Bones pràctiques: gestió infermera de la demanda

Bones pràctiques; Gestió infermera de la demanda; Atenció al pacientBuenas prácticas; Gestión enfermera de la demanda; Atención al pacienteGood practices; Demand nurse management; Patient careAquest document té com a objectiu identificar mesures facilitadores que ajudin a l’escalabilitat de la bona pràctica en Atenció Primària Gestió Infermera de la Demanda, que permetin augmentar i millorar la implementació a tot el territori

Com ha anat el primer PERIS d’infermeria?: anàlisi de l'impacte immediat i directe de la recerca infermera del PERIS 2017

Recerca sanitària; PERIS; InfermeriaInvestigación sanitaria; PERIS; EnfermeríaHealth research; PERIS; NurseryLa convocatòria del PERIS del 2017 ha afavorit, per primera vegada, la intensificació en investigació als professionals infermers i infermeres. Durant un període màxim de nou mesos aquesta intensificació ha permès alliberar aquests professionals de les tasques assistencials per desenvolupar activitats de recerca. El present monogràfic recull una anàlisi sistèmica de l’estat de situació indicant el que ha suposat aquesta convocatòria pel que fa a oportunitats per als professionals intensificats i beneficis per al sistema de salut. Això s’ha fet a través de l’anàlisi de text de les Instantànies de Recerca, unes fitxes que van emplenar els beneficiaris dels ajuts al final del període sobre l’experiència, la recerca, els seus resultats i els beneficis obtinguts. Els beneficis per al sistema i les oportunitats que ha suposat per als 61 professionals intensificats es pot resumir en la generació de coneixement divers i heterogeni que ha impactat tant en l’àmbit assistencial com en l’àmbit de recerca, generant valor, reconeixement i visibilitat a la recerca en infermeria, influència en les actituds dels professionals del seu entorn, reforçant relacions professionals i col·laboracions, creant noves competències formals (tesis doctorals) i informals, interaccions amb els usuaris del coneixement (siguin professionals o altres investigadors) i, en última instància, aplicant els resultats als processos assistencials, a les intervencions sanitàries i als programes. Les oportunitats necessiten, tanmateix, un suport sostingut, sobretot perquè molts dels beneficis que aquí es relaten impliquen un canvi cultural per al col·lectiu de professionals de la salut que no es fa en un, dos o tres anys. És doncs important que aquest camí encetat continuï amb un suport institucional com ja s’està fent i també amb un suport mutu i cooperació entre professionals,que les sessions del SARIS van intentar iniciar i reforçar

Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia

Introduction: Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. Patients and methods: Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. Results: A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94–1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97–1.22). Discussion and conclusion: We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself

Workflow times and outcomes in patients triaged for a suspected severe stroke

Introduction: Current recommendations for regional stroke destination suggest that patients with severe acute stroke in non-urban areas should be triaged based on the estimated transport time to a referral thrombectomy-capable center. Methods: We performed a post hoc analysis to evaluate the association of pre-hospital workflow times with neurological outcomes in patients included in the RACECAT trial. Workflow times evaluated were known or could be estimated before transport allocation. Primary outcome was the shift analysis on the modified Rankin score at 90 days. Results: Among the 1,369 patients included, the median time from onset to emergency medical service (EMS) evaluation, the estimated transport time to a thrombectomy-capable center and local stroke center, and the estimated transfer time between centers were 65 minutes (interquartile ratio [IQR] = 43–138), 61 minutes (IQR = 36–80), 17 minutes (IQR = 9–27), and 62 minutes (IQR = 36–73), respectively. Longer time intervals from stroke onset to EMS evaluation were associated with higher odds of disability at 90 days in the local stroke center group (adjusted common odds ratio (acOR) for each 30-minute increment = 1.03, 95% confidence interval [CI] = 1.01–1.06), with no association in the thrombectomy-capable center group (acOR for each 30-minute increment = 1.01, 95% CI = 0.98–1.01, pinteraction = 0.021). No significant interaction was found for other pre-hospital workflow times. In patients evaluated by EMS later than 120 minutes after stroke onset, direct transport to a thrombectomy-capable center was associated with better disability outcomes (acOR = 1.49, 95% CI = 1.03–2.17). Conclusion: We found a significant heterogeneity in the association between initial transport destination and neurological outcomes according to the elapse of time between the stroke onset and the EMS evaluation (ClinicalTrials.gov: NCT02795962). ANN NEUROL 2022;92:931–942

