https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:45222 Wed 26 Oct 2022 15:50:17 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:30082 versus 25% of acute ischaemic stroke patients, p = 0.0016). In both hospitals, reasons for exclusion from IV-tPA treatment were intracerebral haemorrhage, mild symptoms, and stroke mimic. Patients with baseline National Institutes of Health Stroke Scale score =5 were more likely to be excluded from IV-tPA in the Japanese hospital. Of patients treated with IV-tPA, the door-to-needle time (median, 63 versus 54 minutes, p = 0.0355) and imaging-to-needle time (34 versus 27 minutes, p = 0.0220) were longer in the Australian hospital. Through international benchmarking using cohorts captured under ASC, significant differences were noted in rates of IV-tPA treatment and workflow speed. This variation highlights opportunity to improve and areas to focus targeted practice improvement strategies.]]> Wed 19 Jan 2022 15:15:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:16387 Wed 11 Apr 2018 16:12:54 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:22828 Wed 11 Apr 2018 12:09:04 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:37857 Wed 10 Nov 2021 15:12:46 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:49270 Wed 10 May 2023 12:03:17 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41666 Wed 10 Aug 2022 12:13:25 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:29075 Tue 17 Sep 2019 15:21:28 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35875 Tue 17 Dec 2019 14:15:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51004 Tue 15 Aug 2023 12:55:22 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31178 Tue 11 Sep 2018 12:07:51 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19652 12 months, with the final meeting occurring during the Stroke Treatment Academy Industry Roundtable (STAIR) on March 9 to 10, 2013, in Washington, DC. This process brought together vascular neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss stroke imaging research priorities, especially in the light of the recent negative results of acute stroke clinical trials that tested the concept of penumbral imaging selection. The goal of this process was to propose a research roadmap for the next 5 years. STIR recommendations include (1) the use of standard terminology, aligned with the National Institute of Neurological Disorders and Stroke Common Data Elements. ; (2) a standardized imaging assessment of revascularization in acute ischemic stroke trials, including a modified Treatment In Cerebral Ischemia (mTICI) score. ; (3) a standardized process to assess whether ischemic core and penumbral imaging methods meet the requirements to be considered as an acceptable selection tool in acute ischemic stroke trials. ; (4) the characteristics of a clinical and imaging data repository to facilitate the development and testing process described in recommendation no. 3. ; (5) the optimal study design for a clinical trial to evaluate whether advanced imaging adds value in selecting acute ischemic stroke patients for revascularization therapy. ; (6) the structure of a stroke neuroimaging network to implement and coordinate the recommendations listed above. All of these recommendations pertain to research, not to clinical care.]]> Thu 28 May 2020 06:30:04 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41188 75%) was observed for all the pooled analyses. Publication bias was also identified. Conclusion: There was no evidence for preferring one type of behaviour change intervention strategy, nor for including multiple strategies in improving thrombolysis rates. However, the study results should be interpreted with caution, as they display high heterogeneity and publication bias.]]> Thu 28 Jul 2022 11:05:36 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:37855 Thu 20 May 2021 12:09:25 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:47432 Thu 19 Jan 2023 16:19:30 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42106 Thu 18 Aug 2022 13:32:29 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32925 Thu 17 Mar 2022 14:40:19 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32926 Thu 17 Mar 2022 14:38:48 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:25490 Thu 17 Mar 2022 14:34:05 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31435 P < 0.001). For every millilitre of penumbra salvaged, 7.2 days of disability-adjusted life-year days were saved (ß = -7.2, 95% confidence interval, -10.4 to -4.1 days, P < 0.001). Each minute of earlier onset-to-treatment time resulted in a saving of 4.4 disability-free days after stroke (1.3-7.5 days, P = 0.006). However, after adjustment for imaging variables, onset-to-treatment time was not significantly associated with savings in disability-adjusted life-year days. Pretreatment perfusion computed tomography can (independently of clinical variables) predict significant gains, or loss, of disability-free life in patients undergoing reperfusion therapy for stroke. The effect of earlier treatment on disability-free life appears explained by salvage of penumbra, particularly when the ischaemic core is not too large.]]