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Ding R, Betihavas V, McElduff B, Dale S, Coughlan K, McInnes E, Middleton S, Fasugba O. Fever, Hyperglycemia, and Swallowing Management in Stroke Unit and Non-Stroke-Unit European Hospitals: A Quality in Acute Stroke Care (QASC) Europe Substudy. J Neurosci Nurs 2024; 56:42-48. [PMID: 38064588 DOI: 10.1097/jnn.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
ABSTRACT BACKGROUND: Stroke unit care reduces patient morbidity and mortality. The Quality in Acute Stroke Care Europe Study achieved significant large-scale translation of nurse-initiated protocols to manage Fever, hyperglycemia (Sugar), and Swallowing (FeSS) in 64 hospitals across 17 European countries. However, not all hospitals had stroke units. Our study aimed to compare FeSS protocol adherence in stroke unit versus non-stroke-unit hospitals. METHODS: An observational study using Quality in Acute Stroke Care Europe Study postimplementation data was undertaken. Hospitals were categorized using 4 evidence-based characteristics for defining a stroke unit, collected from an organizational survey of participating hospitals. Differences in FeSS Protocol adherence between stroke unit and non-stroke-unit hospitals were investigated using mixed-effects logistic regression, adjusting for age, sex, and National Institutes of Health Stroke Scale. RESULTS: Of the 56 hospitals from 16 countries providing organizational data, 34 (61%) met all 4 stroke unit characteristics, contributing data for 1825 of 2871 patients (64%) (stroke unit hospitals). Of the remaining 22 hospitals (39%), 17 (77%) met 3 of the 4 stroke unit characteristics (non-stroke-unit hospitals). There were no differences between hospitals with a stroke unit and those without for postimplementation adherence to fever (49% stroke unit vs 57% non-stroke unit; odds ratio [OR], 0.400; 95% confidence interval [CI], 0.087-1.844; P = .240), hyperglycemia (50% stroke unit vs 57% non-stroke unit; OR, 0.403; 95% CI, 0.087-1.856; P = .243), swallowing (75% stroke unit vs 60% non-stroke unit; OR, 1.702; 95% CI, 0.643-4.502; P = .284), or overall FeSS Protocol adherence (36% stroke unit vs 36% non-stroke unit; OR, 0.466; 95% CI, 0.106-2.043; P = .311). CONCLUSION: Our results demonstrate that the nurse-initiated FeSS Protocols can be implemented by hospitals regardless of stroke unit status. This is noteworthy because hospitals without stroke unit resources that care for acute stroke patients can potentially implement these protocols. Further effort is needed to ensure better adherence to the FeSS Protocols.
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McInnes E, Dale S, Bagot K, Coughlan K, Grimshaw J, Pfeilschifter W, Cadilhac DA, Fischer T, van der Merwe J, Middleton S. The Quality in Acute Stroke Care (QASC) global scale-up using a cascading facilitation framework: a qualitative process evaluation. BMC Health Serv Res 2024; 24:144. [PMID: 38287332 PMCID: PMC10823736 DOI: 10.1186/s12913-024-10617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Variation in hospital stroke care is problematic. The Quality in Acute Stroke (QASC) Australia trial demonstrated reductions in death and disability through supported implementation of nurse-led, evidence-based protocols to manage fever, hyperglycaemia (sugar) and swallowing (FeSS Protocols) following stroke. Subsequently, a pre-test/post-test study was conducted in acute stroke wards in 64 hospitals in 17 European countries to evaluate upscale of the FeSS Protocols. Implementation across countries was underpinned by a cascading facilitation framework of multi-stakeholder support involving academic partners and a not-for-profit health organisation, the Angels Initiative (the industry partner), that operates to promote evidence-based treatments in stroke centres. .We report here an a priori qualitative process evaluation undertaken to identify factors that influenced international implementation of the FeSS Protocols using a cascading facilitation framework. METHODS The sampling frame for interviews was: (1) Executives/Steering Committee members, consisting of academics, the Angels Initiative and senior project team, (2) Angel Team leaders (managers of Angel Consultants), (3) Angel Consultants (responsible for assisting facilitation of FeSS Protocols into multiple hospitals) and (4) Country Co-ordinators (senior stroke nurses with country and hospital-level responsibilities for facilitating the introduction of the FeSS Protocols). A semi-structured interview elicited participant views on the factorsthat influenced engagement of stakeholders with the project and preparation for and implementation of the FeSS Protocol upscale. Interviews were recorded, transcribed verbatim and analysed inductively within NVivo. RESULTS Individual (n = 13) and three group interviews (3 participants in each group) were undertaken. Three main themes with sub-themes were identified that represented key factors influencing upscale: (1) readiness for change (sub-themes: negotiating expectations; intervention feasible and acceptable; shared goal of evidence-based stroke management); (2) roles and relationships (sub-themes: defining and establishing roles; harnessing nurse champions) and (3) managing multiple changes (sub-themes: accommodating and responding to variation; more than clinical change; multi-layered communication framework). CONCLUSION A cascading facilitation model involving a partnership between evidence producers (academic partners), knowledge brokers (industry partner, Angels Initiative) and evidence adopters (stroke clinicians) overcame multiple challenges involved in international evidence translation. Capacity to manage, negotiate and adapt to multi-level changes and strategic engagement of different stakeholders supported adoption of nurse-initiated stroke protocols within Europe. This model has promise for other large-scale evidence translation programs.
