https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52943 Wed 28 Feb 2024 16:14:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54324 Wed 28 Feb 2024 15:22:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51317  2) and hemorrhagic stroke. With four arms per stratum (reference arm retained throughout), only the single treatment arm demonstrating the highest proportion of favorable outcomes at the first stage will proceed to the second stage in each stratum, resulting in a final comparison with the reference arm. Three prognostic covariates of age, geographic region and reperfusion interventions, as well as previously observed mRS 0-2 responses inform the adaptive randomization procedure. Participants randomized receive prespecified mobility training regimens (functional task-specific), provided by physiotherapists/nurses until discharge or 14 days. Interventions replace usual mobility training. Fifty hospitals in seven countries (Australia, Malaysia, United Kingdom, Ireland, India, Brazil, Singapore) are expected to participate. Summary: Our novel adaptive trial design will evaluate a wider variety of mobility regimes than a traditional two-arm design. The data-driven adaptions during the trial will enable a more efficient evaluation to determine the optimal early mobility intervention for patients with mild and moderate ischemic stroke.]]> Wed 28 Feb 2024 15:05:25 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:27169 Wed 11 Apr 2018 16:29:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:6972 Wed 11 Apr 2018 15:26:57 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27198 Wed 11 Apr 2018 14:24:41 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18743 Wed 11 Apr 2018 10:46:04 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:15205 Wed 11 Apr 2018 09:45:15 AEST ]]> 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:42925 Wed 07 Sep 2022 13:31:25 AEST ]]> 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: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:54575 Tue 14 May 2024 14:40:10 AEST ]]> 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:25771 Thu 13 Aug 2020 08:45:23 AEST ]]> 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:15698 Sat 24 Mar 2018 08:22:27 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10818 Sat 24 Mar 2018 08:13:37 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:18958 Sat 24 Mar 2018 07:58:56 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:21244 P = 0·77 at discharge; co-located acute/rehabilitation stroke care: 109·5 ± 21·7 vs. traditionally separated acute/rehabilitation stroke care: 104·4 ± 27·9; P = 0·8875 at 90 days post-discharge). Total length of hospital stay was 5·28 days less in co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (24·15 ± 3·18 vs. 29·42 ± 4·5, P = 0·35). There was significant improvement in functional independence measure efficiency score among participants assigned to co-located acute/rehabilitation stroke care compared with traditionally separated acute/rehabilitation stroke care (co-located acute/rehabilitation stroke care: median 1·60, interquartile range: 0·87–2·81; traditionally separated acute/rehabilitation stroke care: median 0·82, interquartile range: 0·27–1·57, P = 0·0393). Linear regression analysis revealed a high inverse correlation (R² = 0·89) between functional independence measure efficiency and time spent in the acute stroke unit. Conclusion: This proof-of-concept study has shown that co-located acute/rehabilitation stroke care was just as effective as traditionally separated acute/rehabilitation stroke care as reflected in functional independence measure scores, but significantly more efficient as shown in greater functional independence measure efficiency. Co-located acute/rehabilitation stroke care has potential for significantly improved hospital bed utilization with no patient disadvantage.]]> Sat 24 Mar 2018 07:53:02 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:21364 11 mmol/L). We also recorded swallow screening and assessment during the first 24 h of admission. Results: Data for 718 (98%) patients were available; 138 (19%) had four hourly or more temperature readings and 204 patients (29%) had a fever, with 44 (22%) receiving paracetamol. A quarter of patients (n = 102/412, 25%) had six hourly or more glucose readings and 23% (95/412) had hyperglycemia, with 31% (29/95) of these treated with insulin. The majority of patients received a swallow assessment (n = 562, 78%) by a speech pathologist in the first instance rather than a swallow screen by a nonspeech pathologist (n = 156, 22%). Of those who passed a screen (n = 108 of 156, 69%), 68% (n = 73) were reassessed by a speech pathologist and 97% (n = 71) were reconfirmed to be able to swallow safely. Conclusions: Our results showed that acute stroke patients were: undermonitored and undertreated for fever and hyperglycemia; and underscreened for swallowing dysfunction and unnecessarily reassessed by a speech pathologist, indicating the need for urgent behavior change.]]> Sat 24 Mar 2018 07:51:25 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27416 Sat 24 Mar 2018 07:35:25 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:28777 11 mmol/l), and swallowing dysfunction in intervention stroke units. Results: Data from 1804 patients (718 preintervention; 1086 postintervention) showed that significantly more patients admitted to hospitals allocated to the intervention group received care according to the fever (n = 186 of 603, 31% vs. n = 74 of 483, 15%, P < 0·001), hyperglycemia (n = 22 of 603, 3·7% vs. n = 3 of 483, 0·6%, P = 0·01), and swallowing dysfunction protocols (n = 241 of 603, 40% vs. n = 19 of 483, 4·0%, P ≤ 0·001). Significantly more patients in these intervention stroke units received four-hourly temperature monitoring (n = 222 of 603, 37% vs. n = 90 of 483, 19%, P < 0·001) and six-hourly glucose monitoring (194 of 603, 32% vs. 46 of 483, 9·5%, P < 0·001) within 72 hours of admission to a stroke unit, and a swallowing screen (242 of 522, 46% vs. 24 of 350, 6·8%, P ≤ 0·0001) within the first 24 hours of admission to hospital. There was no difference between the groups in the treatment of patients with fever with paracetamol (22 of 105, 21% vs. 38 of 131, 29%, P = 0·78) or their hyperglycemia with insulin (40 of 100, 40% vs. 17 of 57, 30%, P = 0·49). Interpretation Our intervention resulted in better protocol adherence in intervention stroke units, which explains our main trial findings of improved patient 90-day outcomes. Although monitoring practices significantly improved, there was no difference between the groups in the treatment of fever and hyperglycemia following acute stroke. A significant link between improved treatment practices and improved outcomes would have explained further the success of our intervention, and we are still unable to explain definitively the large improvements in death and dependency found in the main trial results. One potential explanation is that improved monitoring may have led to better overall surveillance of deteriorating patients and faster initiation of treatments not measured as part of the main trial.]]> Sat 24 Mar 2018 07:23:45 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:4660 Sat 24 Mar 2018 07:19:34 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:4661 Sat 24 Mar 2018 07:19:33 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:16768 Mon 26 Nov 2018 15:27:36 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:49585 Mon 22 May 2023 12:22:22 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:35502 Mon 19 Aug 2019 13:13:21 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38822 4.0% to ≤10.0%); and moderate rates (>10.0%). Hospitals were randomized to an implementation package (experimental group) or usual care (control group) using a 1:1 ratio. The 16‐month intervention was based on behavioral theory and analysis of the steps, roles, and barriers to rapid assessment for thrombolysis eligibility and involved comprehensive strategies addressing individual and system‐level change. The primary outcome was the difference in tissue plasminogen activator proportions between the 2 groups postintervention. The absolute difference in postintervention IVT rates between intervention and control hospitals adjusted for baseline IVT rate and stratum was not significant (primary outcome rate difference=1.1% (95% CI −1.5% to 3.7%; P=0.38). Rates of intracranial hemorrhage remained below international benchmarks. Conclusions: The implementation package resulted in no significant change in tissue plasminogen activator implementation, suggesting that ongoing support is needed to sustain initial modifications in behavior.]]> Mon 14 Feb 2022 14:40:13 AEDT ]]> 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:45490 Fri 28 Oct 2022 15:46:27 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42211 P =.78). Patients managed in SUs more often received recommended management (e.g. swallowing screening). Conclusion: The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.]]> Fri 26 Aug 2022 09:25:59 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27086 Fri 24 May 2019 12:30:11 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27085 40 medical patients each year were targeted to receive the intervention which consisted of a one-to-one educational visit on VTE prevention from a trained peer facilitator. The EOV protocol was designed by a multidisciplinary group of healthcare professionals using social marketing theory. Results: Nineteen (73%) of 26 eligible participants received an EOV. The majority (n = 16, 85%) felt the EOV was effective or extremely effective at increasing their knowledge about VTE prophylaxis and 15 (78%) gave a verbal commitment to provide evidence-based prophylaxis. The average length of each visit was 15 minutes (IQ range 15 to 20) and the average time spent arranging and conducting each visit was 92 minutes (IQ range 78 to 129). There was a significant improvement in the proportion of medical patients receiving appropriate pharmacological VTE prophylaxis following the intervention (54% to 70%, 16% improvement, 95% CI 5 to 26, p = 0.004). Conclusions: EOV is effective at improving doctors’ provision of pharmacological VTE prophylaxis to hospitalised medical patients. It was also found to be an acceptable implementation strategy by the majority of participants; however, it was resource intensive requiring on average 92 minutes per visit.]]> Fri 24 May 2019 12:29:42 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:27082 Fri 13 Jul 2018 15:56:32 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 ]]>