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Start Over Author "Hunter, Annemarie" Publication Type Academic Journals
7 results on '"Hunter, Annemarie"'

2. Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Author

Baigent, Colin, Lasserson, Daniel, Sullivan, Frank, Carrie, Johanna, Rojas, Javier, Amoils, Shannon, Bamford, John, Armitage, Jane, Rinkel, Gabriel, Lowe, Gordon, Emberson, Jonathan, Innes, Karen, Dinsmore, Lynn, Drever, Jonathan, Williams, Carol, Perry, David, McGill, Connor, Buchanan, David, Walker, Allan, Hutchison, Aidan, Matthews, Christopher, Fraser, Ruth, McGrath, Aileen, Deary, Ann, Anderson, Rosemary, Walker, Pauli, Hansen, Christian, Parker, Richard, Rodriguez, Aryelly, Macleod, Malcolm, Gattringer, Thomas, Palmer, Jeb, Sakka, Eleni, Adil-Smith, Jennifer, Minks, David, Mitra, Dipayan, Bhatnagar, Priya, du Plessis, Johannes, Joshi, Yogish, Lerpiniere, Christine, O'Brien, Richard, Burgess, Seona, Mead, Gillian, Paulton, Ruth, Doubal, Fergus, McCormick, Katrina, Hunter, Neil, Taylor, Pat, Parakramawansha, Ruwan, Perry, Jack, Blair, Gordon, MacRaild, Allan, Parry-Jones, Adrian, Johnes, Mary, Lee, Stephanie, Shaw, Kelly Marie, Burger, Ilse, Punter, Martin, Ingham, Andrea, Perez, Jane, Naing, Zin, Morell, Jordi, Marsden, Tracy, Hall, Andrea, Marshall, Sally, Harrison, Louise, Jarapa, Rowilson, Wood, Edith, O'Loughlin, Victoria, Cohen, David, Davies, Silvie, Njoku, Kelechi, Mpelembue, Mushiya, Burgess, Laura, Licenik, Radim, Ngwako, Mmua, Nisar, Nabeela, Niranchanan, Rangah, Roganova, Tatjana, Bathula, Rajaram, Devine, Joseph, David, Anette, Oshodi, Anne, Guo, Fenglin, Owoyele, Emmanuelle, Sukdeo, Varthi, Ballantine, Robert, Abbdul-saheb, Mudhar, Chamberlain, Angela, Chandrakumar, Aberami, Poku, Philip, Harkness, Kirsty, Blank, Catrin, Richards, Emma, Ali, Ali, Kibutu, Faith, Balitska, Olesia, Birchall, Kathryn, Bayliss, Pauline, Doyle, Clare, Stocks, Kathy, Majis, Arshad, Howe, Jo, Kamara, Christine, Barron, Luke, Maatouk, Ahmad, Lindert, Ralf, Dakin, Katy, Redgrave, Jessica, Bhaskaran, Biju, Salih, Isam, Kelly, Debs, Szabo, Susan, Tomlin, Dawn, Bearne, Helen, Buxton, Jean, Fitzell, Pauline, Ayres, Georgina, Saulat, Afaq, Horan, Kathleen, Garfield-Smith, Joanne, Bhakri, Harbens, Guyler, Paul, Sinha, Devesh, Loganathan, Thayalini, Siddiqui, Amber, Siddiqui, Anwer, Coward, Lucy, Kunhunny, Swapna, Tysoe, Sharon, Orath Prabakaran, Rajalakshmi, Kelavkar, Shyam, Rashmi, Sindhu, Ngo, David, Ng, Kheng