Study characteristics
Stroke, intracranial hemorrhage, stroke, stroke diagnoses-, Thrombolysis, ischemic stroke, acute ischemic stroke
STROKE, TRANSIENT ISCHEMIC ATTACK, INTRACRANIAL HEMORRHAGE, STROKE, ISCHEMIC STROKE, EVENTS, COMPLICATIONS
Eight articles describing eight educational interventions were eligible for inclusion in this systematic review (see Fig. Characteristics of included studiesProfessionals:- 122 attendeesPatients:- 90 patients pre-intervention- 199 patients post-intervention1 “hub” facility:- Neurologists- Remote access of spoke facility desktops for assessment of radiological images5 “spoke” community EDs with:- Laboratories- Computed tomography (CT) scanners- Telemedicine technologies- One with magnetic resonance imaging machine- “Hub” facility neurologists provided training to all emergency department staff in the “spoke” facilities- Brief lectures- Live simulations- Encouragement for teamworkIncluded comparisons (evaluative):- Number of stroke diagnoses- Door-to-needle time- TBL rates- Symptomatic intracranial hemorrhage ratesLevel 4- ResultsStudy reported on stroke outcomes pre-post and overall system usageProfessionals:- 4 neurologists- Medical officers (medicine graduates and internal medicine postgraduates), total unknownPatients:- Total unknown- 22 patients received TBL2 tertiary “hub” facilities with:- Neurologists- “WhatsApp” for radiological image examinations and consultations17 “spoke” government-run district hospitals:- CT scan facilities- Tissue plasminogen activator- “WhatsApp” to share radiological images- Medical officers from district hospitals attended workshops on stroke recognition and CT scans- Thrombolysis protocols in ischemic stroke were providedIncluded comparisons (quantitative):- Number of patients that received TBLLevel 4- ResultsStudy reported on stroke outcomes pre-postProfessionals:- Village doctors- Township hospital healthcare providers- County managers- Stroke specialists (app design consultations)- Each village had a village doctor- 50 villages, 25 villages in intervention arm- Education was delivered through a mobile health (mHealth) application designed by the research team- The application included videos, graphs, texts, and a list of important medications to assist village doctors’ decision making on medication prescriptionIncluded information from feasibility survey results at 12 months of the main trial (quantitative):- Village doctor’s ratings on a Likert scale with questions regarding ease and speed of learning how to use app, app’s aid in prescribing medication, and enthusiasm for continued app usageLevel 1- ReactionVillage doctors satisfaction with the mHealth applicationProfessionals:- 210 non-neurologist health workers (medical officers, nurses, and community health extension workers)- One-day basic stroke course- Didactic presentations- Educational stroke documentary film- Practical/interactive sessions on casesIncluded comparisons (quantitative):- Knowledge of risk factors, stroke symptoms, development of stroke, swallowing tests, and use of thrombolyticsLevel 2- LearningPre-post training questionnaire on stroke knowledgeProfessionals:- 1 internal medicine physician, 126 nurses, 2 physiotherapists, and 1 occupational therapistPatients:- 125 before stroke unit (pre-SU)- 125 after stroke unit (post-SU)- Both groups age and gender matchedSecondary care hospital with:- CT scanner- Six SU beds- No neurologist- Physician was trained first over Skype for 2-h sessions that occurred three times a week, over the course of a month- Physician then trained other professionals in 2-h sessions that were conducted for 5 days a week, over 1 month- Stroke unit manual was developed and written by the research group- Multidisciplinary teams were developed to meet once a weekIncluded comparisons (quantitative):- Overall incidence of complications- Lengths of hospital stay- Rates of swallowing assessment, mobility assessment and patient re-education- Observed functional outcomes after 1-month follow up, as recorded by using the modified Rankin scaleLevel 4- ResultsStudy reported on stroke outcomes pre-post stroke unit trainingProfessionals:- Multidisciplinary team of 3 physiotherapists, 1 occupational therapist, 1 speech language therapist, and 1 stroke physician from the Southwest of England- Professionals from the hospital- Workshops on the clinical aspects of stroke management included presentations and small group discussions- Leaders from medicine, nursing, and physiotherapy were identified and trained in clinical knowledge, skills, and developing leadership qualities- Deputy leaders were also appointed to work with the clinical leaders and for succession planning- These leaders took responsibility for leading their respective services and educating their professional groups on core skills- The train-the-train approach was supported with teaching materials and a practical competency frameworkOutcomes included (qualitative):- Results from implementing the “train the trainer” model for creating a multidisciplinary SUProfessionals:- Personnel that took care of acute ischemic stroke (AIS) patientsPatients:- 4800 patients hospitalized with AIS, 2400 in intervention group and 2400 in control group- Mean number of patients in each cluster was 120 (range:102–145)- 3980 (82.9%) patients at 12-month follow-up, 2003 (83.5%) in intervention group and 1977 (82.4%) in control groupInclusion criteria:- Secondary or tertiary centre- EDs- Neurological wards- Capacity to administer intravenous r tPACharacteristics:- Intervention and control groups composed of 20 hospitals each- 72.5% were tertiary hospitals- 62.5% had a stroke unit- 62.5% were teaching hospitals- Median annual number of beds of neurological wards was 77 (IQR: 61–178)- Neurology department director and physician or nurse from each site attended a 2-day workshop- These professionals were then tasked with sharing operational methods with personnel from their sites- An evidence-based clinical pathway written by a panel of stroke experts was provided- Written care protocols for implementation of performance measures were provided- Full-time quality coordinator at each site and monitoring and feedback system for performance measures was implementedIncluded comparisons (quantitative):- Patients receiving eligible performance measures (assessed as a whole and as all-or-none measure)- New clinical vascular events at 3, 6, and 12 monthsLevel—3 BehaviourLevel—4 ResultsAdherence to stroke performance measures for hospital personnel and patient outcomesPatients:- Diagnosed with AIS or transient ischemic attack (TIA)Hospitals:- 19 hospitals randomized to intervention (817 patients in primary analysis until discharge, 684 at 90 days follow-up)- 17 hospitals randomized to routine care (807 patients in primary analysis until discharge, 698 after 90 days follow-up)Professionals:- Physicians- NursesInclusion Criteria:- 24-h emergency care, with at least 1 physician in charge for the unit for 24 h- 1 on-call neurologist- Central nervous system (CNS) imaging and alteplase therapy availableCharacteristics:- 47.2% stroke units- 88.9% intra-arterial TBL capabilities 24 h a day- 77.8% teaching hospitals- Median ED volume 1500 patients/month (IQR: 500–3700)- 2 healthcare professionals from each hospital attended a simulation-based workshop on implementing the intervention- On-site training visits for training healthcare professionals on their hospital’s clinical pathway- Web and telephone training- Audit and feedback reports- Roadmap with therapeutic plan- Checklists for following therapeutic plan- Educational posters- Video on training techniquesIncluded comparisons (quantitative):- Prescriptions for evidence-based therapies- Secondary prevention efforts- Stroke reoccurrence- Total mortality- Cardiovascular mortality- Hemorrhagic transformationsLevel—3 BehaviourLevel—4 ResultsAdherence to stroke performance measures for hospital personnel and patient outcomes