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• Nurses' ratings of context suggest a positive setting for evidence implementation. • Nurse and hospital characteristics impact ratings of work context. • Outcomes did not differ in EDs with high or low work context. • Contextual aspects beyond those of The Alberta Context Tool need to be assessed. Emergency departments (ED) are challenging environments but critical for early management of patients with stroke. To identify how context affects the provision of stroke care in 26 Australian EDs. Nurses perceptions of ED context was assessed with the Alberta Context Tool. Medical records were audited for quality of stroke care and patient outcomes. Collectively, emergency nurses (n = 558) rated context positively with several nurse and hospital characteristics impacting these ratings. Despite these positive ratings, regression analysis showed no significant differences in the quality of stroke care (n = 1591 patients) and death or dependency (n = 1165 patients) for patients in EDs with high or low rated context. Future assessments of ED context may need to examine contextual factors beyond the scope of the Alberta Context Tool which may play an important role for the understanding of stroke care and patient outcomes in EDs. [ABSTRACT FROM AUTHOR]

Background: Oral care is an essential aspect of optimal oral health, yet internationally little is known about current oral care practices for patients with stroke in hospitals. Aim: To explore oral care practices for inpatients with stroke in the UK and Australia. Method: Surveys questionnaires were mailed to stroke specialist nurse or lead stroke clinician in hospitals known to provide inpatient care for patients with stroke. Descriptive analyses are presented. Results: Response rates were high [UK: 86% (150/174)]; [Australia: 74% (120/162)]. Oral care protocols existed in 52% of UK and 30% of Australian hospitals. However, only 17% (n=26) of UK and 6% (n=7) of Australian units had stroke specific protocols. Oral care training was given to 55% (n=83) of UK and 30% (n=36) of Australian staff. Oral care assessment tools were used in 53% (n=80) of UK and 13% (n=16) of Australian hospitals, however, half, 50% (n=40) UK units and 38% (n=6) Australian units used generic tools. Oral care assessments were undertaken on admission in 73% (n=109) of UK and 57% (n=68) of Australian hospitals. When patients were unable to provide their own oral care, staff were only expected to undertake cleaning of natural teeth twice a day in 62% [n=93] of UK and 56% (n=67) Australian hospitals. It was an expectation in only half (UK: 54% [n=81]; AUS: 55% [n=66]) of the hospitals that patients 'nil by mouth' were to receive oral care three times a day. Conclusion: Unacceptable variability exists in oral care practices for stroke in both regions with Australia having poorer practices than the UK. Oral care is a neglected area of stroke clinical practice. Some results reflect an expectation only, the actual practice is likely to be even lower. [ABSTRACT FROM AUTHOR]

Objectives: Low-middle income countries, such as Vietnam have a greater burden from stroke than high-income countries. Few health professionals have stroke specialist training, and the quality of care may vary between hospitals. To support improvements to stroke care, we aimed to gain a better understanding of the resources available in hospitals in Vietnam to manage acute stroke.Materials and Methods: The survey questions were adapted from the Australian Organisational Survey of Stroke Services (Stroke Foundation). The final 65 questions covered the topics: hospital size and admissions for stroke; use of clinical protocols and assessments conducted; team structure and coordination; communication and team roles. The survey was distributed electronically or via paper form in Vietnamese to clinical leaders of 91 eligible hospitals (November-December 2020). Data were summarised descriptively.Results: Sixty-six (73%) hospitals responded, and doctors predominately completed the survey (98%). Approximately 70% of hospitals had a stroke unit; median 630 acute strokes/year (IQR: 250-1200) and >90% used stroke clinical protocols. The daytime nurse-patient ratio was 1:4. There was a perceived lack of access to allied health staff, including psychologists/neuropsychologists, occupational therapists, and speech pathologists. Only 50% reported having a standardised rehabilitation assessment process.Conclusions: This is the first large-scale cross-sectional, national overview of stroke services in Vietnam. Future research should include a systematic clinical audit of stroke care to confirm aspects of the data from these hospitals. Repeating the survey in future years will enable the tracking of progress and may influence capacity building for stroke care in Vietnam. [ABSTRACT FROM AUTHOR]

This study investigated patients’ 90-day outcomes poststroke following an admission to one Australian metropolitan Acute Stroke Unit (ASU) and examined premorbid risk factors associated with these outcomes. Data from patients consecutively admitted from January 2006 to July 2007 (n = 54) to an acute stroke unit within 48 hours of onset of symptoms were linked with the Quality in Acute Stroke Care research project data and were analyzed to identify associations between premorbid risk factors (atrial fibrillation, hypertension, high cholesterol, smoking and diabetes); demographic, clinical and stroke characteristics; and death, disability (modified Rankin Score ≥ 2), dependency (Barthel Index score ≥ 95) and health status (SF-36) poststroke. Within 90 days, 4 participants had died and 45.5% were classified as dependent. Of the total participants, 56.8% were classified as disabled. The SF-36 mean scores indicated that the cohort had less than optimal physical health (46.7, SD = 9.8) and mental health (46.4, SD = 13.1). Analysis of baseline variables showed that participants with atrial fibrillation were more likely to have a severe stroke (p = 0.037). Patients presenting with intracerebral haemorrhage (p = 0.017) and those with subsequent strokes (p = 0.000) had significantly lower Barthel Index scores. A lower SF-36 physical component score at 90 days was significantly associated with intracerebral haemorrhages (p = 0.018) and subsequent strokes (p = 0.026). Although most patients were alive at 90 days poststroke, there were variable levels of morbidity-associated stroke type, subsequent strokes and premorbid risk factors, particularly atrial fibrillation. The findings provide insight into the 90-day outcomes of patients discharged from an ASU, which may be of use to plan appropriate postdischarge support for this group. In particular, aggressive management of stroke risk factors to prevent recurrent stroke is warranted. [Copyright &y& Elsevier]