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  • 1
    Online Resource
    Online Resource
    On-site CT-FFR of an anomalous right coronary artery to influence revascularization strategy
    Springer Science and Business Media LLC ; 2019
    In:  Journal of Nuclear Cardiology Vol. 26, No. 3 ( 2019-6), p. 1020-1022
    Details
    In: Journal of Nuclear Cardiology, Springer Science and Business Media LLC, Vol. 26, No. 3 ( 2019-6), p. 1020-1022
    Type of Medium: Online Resource
    ISSN: 1071-3581 , 1532-6551
    URL: Article
    DOI: 10.1007/s12350-018-01591-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2048325-9
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  • 2
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    Sustaining a New Model of Acute Stroke Care: A Mixed-Method Process Evaluation of the Melbourne Mobile Stroke Unit
    Maad Rayan Publishing Company ; 2023
    In:  International Journal of Health Policy and Management ( 2023-02-22)
    Details
    In: International Journal of Health Policy and Management, Maad Rayan Publishing Company, ( 2023-02-22)
    Abstract: Background: Internationally, Mobile Stroke Unit ambulances (MSUs) have changed prehospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care. Method: Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology, Self Determination Theory (Intrinsic Motivation) and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted. Results: There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β=0.61), not experiencing pressure/tension about working on the MSU (β=0.17) and thinking they did well working within the team model (β=0.17) were significantly associated with wanting to continue working within the MSU model [R 2=0.76; F(15,60)=12.76 p 〈 .001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity. Conclusion: Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability.
    Type of Medium: Online Resource
    ISSN: 2322-5939
    URL: Article
    DOI: 10.34172/ijhpm.2023.7716
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2023
    detail.hit.zdb_id: 2724317-5
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  • 3
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    The Mobile Stroke Unit Nurse: An International Exploration of Their Scope of Practice, Education, and Training
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Neuroscience Nursing Vol. 54, No. 2 ( 2022-4), p. 61-67
    Details
    In: Journal of Neuroscience Nursing, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 2 ( 2022-4), p. 61-67
    Abstract: BACKGROUND: Mobile stroke units (MSUs) are ambulance-based prehospital stroke care services. Through immediate roadside assessment and onboard brain imaging, MSUs provide faster stroke management with improved patient outcomes. Mobile stroke units have enabled the development of expanded scope of practice for stroke nurses; however, there is limited published evidence about these evolving prehospital acute nursing roles. AIMS: The aim of this study was to explore the expanded scope of practice of nurses working on MSUs by identifying MSUs with onboard nurses; describing the roles and responsibilities, training, and experience of MSU nurses, through a search of the literature; and describing 2 international MSU services incorporating nurses from Memphis, Tennessee, and Melbourne, Australia. METHODS: We searched PubMed, CINAHL, and the Joanna Briggs Institute Evidence-Based Practice database using the terms “mobile stroke unit” and “nurse.” Existing MSUs were identified through the PRE-hospital Stroke Treatment Organization to determine models that involved nurses. We describe 2 MSUs involving nurses: one in Memphis and one in Melbourne, led by 2 of our authors. RESULTS: Ninety articles were found describing 15 MSUs; however, staffing details were lacking, and it is unknown how many employ nurses. Nine articles described the role of the nurse, but role specifics, training, and expertise were largely undocumented. The MSU in Memphis, the only unit to be staffed exclusively by onboard nurse practitioners, is supported by a neurologist who consults via telephone. The Melbourne MSU plans to trial a nurse-led telemedicine model in the near future. CONCLUSION: We lack information on how many MSUs employ nurses, and the nurses' scope of practice, training, and expertise. Expert stroke nurse practitioners can safely perform many of the tasks undertaken by the onboard neurologist, making a nurse-led telemedicine model an effective and potentially cost-effective model that should be considered for all MSUs.