Xiong, Menon, Nisha, Shah, Sweni, Barber, Mark, Esson, Derek, Brodie, Fiona, Anjum, Talat, Wani, Mushtaq, Krishnan, Manju, Quinn, Leanne, Spencer, Jayne, Jones, Terry, Thompson-Jones, Helen, Dacey, Lynne, Chenna, Srikanth, Storton, Sharon, Thomas, Sarah, Beaty, Teresa, Treadwell, Shelley, Davies, Caroline, Tucker, Susan, Connor, Lynda, Slade, Peter, Gainard, Glyn, Muddegowda, Girish, Sanyal, Ranjan, Remegoso, Alda, Abano, Nenette, Causley, Chelsea, Carpio, Racquel, Stevens, Stephanie, Butler, Adrian, Varquez, Resti, Denic, Hayley, Alipio, Francis, Moores, Andrew, Barry, Adrian, Maguire, Holly, Grocott, Jeanette, Finney, Kay, Lyjko, Sue, Roffe, Christine, Hiden, Joanne, Ferdinand, Phillip, Cvoro, Vera, Ullah, Khalil, Chapman, Nicola, Couser, Mandy, Pound, Susan, Mcauley, Sean, Raghunathan, Senthil, Shelton, Faye, Hedstrom, Amanda, Godfrey, Margi, Havard, Diane, Buck, Amanda, Krishnan, Kailash, Gilzeane, Nicola, Roffe, Jack, Clarke, Judith, Whittamore, Katherine, Sheikh, Saima, Sprigg, Nikola, Keshvara, Rekha, Jordan, Carla, Jackson, Benjamin, Wilkes, Gwendoline, Appleton, Jason, Law, Zhe, Matias, Oliver, Vasileiadis, Evangelos, Mason, Cathy, Parry, Anthea, Landers, Geraldine, Holden, Melinda, Aweid, Basaam, Rashed, Khalid, Balian, Linda, Vickers, Carinna, Keeling, Elizabeth, Board, Sarah, Allison, Joanna, Buckley, Clare, Williams-Yesson, Barbara, Board, Joanne, Pitt-Kerby, Tressy, Tanate, Alfonso, Wood, Diane, Kini, Manohar, Chadha, Dinesh, Walstow, Deborah, Fong, Rosanna, Luder, Robert, Adesina, Tolu, Gallagher, Jill, Bridger, Hayley, Murali, Elodie, Bhargava, Maneesh, van Someren, Chloe, Harrington, Frances, Mate, Abhijit, James, Ali, Courtauld, Gillian, Schofield, Christine, Adie, Katja, Lucas, Linda, Bond, Kirsty, Maund, Bev, Ellis, Sam, Mudd, Paul, James, Martin, Keenan, Samantha, Bowring, Angela, Cageao, Julie, Kingwell, Hayley, Roughan, Caroline, Hemsley, Anthony, Sword, Jane, Strain, David, Miller, Keniesha, Goff, Anita, Gupwell, Karin, Thorpe, Kevin, Emsley, Hedley, Punekar, Shuja, McLoughlin, Alison, Sultan, Sulaiman, Gregory, Bindu, Raj, Sonia, Doyle, Donna, Muir, Keith, Smith, Wilma, Welch, Angela, Moreton, Fiona, Cheripelli, Bharath Kumar, El Tawil, Salwa, Kalladka, Dheeraj, Huang, Xuya, Day, Nicola, Ramachandran, Sankaranarayanan, Crosbie, Caroline, Elliot, Jennifer, Rudd, Tony, Marks, Katherine, Bhalla, Ajay, Birns, Jonathan, Kullane, Sagal, Weir, Nic, Allen, Christopher, Pressly, Vanessa, Crawford, Pam, Battersby-Wood, Emma, Blades, Alex, Egerton, Shuna, Walters, Ashleigh, Evans, Sue, Marigold, James Richard, Smith, Fiona, Howard, Gabriella, Gartrell, Imogen, Smith, Simon, Creeden, Robyn, Cox, Chloe, Boxall, Cherish, Hewitt, Jonathan, Nott, Claire, Sarah, Procter, Whiteman, Jessica, Buckle, Steve, Wallace, Rebecca, Mardania, Rina, Gray, Jane, Triscott, Claire, Nair, Anand, Greig, Jill, Rana, Pratap, Robinson, Matthew, Alam, Mohammad