https://nova.newcastle.edu.au/vital/access/manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:53492 Wed 28 Feb 2024 15:04:18 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:45074 7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study‐specific unadjusted and adjusted RRs, controlling for confounding variables, were pooled using random‐effects meta‐analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24–1.46). The sex difference in severity was attenuated after adjustment for age, pre‐stroke dependency, and atrial fibrillation but remained statistically significant (pooled RRadjusted 1.20, 95% CI 1.10–1.30). There was no sex difference in severity for intracerebral hemorrhage (RRcrude 1.08, 95% CI 0.97–1.21; RRadjusted 1.08, 95% CI 0.96–1.20). Conclusions: Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre‐stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre‐stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.]]> Wed 26 Oct 2022 13:58:46 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:34583 Wed 23 Feb 2022 16:04:47 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:29929 FEver, hyperglycaemia (Sugar) and Swallowing (the FeSS protocols) in stroke, previously demonstrated in the Quality in Acute Stroke Care (QASC) trial to decrease 90-day death and dependency, into all stroke services in New South Wales (NSW), Australia's most populous state. Design: Pre-test/post-test prospective study. Setting: 36 NSW stroke services. Methods: Our clinical translational initiative, the QASC Implementation Project (QASCIP), targeted stroke services to embed 3 nurse-led clinical protocols (the FeSS protocols) into routine practice. Clinical champions attended a 1-day multidisciplinary training workshop and received standardised educational resources and ongoing support. Using the National Stroke Foundation audit collection tool and processes, patient data from retrospective medical record self-reported audits for 40 consecutive patients with stroke per site pre-QASCIP (1 July 2012 to 31 December 2012) were compared with prospective self-reported data from 40 consecutive patients with stroke per site post-QASCIP (1 November 2013 to 28 February 2014). Inter-rater reliability was substantial for 10 of 12 variables. Primary outcome measures: Proportion of patients receiving care according to the FeSS protocols pre-QASCIP to post-QASCIP. Results: All 36 (100%) NSW stroke services participated, nominating 100 site champions who attended our educational workshops. The time from start of intervention to completion of post-QASCIP data collection was 8 months. All (n=36, 100%) sites provided medical record audit data for 2144 patients (n=1062 pre-QASCIP; n=1082 post-QASCIP). Pre-QASCIP to post-QASCIP, proportions of patients receiving the 3 targeted clinical behaviours increased significantly: management of fever (pre: 69%; post: 78%; p=0.003), hyperglycaemia (pre: 23%; post: 34%; p=0.0085) and swallowing (pre: 42%; post: 51%; p=0.033). Conclusions: We obtained unprecedented statewide scale-up and spread to all NSW stroke services of a nurse-led intervention previously proven to improve long-term patient outcomes. As clinical leaders search for strategies to improve quality of care, our initiative is replicable and feasible in other acute care settings.]]> Wed 15 Dec 2021 16:10:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:45752 7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints. Results: Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year. Conclusion: Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.]]> Wed 13 Mar 2024 08:50:47 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:25880 Wed 10 Nov 2021 15:05:31 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:42923 Wed 07 Sep 2022 13:07:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:35569 Wed 04 Sep 2019 09:33:46 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:48570 Tue 21 Mar 2023 18:40:40 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:41945 Tue 16 Aug 2022 14:24:17 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:49887 Tue 13 Jun 2023 13:43:34 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:54206 Tue 13 Feb 2024 11:43:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:44864 0.7; 0.45–0.90). Item-rest correlations indicated that most ACT items (50 of 56 items) within any concept related well to the total score of the concept. Average inter-item correlations indicated potential redundant items for three concepts (feedback processes, leadership, staffing) that were above the threshold of 0.5. While identifying a few shortcomings for some ACT concepts in an ED context, the majority of findings confirm reliability and validity of the original ACT in an Australian population of ED nurses.]]