    Type of Medium: Online Resource
    ISSN: 1945-2810 , 0888-0395
    URL: Article
    DOI: 10.1097/JNN.0000000000000632
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 4
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    Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial
    Elsevier BV ; 2022
    In:  The Lancet Neurology Vol. 21, No. 6 ( 2022-06), p. 520-527
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 21, No. 6 ( 2022-06), p. 520-527
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(22)00171-5
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 5
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    Mobile Stroke Units Facilitate Prehospital Management of Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 10 ( 2021-10), p. 3163-3166
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 10 ( 2021-10), p. 3163-3166
    Abstract: Mobile stroke units (MSUs) improve reperfusion therapy times in acute ischemic stroke (AIS). However, prehospital management options for intracerebral hemorrhage (ICH) are less established. We describe the initial Melbourne MSU experience in ICH. Methods: Consecutive patients with ICH and AIS treated by the Melbourne MSU were included. We describe demographics, proportions of patients receiving specific therapies, and bypass to comprehensive/neurosurgical centers. We also compare operational time metrics between patients with MSU-ICH and MSU-AIS. Results: During a 2-year period, the Melbourne MSU managed 49 patients with ICH, mean (SD) age 74 (12) years, median (interquartile range) National Institutes of Health Stroke Scale 17 (12–20). Intravenous antihypertensives were the commonest treatment provided (46.9%). Bypass of a primary center to a comprehensive center with neurosurgical expertise occurred in 32.7% of patients with MSU-ICH compared with 20.5% of patients with MSU-AIS. Compared with patients with MSU-AIS, patients with MSU-ICH had faster onset-to-emergency-call, and onset-to-scene-arrival times at the median and 75th percentiles. Conclusions: MSUs can facilitate ultra-early ICH diagnosis, management, and triage.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.121.034592
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Abstract 175: Faster Prehospital Workflow in the Melbourne Mobile Stroke Unit Halves Onset to Reperfusion Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Background: The Melbourne Mobile Stroke Unit (MSU) utilises a specialised ambulance with on-board CT scanner and multidisciplinary team to provide on-scene imaging, treatment and triage for central Melbourne, Australia. We describe the operational impact of the MSU on stroke onset to treatment time for acute reperfusion therapy. Methods: Data from the first 6 months of operation were collected for all patients receiving reperfusion therapy from November 2017. Workflow times were compared to contemporary published Australian data and ambulance travel times were derived using a validated Google Maps algorithm. Results: In the first 6 months of operation, the Melbourne MSU provided prehospital thrombolysis (tPA) to n=28 patients (39% of ischemic stroke 〈 4.5h) and directed n=17 patients (24% of infarcts 〈 6hrs) for endovascular thrombectomy (EVT), of which 6/17 (35%) required bypass of the closest non-EVT hospital. Figure 1 shows workflow times for thrombolysis and thrombectomy bypass compared to historical controls. The overall median onset-to-tPA for MSU patients was 101 mins compared to the Australian metropolitan median of 150 mins. Despite a median travel time of 15 mins to the nearest stroke centre, the calculated time saving to start of tPA was 30-60 mins. Prehospital notification for EVT allowed median hospital arrival-to-groin puncture time of 33 mins compared to historical values of 54 mins. MSU diagnosis and bypass to an EVT hospital conservatively reduced EVT delay by 60-90 mins. Discussion: Prehospital treatment and triage using the Mobile Stroke Unit in metropolitan Melbourne resulted in substantially faster commencement of reperfusion therapy. First medical contact to treatment times were approximately halved for thrombolysis and patients requiring bypass for endovascular thrombectomy. Future research will determine the effect of earlier treatment on patient outcomes and cost-effectiveness analysis.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.175
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 7
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    Abstract 96: Greater Clinical Impact of Thrombectomy Compared to Thrombolysis in First Year of Melbourne Mobile Stroke Unit Operation