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Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia.
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia.
| | - Kathleen Bagot
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Jeremy Grimshaw
- Centre for Practice-Changing Research (CPCR), Ottawa Health Research Institute, Ottawa Hospital - General Campus; and University of Ottawa, Ottawa, ON, Canada
| | - Waltraud Pfeilschifter
- Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Department of Neurology, Germany Centre of Neurology and Neurosurgery, Goethe University, Frankfurt am Main, University Hospital Frankfurt, Frankfurt, Germany
| | - Dominique A Cadilhac
- Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Melbourne, Australia
- Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
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Fasugba O, Sedani R, Mikulik R, Dale S, Vařecha M, Coughlan K, McElduff B, McInnes E, Hladíková S, Cadilhac DA, Middleton S. How registry data are used to inform activities for stroke care quality improvement across 55 countries: A cross-sectional survey of Registry of Stroke Care Quality (RES-Q) hospitals. Eur J Neurol 2024; 31:e16024. [PMID: 37540834 PMCID: PMC10952746 DOI: 10.1111/ene.16024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND AND PURPOSE The Registry of Stroke Care Quality (RES-Q) is a worldwide quality improvement data platform that captures performance and quality measures, enabling standardized comparisons of hospital care. The aim of this study was to determine if, and how, RES-Q data are used to influence stroke quality improvement and identify the support and educational needs of clinicians using RES-Q data to improve stroke care. METHODS A cross-sectional self-administered online survey was administered (October 2021-February 2022). Participants were RES-Q hospital local coordinators responsible for stroke data collection. Descriptive statistics are presented. RESULTS Surveys were sent to 1463 hospitals in 74 countries; responses were received from 358 hospitals in 55 countries (response rate 25%). RES-Q data were used "always" or "often" to: develop quality improvement initiatives (n = 213, 60%); track stroke care quality over time (n = 207, 58%); improve local practice (n = 191, 53%); and benchmark against evidence-based policies, procedures and/or guidelines to identify practice gaps (n = 179, 50%). Formal training in the use of RES-Q tools and data were the most frequent support needs identified by respondents (n = 165, 46%). Over half "strongly agreed" or "agreed" that to support clinical practice change, education is needed on: (i) using data to identify evidence-practice gaps (n = 259, 72%) and change clinical practice (n = 263, 74%), and (ii) quality improvement science and methods (n = 255, 71%). CONCLUSION RES-Q data are used for monitoring stroke care performance. However, to facilitate their optimal use, effective quality improvement methods are needed. Educating staff in quality improvement science may develop competency and improve use of data in practice.