Irfan, Werring, David, Wilson, Duncan, Watchurst, Caroline, Brezitski, Maria, Crook, Luci, Jones, Ifan, Banaras, Azra, Patel, Krishna, Erande, Renuka, Hogan, Caroline, Hostettler, Isabel, Ashton, Amy, Feerick, Shez, Francia, Nina, Oji, Nnebuife, Elliott, Emma, Al-Mayhani, Talal, Dennis, Martin, Sudlow, Cathie, Whiteley, William, Al-Shahi Salman, Rustam, Dutta, Dipankar, Brown, Pauline, Ward, Deborah, Davis, Fiona, Turfrey, Jennifer, Hughes, Chloe, Collins, Kayleigh, Bakawala, Rehana, O'Connell, Susan, Glass, Jon, Broughton, David, Tryambake, Dinesh, Dixon, Lynn, Chapman, Kath, Young, Andrew, Bergin, Adrian, Sigsworth, Andrew, Manoj, Aravind, Fletcher, Glyn, Lopez, Paula, Cox, Penelope, Wilkinson, Mark, Fitzsimmons, Paul, Sharma, Nikhil, Choulerton, James, Button, Denise, Dow, Lindsey, Gbadamoshi, Lukuman, Avis, Joanne, Madigan, Barbara, McCann, Stephanie, Shaw, Louise, Howcroft, Deborah, Lucas, Suzanne, Stone, Andrew, Cluckie, Gillian, Lovelock, Caroline, Clarke, Brian, Chopra, Neha, Clarke, Natasha, Patel, Bhavini, Kennedy, Kate, Williams, Rebecca, Blight, Adrian, O'Reilly, Joanna, Orefo, Chukwuka, Dayal, Nilofer, Ghatala, Rita, Adedoyin, Temi, Watson, Fran, Trippier, Sarah, Choy, Lillian, Moynihan, Barry, Khan, Usman, Jones, Val, Jeyaraj, Naomi, Kerin, Lourda, Thavanesan, Kamy, Tiwari, Divya, Cox, Chantel, Ljubez, Anja, Tucker, Laura, Iqbal, Arshi, Bagnall, Caroline, Keltos, Marketa, Roberts, Josh, Jupp, Becky, Ovington, Catherine, Rogers, Emily, David, Owen, Bell, Jo, Longland, Barbara, Hann, Gail, Cooper, Martin, Nasar, Mohammad, Rajapakse, Anoja, Wynter, Inez, Anwar, Ijaz, Skinner, Helen, Nozedar, Tarn, McArdle, Damian, Kumar, Balakrishna, Crawford, Susan, Annamalai, Arunkumar, Ramshaw, Alex, Holmes, Clare, Caine, Sarah, Osborn, Mairead, Dodd, Emily, Murphy, Peter, Devitt, Nicola, Baker, Pauline, Steele, Amy, Guthrie, Lucy Belle, Clarke, Samantha, Hassan, Ahamad, Waugh, Dean, Veraque, Emelda, Makawa, Linetty, Kambafwile, Mary, Randall, Marc, Papavasileiou, Vasileios, Cullen, Claire, Peters, Jenny, Thant, Hlaing, Ingram, Tanya, Zoe, Mellor, Durairaj, Ramesh, Harrison, Melanie, Stevenson, Sarah, Shackcloth, Daniela, Ewing, Jordan, Sutton, Victoria, McCarron, Mark, McKee, Jacqueline, Doherty, Mandy, McVerry, Ferghal, Blair, Caroline, MacLeod, Mary, Irvine, Janice, Gow, Heather, Furnace, Jacqueline, Joyson, Anu, Jagpal, Baljit, Ross, Sarah, Klaasen, Katrina, Nelson, Sandra, Clarke, Rebecca, Crouch, Nichola, MacLennan, Beverly, Taylor, Vicky, Epstein, Daniel, Shukla, Avani, Krishnamurthy, Vinodh, Nicholas, Paul, Qureshi, Sammie, Webber, Adam, Penge, Justin, Ramadan, Hawraman, Maguire, Stuart, Patterson, Chris, Bellfield, Ruth, Hairsine, Brigid, Stewart, Kelvin, Hooley, Michaela, Quinn, Outi, Richard, Bella, Moseley, Sally, Edwards, Mandy, Lawson, Heidi, Tayler, Michelle, Pai, Yogish, Dhakal, Mahesh, Esisi, Bernard, Dima, Sofia, Smith, Gemma