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Introduction: The role of mobile stroke units (MSU) in earlier provision of thrombolysis (tPA) is well described, but the effect on endovascular thrombectomy (EVT) is less clear. Despite the theoretical advantages of improved triage and prehospital activation of EVT services, only a small effect on hospital arrival to EVT start has so far been described. We aimed to analyze the clinical benefit of EVT and tPA from operation of the Melbourne MSU in the first year. Methods: First ambulance dispatch to reperfusion treatment commencement (DTT) times between MSU patients receiving reperfusion therapy from November 2017-18 were compared to consecutive control cases during MSU operating hours presenting across metropolitan Melbourne for tPA, and direct and metropolitan transfer patients presenting to the Royal Melbourne Hospital for EVT. Median time difference between MSU and controls was regarded as the 50 th quantile using quantile regression analysis. Comparative disability avoidance was estimated for EVT and tPA using calculated time savings. Results: In the first calendar year, the MSU operated for 30.5 service (7-day) weeks. Prehospital tPA was administered to 52 patients, with median time differences for dispatch-to-hospital/scene-arrival of -30 minutes (p 〈 0.0001) and arrival-to-tPA of -17 minutes (p=0.001), resulting in overall DTT time saving of 47 minutes compared to controls. In the same timeframe, 26 patients received EVT with median time difference of -51 minutes (p 〈 0.0001) compared to controls. Prehospital notification resulted in median time difference of -17 minutes (p=0.001) for EVT center-arrival to groin puncture. Using published estimates of disability avoidance per minute of time saved for each reperfusion therapy, the clinical impact of the EVT time saving for the 26 MSU patients is equivalent to the clinical impact of 67 tPA patients treated on the MSU. Conclusion: The clinical impact of Melbourne MSU operation on earlier provision of EVT was greater than that of tPA in the first year of operation, reflecting facilitated triage to EVT centers and early prehospital notification. In locales where EVT capability is limited or unevenly distributed such as Melbourne, facilitation of EVT is likely to be a central driver of MSU operation.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.96
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 8
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    Abstract WMP47: Low Sensitivity Of Widely Used Emergency Dispatch Algorithm For Thrombectomy Patients - Implications For Mobile Stroke Units
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Widely used emergency dispatch algorithms such as the Advanced Medical Priority Dispatch System (AMPDS) have limited diagnostic accuracy for prehospital diagnosis of stroke. With advent of mobile stroke units (MSU), this inaccuracy prevents optimal dispatch to patients who may benefit. Expedited endovascular thrombectomy (EVT) is a major contributor to net benefit of MSUs. We assessed the accuracy of AMPDS for recognizing stroke in thrombectomy patients in the Australian state of Victoria. Methods: We included consecutive patients accepted for EVT (direct and secondary transfer) to The Royal Melbourne Hospital from 2007-2021 in whom linked AMPDS dispatch codes could be obtained from Ambulance Victoria. The primary outcome was the proportion of cases dispatched as stroke vs non-stroke with subgroup analyses of the effect of baseline clinical severity, metropolitan vs rural dispatch and time to thrombectomy. Chi square and Mann Whitney tests were used as appropriate. Results: A total of n=618 patients were included with baseline NIHSS 16 (IQR 10-20). Of these, only 62% (95% CI 58-66) were initially dispatched as suspected stroke, with the most common non-stroke diagnoses being “Unconscious/Fainting” (19.2%) and “Falls” (6.9%). Those with a higher baseline severity (NIHSS ≥10) were less likely to be classified as stroke than those with lower severity (59% vs 76%, p 〈 0.001), while no difference was found between metropolitan and rural patients (p=0.066). Overall, no significant time differences were found between stroke and non-stroke dispatches for ambulance dispatch to arterial access (median 208 vs 216 min, p=0.593) or hospital arrival to arterial access (median 42 vs 42 min, p=0.851). However, only 32 patients were treated on the MSU, which commenced operation November 2017. Conclusions: Almost 40% of thrombectomy patients did not receive an initial AMPDS dispatch of suspected stroke and those with higher baseline severity were more likely to be misclassified. Although time to thrombectomy was not significantly different between stroke vs non-stroke dispatches, MSU treatment was under-represented. Our findings have implications for emergency medical services and particularly mobile stroke units which rely on accurate stroke dispatch.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.WMP47
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 9
