Centre for Neuroscience - Research Publications
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ItemGENDER AND BEING BORN OVERSEAS INFLUENCES THE AMOUNT OF ACUTE STROKE THERAPY(FOUNDATION REHABILITATION INFORMATION, 2013-02)OBJECTIVE: To identify patient factors that influence the amount, frequency and intensity of physical and occupational therapy received by patients each weekday within 14 days of stroke. DESIGN: Exploration of data from studies conducted to monitor activity and therapy. PARTICIPANTS: Stroke patients receiving active treatment (not for palliative care). Physiotherapists and occupational therapists. RESULTS: Therapy data for 274 patients from 7 hospitals were included. Patients received a median of 40.0 min of therapy (physiotherapy plus occupational therapy) per weekday. Multivariable regression found that women had 22% less total therapy per weekday (factor change 0.78, 95% confidence interval (CI): 0.66-0.9, p = 0.001) and a decreased likelihood of receiving two or more sessions of therapy per weekday. Those born overseas had 23% less high intensity therapy per weekday (Factor change 0.77, 95% CI: 0.71-0.84, p < 0.001). Those with more severe stroke had a greater likelihood of receiving two or more sessions of therapy per weekday (OR = 1.05, 95% CI: 1.02-1.09, p = 0.006) but increasing severity increased the odds of receiving no high intensity therapy by 7% (factor change 1.07, 95% CI: 1.02-1.11, p = 0.002). Age did not exhibit a significant association. CONCLUSION: There is some evidence that patient factors may influence the amount of therapy provided. Physiotherapists and occupational therapists should be aware of potential biases associated with therapy provision.
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ItemBed rest or mobilization after rt-PA? A case-crossover study of factors influencing clinical decision making in stroke services(SAGE PUBLICATIONS LTD, 2013-04)BACKGROUND: Acute stroke management is a dynamic field. Treatment with recombinant tissue plasminogen activator is standard care in Australia, but there are no evidence-based practice guidelines about first out of bed activity (mobilization) after recombinant tissue plasminogen activator. AIMS: To identify factors influencing clinicians' decisions to delay or allow mobilization. METHODS: Case-crossover design. Using hypothetical case vignettes, we explored the factors that clinicians consider when deciding to first mobilize a patient after recombinant tissue plasminogen activator. Acute stroke physicians and nurses from Australian hospitals known to treat with recombinant tissue plasminogen activator participated. Information about hospital recombinant tissue plasminogen activator protocols and perceived benefits and harms of mobilization after recombinant tissue plasminogen activator were also captured. RESULTS: Fifty-four clinicians, 52% senior nurses, and 48% senior physicians from all states of Australia participated. Of the factors influencing decisions about mobilization after recombinant tissue plasminogen activator, neurological decline (0.29; confidence interval 0.12, 0.46; P = 0.001), neurological decline with symptomatic intracerebral hemorrhage (0.41; confidence interval 0.24, 0.59; P < 0.0001), infection of uncertain cause (0.32; confidence interval 0.14, 0.50; P = 0.001), severe chest infection (0.35; confidence interval 0.16, 0.53; P = 0.0004), severe stroke (0.29; confidence interval 0.12, 0.46; P = 0.001), drowsiness (0.47; confidence interval 0.29, 0.63; P < 0.0001), and confusion (0.31; confidence interval 0.15, 0.47; P = 0.0001) significantly influenced decisions. Falls risk was a common concern (85%). CONCLUSION: Growing interest in development of clear protocols that guide first mobilization after recombinant tissue plasminogen activator prompted this study. We have identified factors that may influence decisions about when to allow patients to mobilize after recombinant tissue plasminogen activator. These, combined with emerging evidence of risks and benefits of early mobilization, should help protocol development in the future.
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ItemThe benefit of hypothermia in experimental ischemic stroke is not affected by pethidine(WILEY-BLACKWELL, 2013-04)BACKGROUND: Hypothermia is a promising experimental treatment for acute ischemic stroke. Human trials are still at an early stage, with the focus now on using hypothermia in awake patients. Pethidine (meperidine) is the principle agent used to control shivering in humans; however, whether it has any modulating effects on the neuroprotective efficacy of hypothermia is unknown. AIM: The aim of this study was to determine if pethidine influences the neuroprotective effect of hypothermia in experimental stroke. METHODS: Seventy-two male spontaneously hypertensive rats were anesthetized with isoflurane and randomly assigned to either normothermia (37. 4 °C rectal temperature); hypothermia (33 °C maintained for 130 mins); normothermia plus pethidine (2.5 mg/kg); or hypothermia plus pethidine. Temporary (90 mins) endovascular occlusion of the middle cerebral artery was induced blinded to treatment allocation and was confirmed with laser Doppler flowmetry. Pethidine and cooling were started immediately after vessel occlusion. Animals in the normothermia group had active temperature management using a heat lamp and fan. Assessments of outcome were carried out 24 after the induction of injury. RESULTS: Thirteen animals met our prespecified criteria for exclusion, and data for 59 rats were presented here. Hypothermia was associated with a 63% reduction in infarct size, and pethidine had no significant impact on the efficacy of hypothermia. No effects were observed in neurobehavioral outcome or edema volume across experimental groups. CONCLUSIONS: The effects of hypothermia in a model of focal ischemia are not affected by administration of pethidine.