survey from the Protein Data Bank, and structural analyses based on the resulted Hoogsteen structures revealed that Hoogsteen base pairs occur in a wide variety of biological contexts and can induce DNA kinking towards the major groove. As there were documented difficulties in modeling Hoogsteen or Watson-Crick by crystallography, we collaborated with the Richardsons’ lab and identified potential Hoogsteen base pairs that were mis-modeled as Watson-Crick base pairs which suggested that Hoogsteen can be more prevalent than it was thought to be. We developed solution NMR method combined with the site-specific isotope labeling to characterize the formation of, or conformational exchange with Hoogsteen base pairs in large DNA-protein complexes under solution conditions, in the absence of the crystal packing force. We showed that there are enhanced chemical exchange, potentially between Watson-Crick and Hoogsteen, at a sharp kink site in the complex formed by DNA and the Integration Host Factor protein. In stark contrast to B-form DNA, we found that Hoogsteen base pairs are strongly disfavored in A-form RNA duplex. Chemical modifications N1-methyl adenosine and N1-methyl guanosine that block Watson-Crick base-pairing, can be absorbed as Hoogsteen base pairs in DNA, but rather potently destabilized A-form RNA and caused helix melting. The intrinsic instability of Hoogsteen base pairs in A-form RNA endows the N1-methylation as a functioning post-transcriptional modification that was known to facilitate RNA folding, translation and potentially play roles in the epitranscriptome. On the other hand, the dynamic property of DNA that can accommodate Hoogsteen base pairs could be critical to maintaining the genome stability.

Oxidative DNA Damage Modulates Trinucleotide Repeat Instability Via DNA Base Excision Repair

Trinucleotide repeat (TNR) expansion is the cause of more than 40 types of human neurodegenerative diseases such as Huntington’s disease. Recent studies have linked TNR expansion with oxidative DNA damage and base excision repair (BER). In this research, we provided the first evidence that oxidative DNA damage can induce CAG repeat deletion/contraction via BER. We found that BER of an oxidized DNA base lesion, 8-oxoguanine in a CAG repeat tract, resulted in the formation of a CTG hairpin at the template strand. DNA polymerase β (pol b) then skipped over the hairpin creating a 5’-flap that was cleaved by flap endonuclease 1 (FEN1) leading to CAG repeat deletion. To further investigate whether BER may help to shorten an expanded TNR tract, we examined BER in a CAG repeat hairpin loop. We found that 8-oxoguanine DNA glycosylase removed the oxidized base located in the loop region of the hairpin leaving an abasic site. Apurinic/apyrimidinic (AP) endonuclease 1 then incised the 5’-end of the abasic site leaving a nick in the loop. This further converted the hairpin into an intermediate with a 3’-flap and a 5’-flap. As a 5’-3’ endonuclease, FEN1 cleaved the 5’-flap, whereas a 3’-5’ endonuclease, Mus81/Eme1, removed the 3’-flap. The coordination between FEN1 and Mus81/Eme1 ultimately resulted in removal of a CAG repeat hairpin attenuating or preventing TNR expansion. To further explore if pol β bypass of an oxidized base lesion, 5’,8-cyclodeoxyadenosine, may affect TNR instability, we examined pol β DNA synthesis in bypassing this base lesion and found that the lesion preferentially induced TNR deletion during BER and Okazaki fragment maturation. The repeat deletion was mediated by the formation of a loop in the template strand induced specifically by the damage. Pol β then skipped over the loop structure creating a 5’-flap that was efficiently removed by FEN1 leading to repeat deletion. Our study demonstrates that pol β-mediated BER plays an important role in mediating TNR deletion and removing a TNR hairpin to prevent TNR expansion. Our research provides a molecular basis for further developing BER as a target for prevention and treatment of neurodegenerative diseases caused by TNR expansion.