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Affiliation(s)
- Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Rupal Sedani
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Robert Mikulik
- International Clinical Research Centre, Neurology DepartmentSt. Anne's University Hospital and Masaryk UniversityBrnoCzech Republic
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Miroslav Vařecha
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Sabina Hladíková
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Stroke Theme, Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
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Fasugba O, Dale S, McInnes E, Cadilhac DA, Noetel M, Coughlan K, McElduff B, Kim J, Langley T, Cheung NW, Hill K, Pollnow V, Page K, Sanjuan Menendez E, Neal E, Griffith S, Christie LJ, Slark J, Ranta A, Levi C, Grimshaw JM, Middleton S. Evaluating remote facilitation intensity for multi-national translation of nurse-initiated stroke protocols (QASC Australasia): a protocol for a cluster randomised controlled trial. Implement Sci 2023; 18:2. [PMID: 36703172 PMCID: PMC9879239 DOI: 10.1186/s13012-023-01260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing difficulties (FeSS Protocols) in 19 Australian stroke units resulted in reduced death and dependency for stroke patients. However, a significant gap remains in translating this evidence-based care bundle protocol into standard practice in Australia and New Zealand. Facilitation is a key component for increasing implementation. However, its contribution to evidence translation initiatives requires further investigation. We aim to evaluate two levels of intensity of external remote facilitation as part of a multifaceted intervention to improve FeSS Protocol uptake and quality of care for patients with stroke in Australian and New Zealand acute care hospitals. METHODS A three-arm cluster randomised controlled trial with a process evaluation and economic evaluation. Australian and New Zealand hospitals with a stroke unit or service will be recruited and randomised in blocks of five to one of the three study arms-high- or low-intensity external remote facilitation or a no facilitation control group-in a 2:2:1 ratio. The multicomponent implementation strategy will incorporate implementation science frameworks (Theoretical Domains Framework, Capability, Opportunity, Motivation - Behaviour Model and the Consolidated Framework for Implementation Research) and include an online education package, audit and feedback reports, local clinical champions, barrier and enabler assessments, action plans, reminders and external remote facilitation. The primary outcome is implementation effectiveness using a composite measure comprising six monitoring and treatment elements of the FeSS Protocols. Secondary outcome measures are as follows: composite outcome of adherence to each of the combined monitoring and treatment elements for (i) fever (n=5); (ii) hyperglycaemia (n=6); and (iii) swallowing protocols (n=7); adherence to the individual elements that make up each of these protocols; comparison for composite outcomes between (i) metropolitan and rural/remote hospitals; and (ii) stroke units and stroke services. A process evaluation will examine contextual factors influencing intervention uptake. An economic evaluation will describe cost differences relative to each intervention and study outcomes. DISCUSSION We will generate new evidence on the most effective facilitation intensity to support implementation of nurse-initiated stroke protocols nationwide, reducing geographical barriers for those in rural and remote areas. TRIAL REGISTRATION ACTRN12622000028707. Registered 14 January, 2022.
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Affiliation(s)
- O Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - S Dale
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - E McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - D A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - M Noetel
- School of Psychology, University of Queensland, Brisbane, Australia
| | - K Coughlan
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - B McElduff
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - T Langley
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | - N W Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - K Hill
- Stroke Foundation, Sydney, New South Wales, Australia
| | - V Pollnow
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | - K Page
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | | | - E Neal
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - S Griffith
- School of Psychology, University of Queensland, Brisbane, Australia
| | - L J Christie
- Allied Health Research Unit, St Vincent's Health Network, Sydney, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - J Slark
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - A Ranta
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - C Levi
- John Hunter Health and Innovation Precinct, New Lambton Heights, New South Wales, Australia
- Department of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - J M Grimshaw
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - S Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia.