Effectiveness of thrombectomy in stroke according to baseline prognostic factors: inverse probability of treatment weighting analysis of a population-based registry

Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors

Bones pràctiques: gestió infermera de la demanda

Bones pràctiques; Gestió infermera de la demanda; Atenció al pacientBuenas prácticas; Gestión enfermera de la demanda; Atención al pacienteGood practices; Demand nurse management; Patient careAquest document té com a objectiu identificar mesures facilitadores que ajudin a l’escalabilitat de la bona pràctica en Atenció Primària Gestió Infermera de la Demanda, que permetin augmentar i millorar la implementació a tot el territori

Innovation in Systems of Care in Acute Phase of Ischemic Stroke. The Experience of the Catalan Stroke Programme

Stroke, and mainly ischemic stroke, is the second cause of death and disability. To confront the huge burden of this disease, innovative stroke systems of care are mandatory. This requires the development of national stroke plans to offer the best treatment to all patients eligible for reperfusion therapies. Key elements for success include a high level of organization, close cooperation with emergency medical services for prehospital assessment, an understanding of stroke singularity, the development of preassessment tools, a high level of commitment of all stroke teams at Stroke Centres, the availability of a disease-specific registry, and local government involvement to establish stroke care as a priority. In this mini review, we discuss recent evidence concerning different aspects of stroke systems of care and describe the success of the Catalan Stroke Programme as an example of innovation. In Catalonia, reperfusion treatment rates have increased in recent years and currently are among the highest in Europe (17.3% overall, 14.3% for IVT, and 6% for EVT in 2016)

Com ha anat el primer PERIS d’infermeria?: anàlisi de l'impacte immediat i directe de la recerca infermera del PERIS 2017

Recerca sanitària; PERIS; InfermeriaInvestigación sanitaria; PERIS; EnfermeríaHealth research; PERIS; NurseryLa convocatòria del PERIS del 2017 ha afavorit, per primera vegada, la intensificació en investigació als professionals infermers i infermeres. Durant un període màxim de nou mesos aquesta intensificació ha permès alliberar aquests professionals de les tasques assistencials per desenvolupar activitats de recerca. El present monogràfic recull una anàlisi sistèmica de l’estat de situació indicant el que ha suposat aquesta convocatòria pel que fa a oportunitats per als professionals intensificats i beneficis per al sistema de salut. Això s’ha fet a través de l’anàlisi de text de les Instantànies de Recerca, unes fitxes que van emplenar els beneficiaris dels ajuts al final del període sobre l’experiència, la recerca, els seus resultats i els beneficis obtinguts. Els beneficis per al sistema i les oportunitats que ha suposat per als 61 professionals intensificats es pot resumir en la generació de coneixement divers i heterogeni que ha impactat tant en l’àmbit assistencial com en l’àmbit de recerca, generant valor, reconeixement i visibilitat a la recerca en infermeria, influència en les actituds dels professionals del seu entorn, reforçant relacions professionals i col·laboracions, creant noves competències formals (tesis doctorals) i informals, interaccions amb els usuaris del coneixement (siguin professionals o altres investigadors) i, en última instància, aplicant els resultats als processos assistencials, a les intervencions sanitàries i als programes. Les oportunitats necessiten, tanmateix, un suport sostingut, sobretot perquè molts dels beneficis que aquí es relaten impliquen un canvi cultural per al col·lectiu de professionals de la salut que no es fa en un, dos o tres anys. És doncs important que aquest camí encetat continuï amb un suport institucional com ja s’està fent i també amb un suport mutu i cooperació entre professionals,que les sessions del SARIS van intentar iniciar i reforçar

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p&lt;0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons