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dc.contributor.authorHa, J
dc.contributor.authorChurilov, L
dc.contributor.authorLinden, T
dc.contributor.authorBernhardt, J
dc.date.available2014-05-22T08:03:49Z
dc.date.issued2013-04-01
dc.identifierhttp://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000316327800011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=d4d813f4571fa7d6246bdc0dfeca3a1c
dc.identifier.citationHa, J., Churilov, L., Linden, T. & Bernhardt, J. (2013). Bed rest or mobilization after rt-PA? A case-crossover study of factors influencing clinical decision making in stroke services. INTERNATIONAL JOURNAL OF STROKE, 8 (3), pp.172-179. https://doi.org/10.1111/j.1747-4949.2011.00660.x.
dc.identifier.issn1747-4930
dc.identifier.urihttp://hdl.handle.net/11343/33116
dc.descriptionC1 - Journal Articles Refereed
dc.description.abstractBACKGROUND: 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.
dc.formatapplication/pdf
dc.languageEnglish
dc.publisherSAGE PUBLICATIONS LTD
dc.subjectNeurosciences not elsewhere classified; Clinical Sciences not elsewhere classified; Cardiovascular System and Diseases; Expanding Knowledge in the Medical and Health Sciences
dc.titleBed rest or mobilization after rt-PA? A case-crossover study of factors influencing clinical decision making in stroke services
dc.typeJournal Article
dc.identifier.doi10.1111/j.1747-4949.2011.00660.x
melbourne.peerreviewPeer Reviewed
melbourne.affiliationThe University of Melbourne
melbourne.affiliation.departmentFlorey Department Of Neuroscience And Mental Health
melbourne.source.titleINTERNATIONAL JOURNAL OF STROKE
melbourne.source.volume8
melbourne.source.issue3
melbourne.source.pages172-179
dc.research.codefor110999
dc.research.codefor110399
dc.research.codeseo2008920103
dc.research.codeseo2008970111
melbourne.publicationid196931
melbourne.elementsid355694
melbourne.contributor.authorBernhardt, Julie
melbourne.contributor.authorChurilov, Leonid
melbourne.contributor.authorHA, JASON
melbourne.contributor.authorWijeratne, Tissa
dc.identifier.eissn1747-4949
melbourne.accessrightsThis item is currently not available from this repository


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