The evolution of lactase persistence in Europe. A synthesis of archaeological and genetic evidence

Lactase persistence, the ability to digest the milk sugar lactose in adulthood, is highly associated with a T allele situated 13,910 bp upstream from the actual lactase gene in Europeans. The frequency of this allele rose rapidly in Europe after transition from hunter–gatherer to agriculturalist lifestyles and the introduction of milkable domestic species from Anatolia some 8000 years ago. Here we first introduce the archaeological and historic background of early farming life in Europe, then summarize what is known of the physiological and genetic mechanisms of lactase persistence. Finally, we compile the evidence for a co-evolutionary process between dairying culture and lactase persistence. We describe the different hypotheses on how this allele spread over Europe and the main evolutionary forces shaping this process. We also summarize three different computer simulation approaches, which offer a means of developing a coherent and integrated understanding of the process of spread of lactase persistence and dairying.

Chemotherapy patient perception regarding communication with the healthcare staff

Purpose: To qualitatively explore the communication between healthcare professionals and oncology patients based on the perception of patients undergoing chemotherapy.Method: Qualitative and exploratory design. Participants were 14 adult patients undergoing chemotherapy at different stages of the disease. A socio-demographic and clinical data form was utilized along with semi-structured interviews. The interviews were audio-recorded, transcribed and content analysis was performed. Two independent judges evaluated the interview content in regards to emerging categories and obtained a Kappa index of 0.834.Results: Three categories emerged from the data: 1) Technical communication without emotional support, in which the information provided is composed of strictly technical information regarding the diagnosis, treatment and/or prognosis; 2) Technical communication, in which the information provided is oriented towards the technical aspects of the patient’s physical condition, while also providing psychological support for the patients’ subjective needs; and 3) Insufficient technical communication, win which there are gaps in the information provided causing confusion and suffering to the patient.Conclusions: Communication with emotional support contributes to greater satisfaction of chemotherapy patients. Practical implications: the results provide elements for the training of healthcare professionals regarding the importance of the emotional support that can be offered to cancer patients during their treatment.

Sepsis: the LightCycler SeptiFast Test MGRADE®, SepsiTest™ and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi – a systematic review and economic evaluation

Background: Sepsis can lead to multiple organ failure and death. Timely and appropriate treatment can reduce in-hospital mortality and morbidity. Objectives: To determine the clinical effectiveness and cost-effectiveness of three tests [LightCycler SeptiFast Test MGRADE® (Roche Diagnostics, Risch-Rotkreuz, Switzerland); SepsiTest™ (Molzym Molecular Diagnostics, Bremen, Germany); and the IRIDICA BAC BSI assay (Abbott Diagnostics, Lake Forest, IL, USA)] for the rapid identification of bloodstream bacteria and fungi in patients with suspected sepsis compared with standard practice (blood culture with or without matrix-absorbed laser desorption/ionisation time-offlight mass spectrometry). Data sources: Thirteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from January 2006 to May 2015 and supplemented by hand-searching relevant articles. Review methods: A systematic review and meta-analysis of effectiveness studies were conducted. A review of published economic analyses was undertaken and a de novo health economic model was constructed. A decision tree was used to estimate the costs and quality-adjusted life-years (QALYs) associated with each test; all other parameters were estimated from published sources. The model was populated with evidence from the systematic review or individual studies, if this was considered more appropriate (base case 1). In a secondary analysis, estimates (based on experience and opinion) from seven clinicians regarding the benefits of earlier test results were sought (base case 2). A NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Scenario analyses were used to assess uncertainty. Results: For the review of diagnostic test accuracy, 62 studies of varying methodological quality were included. A meta-analysis of 54 studies comparing SeptiFast with blood culture found that SeptiFast had an estimated summary specificity of 0.86 [95% credible interval (CrI) 0.84 to 0.89] and sensitivity of 0.65 (95% CrI 0.60 to 0.71). Four studies comparing SepsiTest with blood culture found that SepsiTest had an estimated summary specificity of 0.86 (95% CrI 0.78 to 0.92) and sensitivity of 0.48 (95% CrI 0.21 to 0.74), and four studies comparing IRIDICA with blood culture found that IRIDICA had an estimated summary specificity of 0.84 (95% CrI 0.71 to 0.92) and sensitivity of 0.81 (95% CrI 0.69 to 0.90). Owing to the deficiencies in study quality for all interventions, diagnostic accuracy data should be treated with caution. No randomised clinical trial evidence was identified that indicated that any of the tests significantly improved key patient outcomes, such as mortality or duration in an intensive care unit or hospital. Base case 1 estimated that none of the three tests provided a benefit to patients compared with standard practice and thus all tests were dominated. In contrast, in base case 2 it was estimated that all cost per QALY-gained values were below £20,000; the IRIDICA BAC BSI assay had the highest estimated incremental net benefit, but results from base case 2 should be treated with caution as these are not evidence based. Limitations: Robust data to accurately assess the clinical effectiveness and cost-effectiveness of the interventions are currently unavailable. Conclusions: The clinical effectiveness and cost-effectiveness of the interventions cannot be reliably determined with the current evidence base. Appropriate studies, which allow information from the tests to be implemented in clinical practice, are required.