> Thu 17 Feb 2022 09:30:10 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27007 Thu 13 Jan 2022 10:29:53 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:41242 Sat 30 Jul 2022 12:26:18 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:8112 90% reduction in magnetic resonance perfusion-weighted imaging lesion volume and recanalization as improvement of MR angiographic Thrombolysis In Myocardial Infarction grading by ≥2 points from baseline to Day 3 to 5. At Day 3 to 5, reperfusion and recanalization with intravenous tissue plasminogen activator were strongly correlated. Reperfusion was associated with improved clinical outcome independent of whether recanalization occurred. In contrast, recanalization was not associated with clinical outcome when reperfusion was included as a covariate in regression analyses. Reperfusion is a surrogate marker of clinical outcomes independent of recanalization based on the criteria applied in EPITHET. The impact of recanalization on clinical outcomes was attributable to reperfusion.]]> Sat 24 Mar 2018 08:40:01 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:8092 Sat 24 Mar 2018 08:34:27 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10736 Sat 24 Mar 2018 08:14:29 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10667 Sat 24 Mar 2018 08:12:09 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10901 190 mL). Excellent outcome from tPA treatment was substantially increased in patients with DWI lesions < 18mL (77% versus 18% placebo, OR= 15.0, P < 0.001). Benefit from tPA was also seen with DWI lesions up to 25mL (69% versus 29% placebo, OR= 5.5, P= 0.03), but not for DWI lesions > 25 mL. In contrast, increasing mismatch ratios did not influence the odds of excellent outcome with tPA. Clinical responsiveness to IV-tPA, and stroke outcome, depends more on baseline DWI and PWI lesion volumes than the extent of perfusion–diffusion mismatch.]]> Sat 24 Mar 2018 08:09:03 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10750 Sat 24 Mar 2018 08:08:22 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10752 Sat 24 Mar 2018 08:08:22 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10746 Sat 24 Mar 2018 08:08:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:21405 P=0·03) and a trend to lower absolute growth (-0·17ml versus 9·6ml, P=0·07). Reperfusion was increased in the tissue plasminogen activator group (58% versus 25%, P=0·03) and was associated with increased rates of good neurological (86% versus 28% P<0·001) and functional (modified Rankin scale 0-2 73% versus 34%, P=0·01) outcomes. Reperfusion was strongly associated with lower relative (80% versus 189%, P<0·001) and absolute (-2·5ml versus 40ml, P<0·001) infarct growth. Conclusions: Thrombolysis 4·5-6h after stroke onset reduced infarct growth and increased the rate of reperfusion, which was associated with good neurological and functional outcome.]]> Sat 24 Mar 2018 08:05:00 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:20340 6 seconds, ratio>1.2) in 3/119 (2.5%) patients. Diffusion lesion reversal between baseline and 3 to 6 hours DWI was also uncommon (7/65, 11%) and often transient. Clinically relevant DLR is uncommon and rarely alters perfusion-diffusion mismatch. The acute diffusion lesion is generally a reliable signature of the infarct core.]]> Sat 24 Mar 2018 08:02:57 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:17758 Sat 24 Mar 2018 07:57:21 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19728 P<0.001) and smaller baseline diffusion lesion volume (Rho −0.70, P<0.001). In 30 patients without reperfusion at day 3 to 5, deterioration in collateral quality between baseline and subacute imaging was strongly associated with absolute (P=0.02) and relative (P<0.001) infarct growth. The deterioration in collateral grade correlated with increased mean Tmax hypoperfusion severity (Rho −0.68, P<0.001). Deterioration in Tmax hypoperfusion severity was also significantly associated with absolute (P=0.003) and relative (P=0.002) infarct growth. Collateral flow is dynamic and failure is associated with infarct growth.]]