Agreement with evidence for tissue Plasminogen Activator use among emergency physicians: a cross-sectional survey (original) (raw)
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Journal of Iranian Medical Council
Background: One of the main parts of the early treatment of Acute Ischemic Stroke (AIS) is the attitude and knowledge of Emergency Medicine (EM) specialists. This study aimed to investigate the knowledge and attitude of emergency physicians working in Iran about the prescription of tissue Plasminogen Activator (tPA) in AIS. Methods: This was a cross-sectional questionnaire-based study including EM physicians working in different cities of Iran in 2020. A previously used English questionnaire was translated into Persian. After face validity and reliability assessment, the final questionnaire was designed as a Google form and sent to 400 EM professionals. Results: 128 physicians filled in the forms. 64.8% of participants had sufficient attitude and 68% had sufficient knowledge about tPA treatment in AIS. The knowledge regarding tPA treatment was higher in the age>40 years, male gender and physicians with up-to-date information (P<0.05), but no significant association was found f...
PLoS ONE, 2014
Objective: To assess emergency physicians' perceptions of individual and system enablers to the use of tissue Plasminogen Activator in acute stroke. Method: Australian fellows and trainees of Australasian College for Emergency Medicine completed a 57-item online survey assessing enablers to implementation of evidence-based practice across six domains: knowledge, skills, modelling, monitoring, feedback, and maintenance. Demographic and workplace characteristics were obtained. Descriptive statistics were calculated to describe demographic and workplace characteristics of responders, and survey responses. Each domain received an overall score (%) based on the number of responders agreeing with all items within the domain. Results: A total of 429 (13%) Australasian College for Emergency Medicine members responded. 17.7% of respondents reported they and/or their workplace met all knowledge-related enablers, however only 2.3% had all skill-related enablers in place. Of respondents who decide which patients receive tissue Plasminogen Activator treatment, 18.1% agreed that all maintenance-related enablers are in place at their hospital, compared to 6.6% for those who do not decide which patients receive tissue Plasminogen Activator treatment. None of the respondents had all items in place cross all domains. Conclusions: Even when allowing for the low response rate, it seems likely there is a lack of individual and system enablers supporting the implementation of bestpractice stroke care in a number of Australian hospitals. Quality improvement programs could target all domains, particularly the skills-training and feedback emergency physicians receive, to aid implementation of tissue Plasminogen Activator treatment for acute stroke.
Background: Stroke is a serious disease that entails an enormous burden of mortality, morbidity, disability and health care cost in the United States. Ischemic stroke accounts for 80 percent of all stroke cases. The aim of this study was to assess the emergency nurse's knowledge and practice regarding care of acute ischemic stroke patients undergoing recombinant tissue plasminogen activator. Data collection tools: the current study was collected by utilized three tools: tool one: socio demographic data, tool two: nurses' knowledge assessment questionnaire and tool three: observational checklist assessment sheet. Results: The mean age of the studied nurses was 25.3 ± 8.3 years. More than half of studied nurses had unsatisfactory level of total knowledge regarding care of acute ischemic stroke patients. The most of the studied nurses had competent regarding care of acute ischemic stroke patients undergoing recombinant tissue plasminogen activator. There was positive fair correlation between total knowledge of the studied nurses with their total practices regarding care of acute ischemic stroke patients undergoing recombinant tissue plasminogen activator. Conclusion: The study concluded thatmore than half of the studied nurses had unsatisfactory level of total knowledge regarding care of acute ischemic stroke patients. Most of the studied nurses had competent regarding care of acute ischemic stroke patients undergoing recombinant tissue plasminogen activator. Recommendations: Increase knowledge of emergency nurses regarding care of acute ischemic stroke patients through a seminar and workshop about it and encourage the implementation of future educational program for nurses in all hospitals where recombinant tissue plasminogen activator administration is applied.
Therapeutic advances in neurological disorders, 2016
In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients. We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined. We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 versus 9.5, respectively). Overall sICH rate was 3.3% (n = 10) and SH rate was 2.9 (n = ...
Acta neurologica Belgica, 2007
The short time window is frequently cited as the main reason for exclusion of intravenous tissue plasminogen activator (tPA) in acute stroke. Identifying and circumventing barriers to thrombolysis other than time could increase the frequency of treatment. The goal of this study was to identify whether the rate of treatment with tPA would increase if time window was not an obstacle to treatment. In four hospitals we prospectively recorded the rate of tPA use in consecutive patients admitted with acute ischemic stroke and in those admitted within 3 hours, the reasons why thrombolysis was not given, and the potential gain in the rate of tPA use if all patients had been admitted within 3 hours considering all exclusion criteria other than time. We recruited 486 patients (258 men; mean age, 70.4 +/- 13.5 years), of whom 154 (31.7%) were admitted within 3 hours. The time of stroke onset was unknown in 28 (5.8%). The rate of tPA use was 11.1% in the whole study population and 35.1% in thos...
In-Hospital Stroke Treated With Intravenous Tissue Plasminogen Activator
Stroke, 2008
Background and Purpose-In-hospital strokes (IHSs) are potential candidates for thrombolysis. We analyzed the treatment procedures, safety, and efficacy of intravenous tissue plasminogen activator (IV-tPA) in IHSs compared with out-of-hospital strokes (OHSs). Methods-This study was based on a multicenter prospective registry of patients treated with IV-tPA divided into IHSs and OHSs. We recorded intrahospital delays and stroke outcomes. Results-Among 367 patients treated with IV-tPA, 30 were IHSs. Baseline characteristics were similar except for a greater proportion of diabetes (36.7% vs 17.5%, Pϭ0.01), cardiac failure (16.7% vs 5.3%, Pϭ0.014), and atrial fibrillation (33.3% vs 17.5%, Pϭ0.034) in IHSs than OHSs. In-hospital delays were significantly longer in IHSs for door-to-computed tomography time (39.5Ϯ18.7 vs 22.6Ϯ19.7 minutes, PϽ0.0001) and computed tomography-to-treatment time (92.0Ϯ26.1 vs 65.4Ϯ25.8 minutes, PϽ0.0001). No differences were observed in safety or efficacy. Conclusions-In-hospital procedures for thrombolysis proceed more slowly in IHSs than in OHSs. Thrombolysis is safe and efficient in IHS.
2000
Objective: To report initial experience with the use of intravenous tissue plasminogen activator (tPA) to treat acute ischaemic stroke at an Australian tertiary-care hospital. Design: Retrospective audit of computerised hospital stroke database. Participants and setting: All patients with acute ischaemic stroke treated with intravenous tPA between April 1999 and July 2002 at the Royal Melbourne Hospital, VIC. Main outcome measures:
Neurology Research International
Background. Intravenous recombinant tissue plasminogen activator (i.v. rt-PA) is the milestone treatment for patients with acute ischemic stroke. Stroke Fast Track (SFT) facilitates time reduction, guarantees safety, and promotes good clinical outcomes in i.v. rt-PA treatment. Nursing case management is a healthcare service providing clinical benefits in many specific diseases. The knowledge about the efficacy of a nurse case management for Stroke Fast Track is limited. We aim to study the effect of nurse case management on clinical outcomes in patients with acute ischemic stroke involving intravenous recombinant tissue plasminogen activator (i.v. rt-PA) treatment. Methods. Seventy-six patients with acute ischemic stroke who received i.v. rt-PA treatment under Stroke Fast Track protocol of Thammasat University Hospital were randomized into two groups. One group was assigned to get standard care (control) while another group was assigned to get standard care under a nurse case manage...