Self-Harm in Secondary Schools: What are the Perceptions and Experiences of Staff ?

The purpose of this study is to explore the perceptions and experiences of secondary school staff with regard to adolescent self-harm. The research was conducted in a Local Authority where there were particular concerns about rising numbers of young people presenting with self-harm. While the majority of young people who self-harm are supported in the community and never access clinical services, surprisingly little research has considered the role of schools and their staff. The research that has been done suggests that school staff can feel underqualified and overwhelmed in their attempts to support young people who self-harm. Further, there is a growing evidence base that when young people experience negative attitudes towards self-harm it is distressing and reduces the chance of them seeking further help. To address this, qualitative exploratory research was conducted with thirteen members of staff working in secondary schools. Since the research was concerned not just with experiences, but also with perceptions of adolescent self-harm, the participants were from two groups: those with direct experience of supporting young people who have self-harmed and those without any direct experience. Data collection involved individual semi-structured interviews which were analysed using thematic analysis. The research indicated that secondary school staff are keen to help and understand young people who self-harm, but that they do not always feel skilled or confident enough to do so, often feeling that some kind of specialist is required and/or fearing that they might make a situation worse. Findings highlighted the emotional impact of this work and illustrated the importance of supporting staff, who expressed a desire for further training and other forms of professional support such as supervision.

Acessibilidade no ambiente escolar: reflexões com base no estudo de duas escolas municipais de Natal-RN

This work was originated through the results of the analysis of the services for the needs of people with disabilities that were permitted by the physical space of two schools of the municipality of Natal/RN. The general objective/goal was to subsidize the elaboration of alternatives for the planning of environments that could be used by any person. The study used the empirical research through the adoption of a multimethod approach including: (i) technical visits oriented by the NBR 9050, (ii) contact with users that have reduced mobility (visually impaired and wheelchair or crutch users) through escorted travels and interviews, and (iii) interview with school managers. The evidence from the research, even though with significant development of laws that guarantee people with disabilities their right to citizenship, the physical environment of our schools still present with many obstacles that prevent the mobility of people with disabilities which proves their lack of readiness to accommodate them. Therefore, the actions taken to address the accessibility has been the adoption of temporary solutions that makes the adaptation more difficult, adds obstacles and reinforces the undesirable segregation, however still very present in our society. Finally, there is the indication that in order to achieve the spatial configuration that promotes social contact and integration in between the persons with different physical status, it is necessary to completely comprehend the activities developed in each space, from the conception of the equipment to the individual learning needs, having in mind creating environments that stimulates the execution of the tasks in an independent manner without the assistance of others. The inclusion regarding attention to accessibility in the decision making process, directed to the arquitectural and urban project, would decrease the constant need to redevelop and adapt spaces, and should be definitely incorporated as an important component in the production of space