> Sat 24 Mar 2018 07:53:45 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19727 Sat 24 Mar 2018 07:53:44 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27117 Sat 24 Mar 2018 07:41:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:26464 Sat 24 Mar 2018 07:27:17 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23567 Sat 24 Mar 2018 07:14:10 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23824 1·2, and absolute mismatch >10 ml) will be randomized to either tissue plasminogen activator or placebo. Study outcome: The primary outcome measure will be modified Rankin Scale 0–1 at day 90. Clinical secondary outcomes include categorical shift in modified Rankin Scale at 90 days, reduction in the National Institutes of Health Stroke Score by 8 or more points or reaching 0–1 at day 90, recurrent stroke, or death. Imaging secondary outcomes will include symptomatic intracranial haemorrhage, reperfusion and or recanalization at 24 h and infarct growth at day 90.]]> Sat 24 Mar 2018 07:12:50 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46642 p < 0.0001). There was no heterogeneity of the effects of BP lowering (intensive vs. guideline) on functional recovery between standard-dose (OR 0.81, 95% CI 0.59-1.12) and low-dose alteplase (1.06, 0.77-1.47; p = 0.25 for interaction). Similar results were observed for ICH (p = 0.50 for interaction). Conclusions: In thrombolysis-treated patients with predominantly mild-to-moderate severity AIS, intensive BP lowering neither improve functional recovery, either with low-or standard-dose intravenous alteplase, nor beneficially interact with low-dose alteplase in reducing ICH. Trial Registration: The trial is registered with ClinicalTrials.gov (NCT01422616).]]> Mon 28 Nov 2022 16:54:24 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:52511 Mon 16 Oct 2023 10:31:18 AEDT ]]> 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:35602 Fri 13 Sep 2019 15:57:13 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41805 Fri 12 Aug 2022 12:31:27 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46103 185/105 mmHg) during the first 24 h following tPA-bolus. The majority of BP excursions (46%) occurred within the first 75 min from tPA-bolus. Patients with at least one BP excursion in the first 24 h following tPA bolus had significantly lower rates of independent functional outcome at 90 days (31 vs. 40.1%, P = 0.028). The total number of BP excursions was associated with decreased odds of 24-h clinical recovery (OR = 0.88, 95% CI:0.80–0.96), 24-h neurological improvement (OR = 0.87, 95% CI: 0.81–0.94), 7-day functional improvement (common OR = 0.92, 95% CI: 0.87–0.97), 90-day functional improvement (common OR = 0.94, 95% CI: 0.88–0.98) and 90-day independent functional outcome (OR = 0.90, 95% CI: 0.82–0.98) in analyses adjusted for potential confounders. DBP excursions were independently associated with increased odds of any intracranial hemorrhage (OR = 1.26, 95% CI: 1.04–1.53). Conclusion: BP excursions above guideline thresholds during the first 24 h following tPA administration for AIS are common and are independently associated with adverse clinical outcomes.]]> Fri 11 Nov 2022 15:33:52 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41588 Fri 05 Aug 2022 14:52:10 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33104 Fri 01 Apr 2022 09:29:07 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:30100 p = 0.022) and did not have different rates of mRS 0 to 2 (72% treated patients vs 77% untreated; RR, 0.93; 95% CI, 0.82-1.95; p = 0.23). Interpretation: This large observational cohort suggests that a portion of ischemic stroke patients clinically eligible for alteplase therapy with a small perfusion lesion have a good natural history and may not benefit from treatment.]]> Fri 01 Apr 2022 09:25:36 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:29067 P<0.0001). Recanalization rates were not significantly higher with additional ultrasound in either model. Conclusion: In this model, the degree of carotid stenosis had a large effect on thrombolytic recanalization. Sonothrombolysis using standard parameters for intracranial sonothrombolysis did not increase recanalization. Further testing is warranted. The degree of underlying stenosis may be an important predictor of thrombolytic recanalization, and clinical correlation of these findings may provide new approaches to treatment selection for patients with carotid occlusion.]]> Fri 01 Apr 2022 09:24:48 AEDT ]]>