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5
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Middleton S, Dale S, McElduff B, Coughlan K, McInnes E, Mikulik R, Fischer T, Van der Merwe J, Cadilhac D, D’Este C, Levi C, Grimshaw JM, Grecu A, Quinn C, Cheung NW, Koláčná T, Medukhanova S, Sanjuan Menendez E, Salselas S, Messchendorp G, Cassier-Woidasky AK, Skrzypek-Czerko M, Slavat-Plana M, Antonella U, Pfeilschifter W. Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe): A pre-test/post-test implementation study. Eur Stroke J 2022; 8:132-147. [PMID: 37021183 PMCID: PMC10069193 DOI: 10.1177/23969873221126027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Poor adoption of stroke guidelines is a problem internationally. The Quality in Acute Stroke Care (QASC) trial demonstrated significant reduction in death and disability with facilitated implementation of nurse-initiated Methods: This was a multi-country, multi-centre, pre-test/post-test study (2017–2021) comparing post implementation data with historically collected pre-implementation data. Hospital clinical champions, supported by the Angels Initiative conducted multidisciplinary workshops discussing pre-implementation medical record audit results, barriers and facilitators to FeSS Protocol implementation, developed action plans and provided education, with ongoing support co-ordinated remotely from Australia. Prospective audits were conducted 3-month after FeSS Protocol introduction. Pre-to-post analysis and country income classification comparisons were adjusted for clustering by hospital and country controlling for age/sex/stroke severity. Results: Data from 64 hospitals in 17 countries (3464 patients pre-implementation and 3257 patients post-implementation) showed improvement pre-to-post implementation in measurement recording of all three FeSS components, all p < 0.0001: fever elements (pre: 17%, post: 51%; absolute difference 33%, 95% CI 30%, 37%); hyperglycaemia elements (pre: 18%, post: 52%; absolute difference 34%; 95% CI 31%, 36%); swallowing elements (pre: 39%, post: 67%; absolute difference 29%, 95% CI 26%, 31%) and thus in overall FeSS Protocol adherence (pre: 3.4%, post: 35%; absolute difference 33%, 95% CI 24%, 42%). In exploratory analysis of FeSS adherence by countries’ economic status, high-income versus middle-income countries improved to a comparable extent. Discussion and conclusion: Our collaboration resulted in successful rapid implementation and scale-up of FeSS Protocols into countries with vastly different healthcare systems.
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Affiliation(s)
- Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Robert Mikulik
- International Clinical Research Centre, Neurology Department, St. Ann’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Thomas Fischer
- Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany
| | - Jan Van der Merwe
- Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany
| | - Dominique Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia
- Sax Institute, Sydney, Australia
| | - Christopher Levi
- John Hunter Health and Innovation Precinct, HNE LHD, New Lambton, NSW, Australia
- Department of Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Jeremy M Grimshaw
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Andreea Grecu
- International Clinical Research Centre, Neurology Department, St. Ann’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Clare Quinn
- Prince of Wales Hospital, Randwick, Australia
| | - Ngai Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | - Merce Slavat-Plana
- Health Department, Agency for Health Quality and Assessment (AQuAS), CIBER Epidemiología y Salud Pública, CIBERESP, Stroke Programme, Barcelona, Spain
| | - Urso Antonella
- Hospital Network Area-Regional Health Department, Regione Lazio, Rome, Italy
| | - Waltraud Pfeilschifter
- Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
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Rihari-Thomas J, Whittam S, Goncharov L, Slade D, McElduff B, Pritchard T, McMahon J, Coventry A, Coughlan K, Steadward Y, Taylor J, Thornton A, Riddell K, Tuqiri K, Olesen K, Dahm MR, Chien L, Kelly P, McInnes E, Middleton S. Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Middleton S, Coughlan K, Mnatzaganian G, Low Choy N, Dale S, Jammali-Blasi A, Levi C, Grimshaw JM, Ward J, Cadilhac DA, McElduff P, Hiller JE, D’Este C. Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention. Stroke 2017; 48:1331-1336. [DOI: 10.1161/strokeaha.116.016038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005–2010). We now examine long-term all-cause mortality.
Methods—
Mortality was ascertained using Australia’s National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber–White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates.
Results—
One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival (>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.
Clinical Trial Registration—
URL:
http://www.anzctr.org.au
. Unique identifier: ACTRN12608000563369.
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Affiliation(s)
- Sandy Middleton
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Kelly Coughlan
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - George Mnatzaganian
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Nancy Low Choy
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Simeon Dale
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Asmara Jammali-Blasi
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Chris Levi
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Jeremy M. Grimshaw
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Jeanette Ward
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Dominique A. Cadilhac
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Patrick McElduff
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Janet E. Hiller
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
| | - Catherine D’Este
- From the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, St Vincent’s Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of
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Bray JE, Coughlan K, Mosley I, Barger B, Bladin C. Are suspected stroke patients identified by paramedics transported to appropriate stroke centres in Victoria, Australia? Intern Med J 2014; 44:515-8. [DOI: 10.1111/imj.12382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J. E. Bray
- Research and Evaluation Department; Ambulance Victoria; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - K. Coughlan
- Department of Neuroscience; Box Hill Hospital; Melbourne Victoria Australia
| | - I. Mosley
- Division of Stroke Epidemiology and Public Health; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
| | - B. Barger
- Research and Evaluation Department; Ambulance Victoria; Melbourne Victoria Australia
| | - C. Bladin
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Neuroscience; Box Hill Hospital; Melbourne Victoria Australia
- Division of Stroke Epidemiology and Public Health; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
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Behan ÁT, Breen B, Hogg M, Woods I, Coughlan K, Mitchem M, Prehn JHM. Retraction: Acidotoxicity and acid-sensing ion channels contribute to motoneuron degeneration. Cell Death Differ 2013; 21:344. [PMID: 24185620 DOI: 10.1038/cdd.2013.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Jordan LA, Mackey E, Coughlan K, Wyer M, Allnutt N, Middleton S. Continence management in acute stroke: a survey of current practices in Australia. J Adv Nurs 2010; 67:94-104. [DOI: 10.1111/j.1365-2648.2010.05480.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bray JE, Coughlan K, Barger B, Bladin C. Paramedic diagnosis of stroke: examining long-term use of the Melbourne Ambulance Stroke Screen (MASS) in the field. Stroke 2010; 41:1363-6. [PMID: 20538702 DOI: 10.1161/strokeaha.109.571836] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Recent evidence suggests the Cincinnati Prehospital Stroke Scale is ineffectively used and lacks sensitivity and specificity. Melbourne (Australia) paramedics have been using the Melbourne Ambulance Stroke Screen (MASS) since 2005. The aim of this study was to review the real-world use of MASS 3 years after city wide implementation. METHODS Two groups of consecutively admitted patients to an Australian hospital between January and May 2008 were used: (1) patients for whom paramedics performed MASS; and (2) patients with a discharge diagnosis of stroke or transient ischemic attack. Use of MASS was examined for all transports and for patients diagnosed with stroke or transient ischemic attack. The sensitivity and specificity of paramedic diagnosis, MASS, and Cincinnati Prehospital Stroke Scale were calculated. Paramedic diagnosis of stroke among patients with stroke was statistically compared with those obtained immediately post-MASS implementation in 2002. RESULTS For the study period, MASS was performed for 850 (16%) of 5286 emergency transports, including 199 of 207 (96%) patients with confirmed stroke and transient ischemic attack. In patients in whom MASS was performed (n=850), the sensitivity of paramedic diagnosis of stroke (93%, 95% CI: 88% to 96%) was higher than the MASS (83%, 95% CI: 77% to 88%, P=0.003) and equivalent to Cincinnati Prehospital Stroke Scale (88%, 95% CI: 83% to 92%, P=0.120), whereas the specificity of the paramedic diagnosis of stroke (87%, 95% CI: 84% to 89%) was equivalent to MASS (86%, 95% CI: 83% to 88%, P=0.687) and higher than Cincinnati Prehospital Stroke Scale (79%, 95% CI: 75% to 82%, P<0.001). The initial improvement in stroke paramedic diagnosis seen in 2002 (94%, 95% CI: 86% to 98%) was sustained in 2008 (89%, 95% CI: 84% to 94%, P=0.19). CONCLUSIONS In our experience, paramedics have successfully incorporated MASS into the assessment of neurologically compromised patients. The initial improvement to the paramedics' diagnosis of stroke with MASS was sustained 3 years after city wide implementation.