THE FEASIBILITY OF USING WEB-BASED TECHNOLOGY FOR THE MANAGEMENT OF DREDGING PROJECTS

The research investigates the feasibility of using web-based project management systems for dredging. To achieve this objective the research assessed both the positive and negative aspects of using web-based technology for the management of dredging projects. Information gained from literature review and prior investigations of dredging projects revealed that project performance, social, political, technical, and business aspects of the organization were important factors in deciding to use web-based systems for the management of dredging projects. These factors were used to develop the research assumptions. An exploratory case study methodology was used to gather the empirical evidence and perform the analysis. An operational prototype of the system was developed to help evaluate developmental and functional requirements, as well as the influence on performance, and on the organization. The evidence gathered from three case study projects, and from a survey of 31 experts, were used to validate the assumptions. Baselines, representing the assumptions, were created as a reference to assess the responses and qualitative measures. The deviation of the responses was used to evaluate for the analysis. Finally, the conclusions were assessed by validating the assumptions with the evidence, derived from the analysis. The research findings are as follows: 1. The system would help improve project performance. 2. Resistance to implementation may be experienced if the system is implemented. Therefore, resistance to implementation needs to be investigated further and more R&D work is needed in order to advance to the final design and implementation. 3. System may be divided into standalone modules in order to simplify the system and facilitate incremental changes. 4. The QA/QC conceptual approach used by this research needs to be redefined during future R&D to satisfy both owners and contractors. Yin (2009) Case Study Research Design and Methods was used to develop the research approach, design, data collection, and analysis. Markus (1983) Resistance Theory was used during the assumptions definition to predict potential problems to the implementation of web-based project management systems for the dredging industry. Keen (1981) incremental changes and facilitative approach tactics were used as basis to classify solutions, and how to overcome resistance to implementation of the web-based project management system. Davis (1989) Technology Acceptance Model (TAM) was used to assess the solutions needed to overcome the resistances to the implementation of web-base management systems for dredging projects.

The organization, form and function of intermediate care services and systems in England: results from a national survey

This paper reports the results of a postal survey of intermediate care co-ordinators (ICCs) on the organization and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, ‘tick-box’ and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). We discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, we highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate our findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care and the evidence for and aims of the policy as part of NHS modernization, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.

Acessibilidade no ambiente escolar: reflexões com base no estudo de duas escolas municipais de Natal-RN

This work was originated through the results of the analysis of the services for the needs of people with disabilities that were permitted by the physical space of two schools of the municipality of Natal/RN. The general objective/goal was to subsidize the elaboration of alternatives for the planning of environments that could be used by any person. The study used the empirical research through the adoption of a multimethod approach including: (i) technical visits oriented by the NBR 9050, (ii) contact with users that have reduced mobility (visually impaired and wheelchair or crutch users) through escorted travels and interviews, and (iii) interview with school managers. The evidence from the research, even though with significant development of laws that guarantee people with disabilities their right to citizenship, the physical environment of our schools still present with many obstacles that prevent the mobility of people with disabilities which proves their lack of readiness to accommodate them. Therefore, the actions taken to address the accessibility has been the adoption of temporary solutions that makes the adaptation more difficult, adds obstacles and reinforces the undesirable segregation, however still very present in our society. Finally, there is the indication that in order to achieve the spatial configuration that promotes social contact and integration in between the persons with different physical status, it is necessary to completely comprehend the activities developed in each space, from the conception of the equipment to the individual learning needs, having in mind creating environments that stimulates the execution of the tasks in an independent manner without the assistance of others. The inclusion regarding attention to accessibility in the decision making process, directed to the arquitectural and urban project, would decrease the constant need to redevelop and adapt spaces, and should be definitely incorporated as an important component in the production of space

Employee engagement in the public sector:a narrative evidence synthesis

It has been claimed that employee engagement can harness public service motivation in ways that lead to better improve functioning and positive organizational outcomes, and can help address the increasingly complex challenges associated with public service in an era of austerity. Despite this, there has not yet been a systematic review of the literature that would enable researchers to understand more about the antecedent factors and the outcomes of engagement in the public sector. To address this issue, we undertook a systematic narrative synthesis of the empirical research on engagement that yielded 5111 published studies, of which just 59 were conducted in public sector settings and met our inclusion criteria. Studies generally found that motivational features of jobs (such as autonomy), group (such as social support), management (such as leader consideration), and organizations (such as voice mechanisms) as well as psychological resources were key antecedents of engagement within the public sector; and that engagement was associated with positive employee health/morale and enhanced performance behaviors. The evidence was far from conclusive, suggesting a need for much more rigorous research focused on the specific challenges of public sector settings. We make recommendations for further research on this important topic, particularly with regards to understanding the connection between public service motivation and engagement and the need to examine engagement across different public sector/service contexts.

