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Bed rest or mobiliz...
Bed rest or mobilization after rt-PA? A case-crossover study of factors influencing clinical decision making in stroke services
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Ha, Jason, 1985 (författare)
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Churilov, Leonid, 1966 (författare)
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- Lindén, Thomas, 1962 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
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visa fler...
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Bernhardt, Julie (författare)
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(creator_code:org_t)
- 2011-10-13
- 2013
- Engelska.
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Ingår i: International journal of stroke. - : SAGE Publications. - 1747-4949 .- 1747-4930. ; 8:3, s. 172-179
- Relaterad länk:
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- 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=0·0010), 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=0·0010), 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Sjukgymnastik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Physiotherapy (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Omvårdnad (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Nursing (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- clinical decision making;recombinant tissue plasminogen activator;stroke;very early mobilisation
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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