Marie, Garside, Mark, Naeem, Muhammad, Baliga, Vidya, Rogers, Gill, Brown, Ellen, Bruce, David, Hayman, Rachel, Clayton, Susan, Gamble, Ed, Grue, Rebecca, Charles, Bethan, Hague, Adam, Blane, Sujata, Lambert, Caroline, Chaudhry, Afnan, Harrison, Thomas, Saastamoinen, Kari, Hove, Dionne, Howaniec, Laura, Grimwood, Gemma, Redjep, Ozlem, Humphries, Fiona, Argandona, Lucia, Cuenoud, Larissa, Erumere, Esther, Amlani, Sageet, Auld, Grace, Salek-Haddadi, Afraim, Schulz, Ursula, Kennedy, James, Ford, Gary, Mathieson, Philip, Reckless, Ian, Teal, Rachel, Lenti, Giulia, Harston, George, O'Brien, Eoin, Mcgee, Joanne, Mitchell, Jennifer, Amis, Elaine, Handley, Dominic, Kelly, Siobhan, Zachariah, George, Francis, Jobbin, Crisp, Sarah, Sesay, Juliana, Finlay, Sarah, Hayhoe, Helen, Hannon, Niamh, Hughes, Tom, Morse, Bethan, De Berker, Henry, Tallantyre, Emma, Osman, Ahmed, White, Susan, Schwarz, Stefan, Jelley, Benjamin, Yadava, Rajendra, Azhar, Khalid, Reddan, Julie, Sangombe, Mirriam, Stafford, Samantha, Fotherby, Ken, Morgan, Debbie, Baig, Farrukh, Jennings-Preece, Karla, Butler, Donna, Ahmad, Nasar, Willberry, Angela, Stevens, Angela, Rai, Baljinder, Siddegowda, Prasad, Howard, Peter, Hyatt, Lisa, Dobson, Tracey, Jarrett, David, Ponnambath, Suheil, Tandy, Jane, Harrington-Davies, Yasmin, Butler, Rebecca, James, Claire, Valentine, Stacey, Suttling, Anne, Langhorne, Peter, Kerr, Gillian, Wright, Fiona, Graham, Ruth, McAlpine, Christine, Iqbal, Mohammad Shahzad, Humphreys, Louise, Pasco, Kath, Balazikova, Olga, Nasim, Ashraf, Peixoto, Cassilda, Gallagher, Louise, Shahmehri, Shahrzad, Ghosh, Sandip, Barrie, Elizabeth, Gilmour, Danielle, Henry, Margo, Webb, Tom, Cowie, Linda, Rudenko, Hannah, McDonald, Shanni, Schumacher, Natasha, Walker, Susannah, Cosier, Tracey, Verrion, Anna, Beranova, Eva, Thomson, Audrey, Venter, Marius, Kar, Arindam, Mashate, Sheila, Harvey, Kirsten, Gardener, Léjeune, Nguyen, Vinh, Halse, Omid, Geraghty, Olivia, Hazel, Beth, Wilding, Peter, Tilley, Victoria, Cassidy, Tim, McClelland, Beverley, Bokhari, Maria, England, Timothy, Maddula, Mohana, Donnelly, Richard, Findlay, Paul, Macaden, Ashish, Shread, Ian, Barr, Charlotte, Mohd