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    Abstract 129: Electromagnetic Portable Brain Imaging For Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background: Electromagnetic imaging (EMI) is an emerging technology that transmits low energy electromagnetic waves from a ring of transceivers around the head, modified as they pass through abnormal tissue, providing unique signatures for brain pathology. It promises to provide portable, non-ionizing, rapid neuroimaging for prehospital and bedside evaluation of stroke, based on the dielectric properties of the tissue. We aimed to assess the clinical utility of EMI in stroke diagnosis in a pilot study. Methods: In a prospective, observational, open, non-interventional pilot study, patients with imaging-proven ischemic (IS) or haemorrhagic stroke (ICH) within the preceding 48 hours were recruited. Using the EMVision scanner, EMI was performed within 1-24 hours of diagnostic CT or MRI. Images were obtained by processing signals from encircling transceiver antennae contained in an instrumented 18 kg helmet which emit and detect low energy non-ionising signals in the microwave frequency spectrum (0.5-2.0 GHz). Localisation was assessed by determining whether fusion images resulted in target detection in the same quadrant as comparable CT or MRI. Electromagnetic (EM) images were reconstructed by creating maps of the EM wave scattering arising from contrast in electrical parameters between IS or ICH lesions and normal brain. A blinded clinician assessed agreement between regional abnormalities on EMI and CT or MRI scans. Algorithms for distinction between IS and ICH were based on differences in EM transmission, reflection and scattering through brain tissue. Results: Thirty patients were studied, 21 IS and 9 ICH. Mean age was 66.7 years (range 37-87), 57% were female. Mean NIHSS at presentation was 5. Mean time to routine imaging was 5.5 hrs (range 1-48) and to EMI 24 hrs (range 6-60). Nineteen patients (63%) had only CT performed; 11 (37%) had both CT and MRI. EMI differentiated ICH from IS with 93% accuracy and localised the stroke to the correct brain quadrant with 87% accuracy. Conclusion: In this early validation pilot study we show the ability to distinguish between IS and ICH and stroke location within a given brain quadrant. Further developments may produce a valuable imaging tool to assist in prehospital and bedside stroke diagnosis and management.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.129
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 10
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    Melbourne Mobile Stroke Unit and Reperfusion Therapy : Greater Clinical Impact of Thrombectomy Than Thrombolysis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 3 ( 2020-03), p. 922-930
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 3 ( 2020-03), p. 922-930
    Abstract: Mobile stroke units (MSUs) are increasingly used worldwide to provide prehospital triage and treatment. The benefits of MSUs in giving earlier thrombolysis have been well established, but the impacts of MSUs on endovascular thrombectomy (EVT) and effect on disability avoidance are largely unknown. We aimed to determine the clinical impact and disability reduction for reperfusion therapies in the first operational year of the Melbourne MSU. Methods— Treatment time metrics for MSU patients receiving reperfusion therapy were compared with control patients presenting to metropolitan Melbourne stroke units via standard ambulance within MSU operating hours. The primary outcome was median time difference in first ambulance dispatch to treatment modeled using quantile regression analysis. Time savings were subsequently converted to disability-adjusted life years avoided using published estimates. Results— In the first 365-day operation of the Melbourne MSU, prehospital thrombolysis was administered to 100 patients (mean age, 73.8 years; 62% men). The median time savings per MSU patient, compared with the control cohort, was 26 minutes ( P 〈 0.001) for dispatch to hospital arrival and 15 minutes ( P 〈 0.001) for hospital arrival to thrombolysis. The calculated overall time saving from dispatch to thrombolysis was 42.5 minutes (95% CI, 36.0–49.0). In the same period, 41 MSU patients received EVT (mean age, 76 years; 61% men) with median dispatch-to-treatment time saving of 51 minutes ([95% CI, 30.1–71.9], P 〈 0.001). This included a median time saving of 17 minutes ([95% CI, 7.6–26.4], P =0.001) for EVT hospital arrival to arterial puncture for MSU patients. Estimated median disability-adjusted life years saved through earlier provision of reperfusion therapies were 20.9 for thrombolysis and 24.6 for EVT. Conclusions— The Melbourne MSU substantially reduced time to reperfusion therapies, with the greatest estimated disability avoidance driven by the more powerful impact of earlier EVT. These findings highlight the benefits of prehospital notification and direct triage to EVT centers with facilitated workflow on arrival by the MSU.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.027843
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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