> Thu 27 Oct 2022 13:57:10 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:44863 Thu 27 Oct 2022 13:56:05 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:31270 Thu 09 Dec 2021 11:04:26 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:34659 20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI] , 0.58-1.07; P=0.13; adjusted HR, 0.77; 95% CI, 0.59-0.99; P=0.045). Older age (75-84 years; HR, 4.9; 95% CI, 2.8-8.7; P < 0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3-1.9; P < 0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49-0.99; P=0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths. Conclusions: Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care.]]> Thu 03 Feb 2022 12:20:16 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10907 Sat 24 Mar 2018 08:07:41 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:21404 n=3467, mean age 74 years [standard deviation 13], 50% female; intracerebral haemorrhage n=275, mean age 74 years [standard deviation 13], 48% female). Following multivariable analyses patients with intracerebral haemorrhage were less likely to be admitted to a stroke unit (adjusted odds ratio 0·65; 95% confidence interval 0·45-0·94) or receive an assessment from allied health (adjusted odds ratio 0·54; 95% confidence interval 0·33-0·89) than patients with ischemic stroke. Patients with intracerebral haemorrhage are also less likely to be independent (adjusted odds ratio 0·36; 95% confidence interval 0·3-0·5) at time of hospital discharge and had a greater odds of dying in hospital (adjusted odds ratio 2·1; 95% confidence interval 1·3-3·5). Patients that were admitted to a stroke unit had a greater odds of being independent (modified Rankin Score 0-2) at day 7-10 irrespective of stroke type or severity on admission (adjusted odds ratio 1·3; 95% confidence interval 1·01-1·66). Conclusions: Following intracerebral haemorrhage, patients were less likely to be admitted to an acute stroke unit and receive allied health interventions. Admission to stroke units improved the likelihood of being independent at days 7-10 and, therefore, more should be done to encourage evidence-based care for intracerebral haemorrhage.]]> Sat 24 Mar 2018 08:04:59 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:19904 Sat 24 Mar 2018 08:03:48 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:27872 Sat 24 Mar 2018 07:41:12 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:28765 P<0.15 or if considered clinically important and readmission status. Results: Among 3328 patients, 6.5% were readmitted within 28 days (mean age, 75; 48% female; 92% ischemic). After bivariate analyses 14/43 factors from 4/5 categories were associated with readmission after hospitalization for stroke. Two factors from patient and health outcome categories remained independently associated with readmission after multivariable analyses. These were dependent premorbid functional status (adjusted odds ratio, 1.87; 95% confidence interval, 1.25–2.81) and having a severe adverse event during the initial hospitalization for stroke (adjusted odds ratio, 2.81; 95% confidence interval, 1.55–5.12). Conclusions: This is the first study to comprehensively evaluate factors associated with 28-day readmission after stroke. The factors associated with 28-day readmission are diverse and include potentially modifiable and nonmodifiable factors.]]> Sat 24 Mar 2018 07:24:50 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:46667 International Statistical Classification of Diseases and Related Health Problems (Tenth Edition, Australian Modification) codes from the hospital admissions and emergency presentation data. The outcome variable and other system factors were derived from the Australian Stroke Clinical Registry dataset. Multivariable, multilevel logistic regression was used to examine factors associated with the prescription of antihypertensive medications at hospital discharge. Results: Of the 10 315 patients included, 79.0% (intracerebral hemorrhage, 74.1%; acute ischemic stroke, 79.8%) were prescribed antihypertensive medications at discharge. Prescription varied between hospital sites, with 6 sites >2 SDs below the national average for provision of antihypertensives at discharge. Prescription was also independently associated with patient and clinical factors including history of hypertension, diabetes mellitus, management in an acute stroke unit, and discharge to rehabilitation. In patients with acute ischemic stroke, females (odds ratio, 0.85; 95% CI, 0.76-0.94), those who had greater stroke severity (odds ratio, 0.81; 95% CI 0.72-0.92), or dementia (odds ratio, 0.65; 95% CI, 0.52-0.81) were less likely to be prescribed. Conclusions: Prescription of antihypertensive medications poststroke varies between hospitals and according to patient factors including age, sex, stroke severity, and comorbidity profile. Implementation of targeted quality improvement initiatives at local hospitals may help to reduce the variation in prescription observed.]]