Nor, Azlisham, Brown, Claire, Persad, Nicola, Eglinton, Charlotte, Weinling, Marie, Hyams, Benjamin, Shah, Alex, Baker, John, Byrne, Anthony, McGhee, Caroline, Smart, Amanda, Copeland, Claire, Carpenter, Michael, Walker, Marion, Davey, Richard, Needle, Ann, Fathima, Razik, Bateman, Gavin, Datta, Prabal, Stanners, Andrew, Jackson, Linda, Ball, Julie, Davis, Michelle, Atkinson, Natalie, Fawcett, Michelle, Thompson, Teresa, Guy, Helen, Hogg, Valerie, Hays, Carole, Woodward, Stephen, Haque, Mohammad, Hakim, Eluzai, Symonds, Stuart, Maanoosi, Mehran, Herman, Jane, Black, Toby, Miriam, Skelton, Clarke, Caroline, Anthony, Alpha, Tribbeck, Michele, Cronin, Julie, Mead, Denise, Fennelly, Ruth, McIlmoyle, James, Dickinson, Christina, Jeffs, Carol, Anwar, Sajjad, Howard, Joanne, Jones, Kirsty, Dhar, Saikat, Clay, Caroline, Siddiq, Muhammad, Ivatts, Simone, Baird, Yolanda, Sally, Moore, Amey, Isobel, Newton, Sophie, Clayton-Evans, Lisa, Chadbourn, Indra, Rayessa, Rayessa, Naylor, Charde, Rodgers, Alicia, Wilson, Lisa, Wilson, Sarah, Clarkson, Emma, Davies, Ruth, Owings, Paula, Sangster, Graeme, Gott, Valerie, Little, Victoria, Weir, Pauline, Cherian, Suja, Jose, Deepa, Moroney, Helen, Downham, Susan, Dodd, Angela, Vettimootal Johnson, Venetia, Codd, Laura, Robinson, Naomi, Ahmed, Ashraf, Albazzaz, Mo, Johnson, Sharon, Denniss, Carol, Cunningham, Mishell, Zahoor, Tajammal, Webster, Timothy, Leason, Sandra, Haider, Syed, Chatterjee, Kausic, Nallasivan, Arumugam, Perkins, Charlotte, Seagrave, Samantha, Jenkins, Colin, Price, Fiona, Hughes, Claire, Mercer, Lily, Hussain, Malik, Brown, Sarah, Harvey, Miriam, Homan, Jane, Khan, Mohammad, Whiting, Robert, Foote, Leanne, Hunt, Nicholas, Durman, Helen, Brotherton, Lucy, Foot, Jayne, Pawley, Corinne, Foster, Eliza, Whitcher, Alison, Metcalf, Kneale, Jagger, Jenny, McDonald, Susan, Waterfield, Kelly, Sutton, Patrick, Shinh, Naval, Anversha, Ajmal, Ravenhill, Garth, Greenwood, Richard, Saada, Janak, Wiltshire, Alison, Perfitt, Rebekah, Andole, Sreeman, Gadapa, Naveen, Dunne, Karen, Krommyda, Magdalini, Burssens, Evelyne, King, Sam, Plewa, Catherine, Smyth, Nigel, Wilson, Jenny, Giallombardo, Elio, Sykes, Lucy, Kumar, Pradeep, Barker, James, Huggett, Isabel, Dunn, Linda, Culmsee, Charlotte, Thomas, Philip, Myint, Min, Brew, Helen, Majmudar, Nikhil, OConnell, Janice, Bunea, George, Fox, Charlotte, Gulliver, Diane, Smith, Andrew, Mokoena, Betty, Sattar, Naweed, Krishnamurthy, Ramesh, Osborne, Emily, Wilson, David, Wroath, Belinda, Dynan, Kevin, Power, Michael, Thompson, Susan, Adell, Victoria, Orugun, Enoch, Poultney, Una, Glover, Rachel, Crowther, Hannah, Thornthwaite, Sarah, Wiggam, Ivan, Wallace, Aine, Kerr, Enda, Fulton, Ailsa, Hunter, Annemarie, Tauro, Suzanne, Cuddy, Sarah, Mangion, David, Hardwick, Anne, Markova, Skarlet, Lawrence, Tara, Constantin, Carmen, Fletcher, Jo, Thomas, Isobel, Pettitt, Kerry, Sekaran, Lakshmanan, Tate, Margaret, Bharaj, Kiranjit, Simon, Rohan, Justin, Frances, Sethuraman, Sakthivel, Phiri, Duke, Mohammed, Niaz, Chauhan, Meena, Elfandi, Khaled, Khan, Uzma, Eveson, David, Mistri, Amit, Manning, Lisa, Khan, Shagufta, Patel, Champa, Moqsith, Mohammed, Sattar, Saira, Lam, Man Yee, Musarrat, Kashif, Stephens, Claire, Kalathil, Latheef, Miller, Richard, Salehin, Maqsud, Gautam, Nikki, Bailey, Duncan, Amor, Kelly, Meir, Julie, Nicolson, Anne, Imam, Javed, Wood, Lisa, White, Julie, Sajid, Mahmud, Ghaly, George, Ball, Margaret, Gascoyne, Rachel, Proeschel, Harald, Sharpe, Simon, Horton, Sarah, Beaves, Emily, Jones, Stephanie, Yip, Brigitte, Bell, Murdina, MacLiver, Linda, MacInnes, Brian, Sims, Don, Hurley, Jennifer, Willmot, Mark, Sutton, Claire, Littleton, Edward, Maiden, Susan, Jones, Rachael, Cunningham, James, Green, Carole, Bates, Michelle, Shekhar, Raj, Gilham, Ellie, Ahmed, Iman, Crown, Rachel, Fuller, Tracy, Goorah, Neetish, Bell, Angela, Kelly, Christine, Singh, Arun, Walford, Jamie, Tomlinson, Benjamin, Patel, Farzana, Duberley, Stephen, Kane, Ingrid, Rajkumar, Chakravarthi, Gaylard, Jane, Breeds, Joanna, Gainsborough, Nicola, Pitt-Ford, Alexandra, Barbon, Emma, Latter, Laura, Thompson, Philip, Hervey, Simon, Krishnamoorthy, Shrivakumar, Vassallo, Joseph, Walter, Deborah, Cochrane, Helen, Srinivasan, Meena, Campbell, Robert, Donaldson, Denise, Motherwell, Nichola, Hurford, Frances, Mukherjee, Indranil, Kenton, Antony, Nyabadza, Sheila, Martin, Irene, Hunt, Benjamin, Hassan, Hardi, O'Toole, Sarah, Dallol, Bander, Putterill, Janet, Jha, Ratneshwari, Gallifent, Rachel, Kakar, Puneet, Pusalkar, Aparna, Chan, kelly, Dangri, Puneet, Beadle, Hannah, Cook, Angela, Crabtree, Karen, Subramonian, Santhosh, Owusu-Agyei, Peter, Temple, Natalie, Butterworth-Cowin, Nicola, Ragab, Suzanne, Knops, Kerstin, Jinks, Emma, Dickson, Christine, Gleave, Laura, Dube, Judith, Leggett, Jacqui, Garcia, Tatiana, Ispoglou, Sissy, Evans, Rachel, Ankolekar, Sandeep, Hayes, Anne, Ni, Hlaing, Rahman, Bithi, Milligan, Josette, Graham, Carol, Jose, Josin, Keegan, Breffni, Kelly, Jim, Dewar, Richard, White, James, Thomas, Kelly, Minks, David P, Rodrigues, Mark A, du Plessis, Johann C, Dennis, Martin S, Murray, Gordon D, Newby, David E, Sandercock, Peter A G, Stephen, Jacqueline, Sudlow, Cathie L M, Werring, David J, Whiteley, William N, Wardlaw, Joanna M, and White, Philip M