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Affiliation(s)
- Janet E Bray
- Box Hill Hospital and Deakin University, Victoria, Australia
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Abstract
UNLABELLED Animals provide benefits to elderly and chronically ill people by decreasing loneliness, increasing social interactions, and improving mental health. As a result, many hospitals and long-term care facilities allow family pets to visit ill or convalescing patients or support animal-assisted therapy programs. These include programs that have resident animals in long-term care facilities. Despite the benefits, there are concerns about disease transmission between pets and patients. Antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), are a recognized problem in healthcare settings leading to refractory infections and potentially life-threatening illnesses. MRSA has been isolated from numerous animal species, yet few studies are available on the carriage of this pathogen in animals residing in long-term care facilities. Our objective was to characterize MRSA carriage among resident animals in a long-term care facility. METHODS To document MRSA colonization, nasal swabs from 12 resident animals (one dogs and 11 cats) of a long-term care facility were collected weekly for 8 weeks. Staphylococcus isolates were characterized by antimicrobial susceptibility and MRSA isolates were further characterized by pulsed-field gel electrophoresis (PFGE). PFGE isolate patterns were compared with an existing database of MRSA isolate patterns at the Minnesota Department of Health. RESULTS Two of 11 cats were colonized with MRSA. MRSA was recovered from five of eight weekly samples in one cat and two of eight weekly samples in the other cat. All isolates were classified as USA100 (healthcare-associated strains). DISCUSSION Long-term care resident animals may acquire MRSA. Clonally related strains were identified over the 8-week sampling period. It is unclear if pets serve as an on-going source of infection to their human companions in long-term care facilities.
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Affiliation(s)
- K Coughlan
- Veterinary Public Health, University of Minnesota, St Paul, MN 55108, USA
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Bray JE, Coughlan K, Bladin C. Can the ABCD Score be dichotomised to identify high-risk patients with transient ischaemic attack in the emergency department? Emerg Med J 2007; 24:92-5. [PMID: 17251611 PMCID: PMC2658215 DOI: 10.1136/emj.2006.041624] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent evidence shows a substantial short-term risk of ischaemic stroke after transient ischaemic attack (TIA). Identification of patients with TIA with a high short-term risk of stroke is now possible through the use of the "ABCD Score", which considers age, blood pressure, clinical features and duration of symptoms predictive of stroke. AIM To evaluate the ability of dichotomising the ABCD Score to predict stroke at 7 and 90 days in a population with TIA presenting to an emergency department. METHODS A retrospective audit was conducted on all probable or definite TIAs presenting to the emergency department of a metropolitan hospital from July to December 2004. The ABCD Score was applied to 98 consecutive patients with TIA who were reviewed for subsequent strokes within 90 days. Patients obtaining an ABCD Score > or = 5 were considered to be at high risk for stroke. RESULTS Dichotomising the ABCD Score categorised 48 (49%) patients with TIA at high risk for stroke (ABCD Score > or = 5). This high-risk group contained all four strokes that occurred within 7 days (sensitivity 100% (95% confidence interval (CI) 40% to 100%), specificity 53% (95% CI 43% to 63%), positive predictive value 8% (95% CI 3% to 21%) and negative predictive value 100% (95% CI 91% to 100%)), and six of seven occurring within 90 days (sensitivity 86% (95% CI 42% to 99%), specificity 54% (95% CI 43% to 64%), positive predictive value 12.5% (95% CI 5% to 26%) and negative predictive value 98% (95% CI 88% to 100%)). Removal of the "age" item from the ABCD Score halved the number of false-positive cases without changing its predictive value for stroke. CONCLUSION In this retrospective analysis, dichotomising the ABCD Score was overinclusive but highly predictive in identifying patients with TIA at a high short-term risk of stroke. Use of the ABCD Score in the emergency care of patients with TIA is simple, efficient and provides a unique opportunity to prevent stroke in this population of patients.
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Affiliation(s)
- Janet E Bray
- Eastern Melbourne Neurosciences, Box Hill Hospital, Deakin University, Melbourne, Victoria, Australia
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Abstract
The use of tissue-type plasminogen activator (t-PA) in ischaemic stroke outside of experienced stroke centres remains controversial. The aim of this study was to present the initial experience with t-PA in patients with ischaemic stroke at an institution with no prior experience in i.v. stroke thrombolysis and to compare results to published reports. Prospective audit of 888 patients with consecutive stroke and transient ischaemic attack admitted to a 426-bed tertiary referral hospital from March 2003 to October 2005. Main outcome measures were treatment rate, exclusion criteria, protocol violations, intracerebral haemorrhage, disability (modified Rankin scale) and mortality at 3 months. Over the study period, 72 patients received t-PA (11% of ischaemic strokes). The main reason for exclusion was presentation beyond 3 h of onset (44%); if all eligible patients had arrived within 3 h, treatment rate was estimated at 32.5%. Protocol violations occurred in 15 (21%) patients. There were seven (10%) asymptomatic intracerebral haemorrhage and one (1%) non-fatal symptomatic intracerebral haemorrhage. At 3 months, 37% had achieved excellent recovery (modified Rankin scale 0-1) and seven (10%) had died. The delivery and outcomes associated with the use of t-PA were comparable to the results of the National Institute of Neurological Disorders and Stroke trial and meta-analysis of open-labelled studies. With appropriate infrastructure and protocols, previously inexperienced tertiary referral centres can replicate the experience and outcome measures reported by clinical trials of t-PA in patients with stroke.
