The Early Outcomes of Nurse Case Management in Patients with Acute Ischemic Stroke Treated with Intravenous Recombinant Tissue Plasminogen Activator: A Prospective Randomized Controlled Trial (original) (raw)
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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.
International Journal of Environmental Research and Public Health
Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5...
Background: In ischemic stroke, administration of tissue plasminogen activator (tPA) within 4.5 hours from the time last known well (LKW) improves outcomes, with better outcomes seen with earlier administration. However, for patients presenting early, a perception of significant remaining time within this window may lead to delayed tPA administration. We hypothesized that cases with a shorter LKW-to-stroke team activation (code) time will have a longer " code-to-tPA " administration time. Methods: In the Mount Sinai Hospital Stroke Registry (2009-2015), 122 patients received tPA. The patients were divided by " LKW-to-code " time into 3 groups: 0-59 minutes (n = 38), 60-119 minutes (n = 49), and 120 minutes or more (n = 35). The code-to-tPA time was compared among these groups, adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS) score, and race–ethnicity. Results: The average code-to-tPA time was 80 minutes in the 0-59 minutes group, 67 minutes in the 60-119 minutes group, and 52 minutes in the 120 minutes or more group (analysis of variance P < .0001). There was an average 28-minute difference (P = .021) between the 0-59 and 120 minutes or more groups. Conclusion: There was a significant negative correlation between the LKW-to-code time and the code-to-tPA time that was independent of age, sex, NIHSS score, and race–ethnicity. Key Words: Ischemic stroke—cerebrovascular disease—quality improvement— tPA—alteplase.
International Journal of Basic & Clinical Pharmacology, 2016
Background: Stroke is an abrupt onset of a neurologic deficit due to a focal vascular disease. Treatment guidelines for acute ischemic stroke (AIS) within 4.5 hours of onset are thrombolysis with recombinant tissue plasminogen activator (rtPA). To determine the practice pattern of rtPA in the treatment of acute ischemic stroke among consultants using a questionnaire.Methods: A questionnaire based study was carried out from May to September 2015. Neurologists and physicians from Kolar and Bengaluru were given a questionnaire comprising of 21 questions, regarding the treatment of AIS with rtPA. The data was analyzed using descriptive statistics.Results: A total of 76.9% responded to the questionnaire, of which 18 were neurologists and 82 were physicians. An average of 4-5 AIS patients per month were seen by the doctors. Majority (72%) did not use rtPA, due to delay in patient reaching hospital or non-affordability of the drug. The consultants (66%) opined that rtPA was the best if pat...
2010
Background and Purpose-Some patients with mild or improving ischemic stroke symptoms do not receive intravenous tissue plasminogen activator (tPA) because they look "too good to treat" (TGT); however, some have poor outcomes. Methods-We retrospectively analyzed data from a prospective single-center study between 2002 and 2004. TGT patients were those arriving within 3 hours of symptom onset and not treated with intravenous tPA solely because of mild or improving symptoms. Results-Of 128 patients presenting within 3 hours, 41 (34%) were not given tPA because of mild or improving stroke.
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...
Stroke, 2004
Background and Purpose-Acute ischemic stroke patients are infrequently treated with recombinant tissue plasminogen activator (rtPA). We present unique population-based data regarding the eligibility of ischemic stroke patients for rtPA treatment. Methods-All ischemic strokes presenting to an emergency department (ED) within a biracial population of 1.3 million were identified. The patient was considered eligible for rtPA on the basis of exclusion criteria from the National Institute of Neurological Disorders and Stroke rtPA trial. Results-Of 2308 ischemic strokes, 1849 presented to an ED. Only 22% of all ischemic strokes in the population arrived in the ED in Ͻ3 hours from symptom onset; of these, 209 (51%) were ineligible for rtPA on the basis of mild stroke severity, medical and surgical history, or blood tests.
Stroke; a journal of cerebral circulation, 2012
The publication of the European Cooperative Acute Stroke Study (ECASS III) expanded the treatment time to thrombolysis for acute ischemic stroke from 3 to 4.5 hours from symptom onset. The impact of the expanded time window on treatment rates has not been comprehensively evaluated in a population-based study. All patients with an ischemic stroke presenting to an emergency department during calendar year 2005 in the 17 hospitals that compromise the large 1.3 million Greater Cincinnati/Northern Kentucky population were included in the analysis. Criteria for exclusion from thrombolytic therapy are analyzed retrospectively for both the standard and expanded timeframes with varying door-to-needle times. During the study period, 1838 ischemic strokes presenting to an emergency department were identified. A small proportion of them arrived in the expanded time window (3.4%) compared with the standard time window (22%). Only 0.5% of those who arrived in this timeframe met eligibility criter...
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.