Published
2019
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3. A Neurology Advanced Referral Management System (NARMS) Reduces Face-to- Face Consultations By Over Sixty Percent.

Author

McConville, John, Hunter, Annemarie, Fulton, Ailsa, Gray, Orla, Kerr, Andrew, and Patterson, Victor

Abstract

Background The COVID-19 pandemic has made neurology clinic waiting times longer. To prevent a build-up of patients waiting, we introduced a neurology advanced referral management system (NARMS) to deal with new referrals from GPs, using advice, investigations, or the telephone, as alternatives to face-to-face (FF) assessment. Methods For six months, electronic referrals from GPs were triaged to the above categories. We recorded the numbers in each category, patient satisfaction, inter-consultant triage variation, re-referrals, and calculated CO2 emissions. Results There were 573 referrals. Triage destinations were advice 33%, investigations 27%, telephone 17%, and FF 33%. Of patients referred for MRI, 95% were happy not to be seen if their investigation was normal. Less-experienced consultants triaged 20% and 30% respectively, to advice or investigations, compared with 40% by a triage-experienced neurologist. Four percent were re-referred. Numbers on the waiting list did not increase. CO2 emissions were reduced by 50%. Discussion Two thirds of neurological referrals from GPs did not need to be seen FF and 50% were dealt with without the neurologist meeting the patient. Carbon emission was halved. This system should be employed more, with FF examination reserved for those patients who need a neurological examination for diagnosis and management. [ABSTRACT FROM AUTHOR]

Published
2023

4. Country-Wide Analysis of Systemic Factors Associated With Acute Ischemic Stroke Door to Needle Time.

Author

McVerry, Ferghal, Hunter, Annemarie, Dynan, Kevin, Matthews, Maureen, McCormick, Michael, Wiggam, Ivan, Vahidassr, Djamil, McErlean, Fintan, Stevenson, Mike, Hopkins, Emer, McKee, Jacqueline, Kelly, James, Kennedy, Fiona, and McCarron, Mark O.

Subjects
AMBULANCES, FACTOR analysis, TISSUE plasminogen activator, WORKING hours, STROKE
Abstract

Objective: Pre-hospital, in-hospital, and patient factors are associated with variation in door to needle (DTN) time in acute ischemic stroke (AIS). Publications are usually from large single centers or multicenter registries with less reporting on national results. Materials and methods: All AIS patients treated with intravenous tissue plasminogen activator (iv-tPA) over 4 years (2013–2016) in Northern Ireland were recorded prospectively, including patient demographics, pre-hospital care, thrombolysis rate, and DTN time. Logistic regression was performed to identify factors associated with DTN time. Results: One thousand two hundred and one patients from 10,556 stroke admissions (11.4%) were treated with iv-tPA. Median NIHSS was 10 (IQR 6-17). Median DTN time was 54 min (IQR 36-77) with 61% treated < 60 min from arrival at hospital. National thrombolysis numbers increased over time with improving DTN time (P = 0.002). Arrival method at hospital (ambulance OR 2.3 CI1.4-3.8) pre-alert from ambulance (pre-alert OR = 5.3 CI3.5-8.1) and time of day (out of hours, n = 650, OR 0.20 CI 0.22-0.38) all P < 0.001, were the independent factors in determining DTN time. Variation in DTN time between centers occurred but was unrelated to volume of stroke admissions. Conclusion: Ambulance transport with pre-hospital notification and time of day are associated with shorter DTN time on a national level. Most thrombolysis was delivered outside of normal working hours but these patients are more likely to experience treatment delays. Re-organization of stroke services at a whole system level with emphasis on pre-hospital care and design of stroke teams are required to improve quality and equitable care in AIS nationally. [ABSTRACT FROM AUTHOR]

Published
2019
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5. Outcomes after Thrombectomy in Belfast: Mothership and Drip-and-Ship in the Real World.