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Affiliation(s)
- J E Bray
- Eastern Melbourne Neurosciences, Box Hill Hospital, Melbourne, Victoria, Australia
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Coughlan K, Shaw N, Kerry J, Kerry J. Combined Effects of Proteins and Polysaccharides on Physical Properties of Whey Protein Concentrate-based Edible Films. J Food Sci 2006. [DOI: 10.1111/j.1365-2621.2004.tb10997.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The objectives of this study were to determine the local effects of transforming growth factor-beta1 (TGF-beta1) on mammary epithelial and stromal cell proliferation and expression of the TGF-beta1 responsive genes c-myc and fibronectin. A single slow-release plastic pellet containing 5 microg of TGF-beta1 and 20 mg of BSA was implanted in the parenchyma of the right rear quarter of the mammary gland of 9-mo-old prepubertal heifers. A control pellet containing 20 mg of BSA was implanted in the left rear quarter of each heifer. All heifers were treated with bromodeoxyuridine (BrdU) at 4, 12.5, and 22 h after the pellets were implanted to label proliferating cells. Two hours after the last BrdU injection, the animals were euthanatized, and their mammary glands were recovered. Proliferation of mammary stromal cells was significantly higher in TGF-beta1-treated quarters than in BSA-treated, control quarters (3.5 vs. 1.8% BrdU-positive cells). This result coincided with a lack of significant effect of TGF-beta1 on proliferation of mammary epithelial cells and apoptosis. By quantitative reverse transcriptase-polymerase chain reaction, we found that c-myc gene expression was unchanged after TGF-beta1 treatment, but fibronectin gene expression was increased 3-fold in TGF-beta1-treated quarters compared with BSA-treated, control quarters. Thus, we concluded that TGF-beta1 selectively acts on the stromal compartment of the bovine mammary gland by increasing cell proliferation and gene expression of the extracellular matrix protein fibronectin.
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Affiliation(s)
- S Musters
- Department of Animal Science, University of Vermont, Burlington 05405, USA
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Ryan NJ, Sutherland G, Coughlan K, Globan M, Doultree J, Marshall J, Baird RW, Pedersen J, Dwyer B. A new trichrome-blue stain for detection of microsporidial species in urine, stool, and nasopharyngeal specimens. J Clin Microbiol 1993; 31:3264-9. [PMID: 7508457 PMCID: PMC266395 DOI: 10.1128/jcm.31.12.3264-3269.1993] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Detection of microsporidia in clinical specimens has relied on electron microscopy, histology, or staining. This article describes further alterations to the modified trichrome staining method which make it easier to identify microsporidial spores. The changes are a decrease in the phosphotungstic acid level and the substitution of a colorfast counterstain, aniline blue, for the fast green of the original stain. The modified stain provides good contrast between microsporidial spores and background material including human and fungal cells. Stool specimens from 139 human immunodeficiency virus-seropositive patients revealed that 5 patients were infected with Enterocytozoon bieneusi and 6 patients had larger spores. Thin-section electron microscopy of the larger spores showed a structure consistent with that of either Encephalitozoon or Septata species. Three of the patients with Encephalitozoon- or Septata-like species had disseminated infection, with spores detected in nasopharyngeal aspirates and urine samples.
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Affiliation(s)
- N J Ryan
- Victorian Infectious Diseases Reference Laboratory, Fairfield Hospital, Victoria, Australia
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Affiliation(s)
- K Coughlan
- Inpatient Program, Veterans Administration Medical and Regional Office Center, Togus, Maine 04330
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