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  • 1
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Background and purpose: Institutions around the world have re-engineered acute stroke care to achieve dramatic reductions in tPA door-to-needle times (DNT). We investigated the effects of specific process elements on DNT. Methods: The “code stroke” system at Royal Melbourne Hospital was systematically evaluated and redesigned in 2012 to take patients directly from triage to CT on ambulance stretchers and deliver tPA on the CT table. We studied the 12 months post implementation data within business hours (when stroke team members were located in the hospital) for effects of variably utilized key components of the new system - ambulance pre-notification including patient name and date of birth (allowing transfer direct to CT), and point-of-care (POC)-INR. Results: In the 12 months post-implementation, 40/80 (50%) of patients who received tPA were treated in-hours. In-hours DNT reduced from pre-implementation median 43 min to 23 min (p 〈 0.001). However, only 33% of the patients had full pre-notification including name and date of birth. In these patients median DNT was 16 min vs. pre-notification without personal details 22 min, p=0.02. Patients with no prenotification which prevented transfer direct to CT had significant delays (median DNT 51 min; p 〈 0.001 vs prenotification). After-hours where the system remained unchanged there was no change in DNT (median 67 min vs. 65 min; p=0.87). Patients possibly taking warfarin previously required laboratory INR pre-tPA (median DNT 77 min; range 38-92 min). Subsequently 6/80 (7.5%) patients were treated after confirming sub-therapeutic POC-INR (25 min; range 14-34 min). Conclusions: Pre-notification and going direct to CT have the greatest impact in reducing treatment delays. Combined, these simple, resource-neutral procedures halved our median DNT. The optimal pre-notification includes patient details, allowing pre-registration, pre-ordering of CT, and access to prior medical history during transport. POC-INR is helpful in select patients.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 2
    In: International Journal of Stroke, SAGE Publications, Vol. 9, No. 4 ( 2014-06), p. 519-524
    Abstract: No evidence-based acute therapies exist for intracerebral hemorrhage. Intracerebral hemorrhage growth is an important determinant of patient outcome. Tranexamic acid is known to reduce hemorrhage in other conditions. Aim The study aims to test the hypothesis that intracerebral hemorrhage patients selected with computed tomography angiography contrast extravasation ‘spot sign’ will have lower rates of hematoma growth when treated with intravenous tranexamic acid within 4·5-hours of stroke onset compared with placebo. Design The Spot sign and Tranexamic acid On Preventing ICH growth – AUStralasia Trial is a multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled, investigator-initiated, academic Phase II trial. Intracerebral hemorrhage patients fulfilling clinical criteria (e.g. Glasgow Coma Scale 〉 7, intracerebral hemorrhage volume 〈 70 ml, no identified secondary cause of intracerebral hemorrhage, no thrombotic events within the previous 12 months, no planned surgery) and demonstrating contrast extravasation on computed tomography angiography will receive either intravenous tranexamic acid 1 g 10-min bolus followed by 1 g eight-hour infusion or placebo. A second computed tomography will be performed at 24 ± 3 hours to evaluate intracerebral hemorrhage growth and patients followed up for three-months. Study outcomes The primary outcome measure is presence of intracerebral hemorrhage growth by 24 ± 3 hours, defined as either 〉 33% or 〉 6 ml increase from baseline, and will be adjusted for baseline intracerebral hemorrhage volume. Secondary outcome measures include growth as a continuous measure, thromboembolic events, and the three-month modified Rankin Scale score. Discussion This is the first trial to evaluate the efficacy of tranexamic acid in intracerebral hemorrhage patients selected based on an imaging biomarker of high likelihood of hematoma growth. The trial is registered as NCT01702636.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2211666-7
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  • 3
    Online Resource
    Online Resource
    Elsevier BV ; 2014
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 23, No. 5 ( 2014-05), p. 1245-1246
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 23, No. 5 ( 2014-05), p. 1245-1246
    Type of Medium: Online Resource
    ISSN: 1052-3057
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 2052957-0
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