St Vincents and Mater Health Sydney, Victoria St, Darlinghurst, 2010, NSW, Australia.
Implement Sci. 2009 Mar 16;4:16. doi: 10.1186/1748-5908-4-16.
Hyperglycaemia, fever, and swallowing dysfunction are poorly managed in the admission phase of acute stroke, and patient outcomes are compromised. Use of evidence-based guidelines could improve care but have not been effectively implemented. Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever, hyperglycaemia, and swallowing dysfunction in patients following acute stroke.
Metropolitan acute stroke units (ASUs) located in New South Wales, Australia will be stratified by service category (A or B) and, within strata, by baseline patient recruitment numbers (high or low) in this prospective, multicentre, single-blind, cluster randomised controlled trial (CRCT). ASUs then will be randomised independently to either intervention or control groups. ASUs allocated to the intervention group will receive: unit-based workshops to identify local barriers and enablers; a standardised core education program; evidence-based clinical treatment protocols; and ongoing engagement of local staff. Control group ASUs will receive only an abridged version of the National Clinical Guidelines for Acute Stroke Management. The following outcome measures will be collected at 90 days post-hospital admission: patient death, disability (modified Rankin Score); dependency (Barthel Index) and Health Status (SF-36). Additional measures include: performance of swallowing screening within 24 hours of admission; glycaemic control and temperature control.
This is a unique study of research transfer in acute stroke. Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke. Our CRCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines, an imperative of modern hospital services.
Australia New Zealand Clinical Trial Registry (ANZCTR) No: ACTRN12608000563369.
在急性中风的入院阶段，高血糖、发热和吞咽功能障碍的管理不善，患者的预后受到影响。循证指南的使用可以改善护理，但尚未得到有效实施。我们的研究旨在开发和试验一项基于多学科团队建设的干预措施，以改善急性中风后患者的发热、高血糖和吞咽功能障碍的管理。
澳大利亚新南威尔士州的都市急性中风病房（ASU）将根据服务类别（A 或 B）和基线患者招募数量（高或低）进行分层，在此前瞻性、多中心、单盲、集群随机对照试验（CRCT）中。然后，ASU 将被独立随机分配到干预组或对照组。分配到干预组的 ASU 将接受：以单位为基础的研讨会，以确定当地的障碍和促进因素；标准化的核心教育计划；基于证据的临床治疗方案；以及当地工作人员的持续参与。对照组 ASU 将仅接受急性中风管理国家临床指南的缩写版本。以下结果将在入院后 90 天收集：患者死亡、残疾（改良 Rankin 评分）；依赖（巴氏指数）和健康状况（SF-36）。其他措施包括：在入院后 24 小时内进行吞咽筛查；血糖控制和体温控制。
这是一项关于急性中风研究转化的独特研究。如果我们要对抗不断增加的致残性中风发病率，在入院阶段提供最佳的住院护理是至关重要的。我们的 CRCT 还将使我们能够测试以急性中风病房多学科团队为重点的干预措施，而不是以单个学科为重点，这是现代医院服务的必要条件。
澳大利亚新西兰临床试验注册（ANZCTR）编号：ACTRN12608000563369。