Author

Adams, Karen M., Burns, Paul A., Hunter, Annemarie, Rennie, Ian, Flynn, Peter A., Smyth, Graham, Gordon, Patricia L., Patterson, Cathy E., Fearon, Patricia, Kerr, Enda L.F., and Wiggam, M. Ivan

Subjects
STROKE, REPERFUSION
Abstract

Background: Mechanical thrombectomy has revolutionised the treatment of acute ischaemic stroke due to large vessel occlusion. It is well recognised that patients are more likely to benefit when reperfusion happens quickly, however, there is uncertainty as to how best to deliver this service. Objectives: To compare outcomes of patients in Northern -Ireland who underwent thrombectomy via direct admission to the single endovascular centre (mothership [MS]) with those transferred from primary stroke centres (drip-and-ship [DS]). Methods: Analysis was conducted on the records of all patients who underwent thrombectomy from January 2014 to December 2017 inclusive. The primary outcome measure was 3 months functional independence (modified Rankin Score [mRS] 0–2). Secondary outcome measures were full recovery (mRS 0) at 3 months, symptomatic intracranial haemorrhage (sICH) rates and mortality rates. Results: Two hundred fourteen patients underwent thrombectomy (MS 124, DS 90). Patients in the MS group were older (median 73 vs. 70 years, p = 0.026), but there was no significant difference in baseline National Institutes of Health Stroke Scale (median 15 MS vs. 16.5 DS, p = 0.162) or thrombolysis rates (41.9% MS vs. 54.4% DS, p = 0.070) between the groups. Time from stroke onset to arrival at thrombectomy centre was shorter in the MS group (median 71 vs. 218 min, p < 0.001) but door to groin puncture time was shorter in the DS group (median 30 vs. 60 min, p < 0.001). There was no significant difference in 3 months functional independence (51.6% MS vs. 62.2% DS, p = 0.123), or in the secondary outcome measures of full recovery (21.8% MS vs. 12.2% DS, p = 0.071), sICH (MS 0.8%, DS 4.4%, p = 0.082) and mortality (MS 24.2%, DS 20.0%, p = 0.468). Conclusions: Our analysis showed similar outcomes after thrombectomy in the MS and DS groups. For patients potentially eligible for thrombectomy, rapid access to the endovascular centre is essential to optimise both the number of patients treated and the outcomes achieved. [ABSTRACT FROM AUTHOR]

Published
2019
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6. ESCAPE to Reality, Post-Trial Outcomes in an ESCAPE Centre: A Retrospective Case-Control Study.

Author

Nixon, Amy M., Jamison, Michael, Rennie, Ian M., Flynn, Peter A., Smyth, Graham, Wiggam, Ivan, Kerr, Enda, Fulton, Ailsa, Hunter, Annemarie, and Burns, Paul A.

Abstract

Introduction The Royal Victoria Hospital, Belfast provides the regional neuroendovascular service for Northern Ireland and was an enrolling centre for the ESCAPE endovascular stroke trial. Our aim was to assess outcomes for patients presenting with acute stroke following discontinuation of trial enrolment at our centre. Methods We collected data on all patients presenting with acute stoke between Nov-1st-2014 and Oct-31st-2015 who received endovascular treatment or received IV thrombolysis (IV-tPA) alone. ESCAPE eligibility of each patient was assessed. Primary outcome was modified Rankin Score (mRS) at 3 months. Results 129 patients presented with acute stoke symptoms during the time period; 56/129 (43.4%) patients in the intervention group and 73/129 (56.5%) patients in the control group. In the interventional group, 42/56 (75%) were considered ESCAPE eligible and 14/56 (25%) were considered ESCAPE ineligible. 30/42 (71.4%) ESCAPE eligible patients had a positive functional outcome at 3 months compared to 9/14 (64.2%) ESCAPE ineligible patients. In the control group, 37 (50.7%) had identifiable thrombotic occlusion and 13/37 (35.1%) were considered eligible for intervention. 4/13 (30.8%) achieved functional independence (mRS<3) at 3 months. There was a statistically significant difference in functional independence in those who underwent endovascular therapy compared to the control group (p= 0.04). Conclusion ESCAPE eligible patients in our centre had favourable outcome rates superior to the published trial data. ESCAPE ineligible patients tended to do slightly less well, but still better than the favourable outcome rates achieved with IVtPA alone. There is potentially a wide discordance between the threshold for futility and trial eligibility criteria when considering endovascular treatment for acute ischaemic stroke. [ABSTRACT FROM AUTHOR]

Published
2018

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