> Mon 28 Nov 2022 18:46:24 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:46624 unadjusted 1 year, -0.147; 95% CI, -0.258 to -0.036; 5 years, -0.090; 95% CI, -0.119 to -0.062). After adjustment for age, stroke severity, prestroke dependency, and depression, these pooled median differences were attenuated, more greatly at 1 year (-0.067; 95% CI, -0.111 to -0.022) than at 5 years (-0.085; 95% CI, -0.135 to -0.034). Conclusions: Women consistently exhibited poorer HRQoL after stroke than men. This was partly attributable to women's advanced age, more severe strokes, prestroke dependency, and poststroke depression, suggesting targets to reduce the differences. There was some evidence of residual differences in HRQoL between sexes but they were small and unlikely to be clinically significant.]]> Mon 28 Nov 2022 11:32:40 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:32413 Mon 23 Sep 2019 12:03:48 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:46403 Mon 21 Nov 2022 10:00:52 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:53268 Mon 20 Nov 2023 12:48:48 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:40197 Mon 08 Aug 2022 13:29:07 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:39528 Mon 08 Aug 2022 11:13:05 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:42851 Mon 05 Sep 2022 15:40:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:38990 Fri 25 Mar 2022 14:35:33 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:51912 Fri 22 Sep 2023 10:40:45 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:52657 Fri 20 Oct 2023 09:10:15 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:53133 Fri 17 Nov 2023 11:23:28 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:41725 2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0-100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis. Results: In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RR_unadjusted 1.32, 95% confidence interval [CI] 1.18-1.48; 5 years: RR_unadjusted 1.31, 95% CI 1.16-1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RR_adjusted 1.08, 95% CI 0.97-1.20; 5 years: RR_adjusted 1.05, 95% CI 0.94-1.18). Women also had greater participation restriction than men (pooled MD_unadjusted-5.55, 95% CI -8.47 to -2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MD_adjusted-2.48, 95% CI -4.99 to 0.03). Conclusions: Worse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.]]> Fri 12 Aug 2022 13:12:50 AEST ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:47867 Fri 03 Feb 2023 14:14:59 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:47863 n = 45 hospitals) were analyzed. Differences in processes of care by the timing of discharge are described. Multilevel regression and survival analyses (up to 180 days postevent) were undertaken. Results: Among 30,649 registrants, 2621 (8.6%) were discharged on weekends (55% male; median age 74 years). Compared to those discharged on weekdays, patients discharged on weekends were more often patients with a transient ischemic attack (weekend 35% vs. 19%; p < 0.001) but were less often treated in a stroke unit (69% vs. 81%; p < 0.001), prescribed antihypertensive medication at discharge (65% vs. 71%; p < 0.001) or received a care plan if discharged to the community (47% vs. 53%; p < 0.001). After accounting for patient characteristics and clustering by hospital, patients discharged on weekends had a 1 day shorter length of stay (coefficient = -1.31, 95% confidence interval [CI] = -1.52, -1.10), were less often discharged to inpatient rehabilitation (aOR = 0.39, 95% CI = 0.34, 0.44) and had a greater hazard of death within 180 days (hazard ratio = 1.22, 95% CI = 1.04, 1.42) than those discharged on weekdays. Conclusions: Patients with stroke/transient ischemic attack discharged on weekends were more likely to receive suboptimal care and have higher long-term mortality. High quality of stroke care should be consistent irrespective of the timing of hospital discharge.]]> Fri 03 Feb 2023 14:00:52 AEDT ]]> https://nova.newcastle.edu.au/vital/access/manager/Repository/uon:33634 Fri 01 Apr 2022 09:21:50 AEDT ]]>