A SOCIO-HISTORICAL ANALYSIS OF CONTENT AND SCTRUCTURE OF THE TEACHING ACTIVITY

ABSTRACT: This text reports an analysis of teaching activity with basis in the category of human activity. Refers to a theoretical research that focuses the essential nexus generators of objectification of educational practice both in the material aspect as the ideal. It is assumed that this practice, in dialectical unity between those aspects, constitutes in the material relations of social life, is structured and institutionalized as universal model of education (ideally) and becomes the main determinant of teacher performance. Methodologically, this study analyzes the educational practice in the totality of its relations.Therefore, the actions and operations of teaching, as well as, the reason and  purposes that moved and guide this activity are determined by the objective conditions current of the school and the effects generated by the position of the teacher in these relations as an active subject. The guiding worry of this research focuses on the characterization of teaching activity in educational performance: in its accomplishment. When to investigate the evidence of these connections is necessary to reflect on the correlative links between the structural elements of the teaching activity and the natural practice of teachers under the determinations derived from the first. This reflection, arise the need to investigate the process of appropriation of the activity by the teacher. Thereby, concludes that the teacher not only appropriates the specific knowledge of the disciplines that teaches and the means of education which is available in their educational practice, but also the elements that structure their activity. This evinced the importance of investigations that worry with: the significance of the purpose of education for the teacher; the necessities that move in your performance; the meaning of your activity; among others. In addition to the responses of teachers is necessary to analyze what the content and the origin of appropriation. KEYWORDS: Teacher; Teaching activity; Educational practice.   

The way forward : report on the preparatory phase of prefabricated building design and construction methodology: identifying critical issues and recommending the way forward

This is an initial report of the PolyU SD part of the team to study Pre-fabricated Building Design and Construction Methodology and marks the completion of Phase 1. It follows our first notes prepared for the meeting on 2 February that identified some critical issues including future lifestyles, life expectancy of buildings, sustainability, size, flexibility and planning considerations. It is also an expansion of our presentation in Dongguan on 23 February. It is not a comprehensive survey of existing approaches or possible ways forward, but it has homed in on certain specific issues and does give specific examples to make the suggestions concrete. It is recommended that more comprehensive research be done to establish previous work and experience internationally. It is also recommended that more research be done on lifestyles as a preliminary to developing at least three concepts for evaluation before proceeding to the detailed design of one concept for full prototyping and market testing. The goal at this point is not to define a single direction but to suggest several future trajectories for further consideration. By the same token, this report is not intended as an exhaustive description of the considerable base of knowledge and ideas brought by the PolyU team to this exciting task. Before taking on an issue of this magnitude and importance in the definition of Hong Kong's future, one must carry out a thoughtful analysis of the issues at hand and an informed definition of paradigms, directions, goals and methods whereby our energies can be best used in the next steps. This report is the result of this analysis

Cholesterol-lowering management of stroke : inconsistencies of evidence and practice

Cholesterol-lowering treatment by statins is an important and costly issue; however, its role in stroke has not been well documented. The aim of the present study was to review literature and current practice regarding cholesterol-lowering treatment for stroke patients. A literature review was conducted on lipids in stroke and their management with both statins and diet, including the cost-effectiveness of medical nutrition therapy. Qualifying criteria and prescription procedures of the Pharmaceutical Benefits Scheme (PBS) were also reviewed. Data on lipid levels and statin prescriptions were analysed for 468 patients admitted to a stroke unit. The literature shows that management with both medication and diet can be effective, especially when combined; however, 60% of patients with an ischaemic event had fasting total cholesterol measures ≥4 mmol/L (n = 231), with only 52% prescribed statins on discharge (n = 120). Hypercholesterolaemia is an underdiagnosed and undertreated risk factor within the stroke population. It appears that the PBS has not kept pace with advances in the evidence in terms of statin use in the stroke population, and review is needed. The present review should address the qualifying criteria for the stroke population and recommendations on referral to dietitians for dietary advice. Cholesterol-lowering treatment for both stroke patients and the wider population is an area that needs awareness raising and review by the PBS, medical practitioners and dietitians. The role of dietary and pharmacological treatments needs to be clearly defined, including adjunct therapy, and the cost-effectiveness of medical nutrition therapy realised.