Adherence to Canadian Best Practice Recommendations for Stroke Care: Vascular Cognitive Impairment Screening and Assessment Practices in an Ontario Inpatient Stroke Rehabilitation Facility

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

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Best practice guidelines for stroke in Cameroon: An innovative and participatory knowledge translation project

African Journal of Disability ◽

10.4102/ajod.v3i1.92 ◽

2014 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Lynn Cockburn ◽

Timothy N. Fanfon ◽

Alexa Bramall ◽

Eta M. Ngole ◽

Pius Kuwoh ◽

...

Keyword(s):

Patient Outcomes ◽

Practice Guidelines ◽

Stroke Rehabilitation ◽

Best Practice ◽

Guideline Development ◽

Front Line ◽

African Countries ◽

Practice Recommendations ◽

Best Practice Guidelines ◽

Successes And Challenges

Background: Although the adherence to stroke guidelines in high-income countries has been shown to be associated with improved patient outcomes, the research, development and implementation of rehabilitation related guidelines in African countries is lacking.Objectives: The purpose of this article is to describe how a group of front-line practitioners collaborated with academics and students to develop best practice guidelines (BPG) for the management and rehabilitation of stroke in adult patients in Cameroon.Method: A working group was established and adapted internationally recognised processes for the development of best practice guidelines. The group determined the scope of the guidelines, documented current practices, and critically appraised evidence to develop guidelines relevant to the Cameroon context.Results: The primary result of this project is best practice guidelines which provided an overview of the provision of stroke rehabilitation services in the region, and made 83 practice recommendations to improve these services. We also report on the successes and challenges encountered during the process, and the working group’s recommendations aimed at encouraging others to consider similar projects.Conclusion: This project demonstrated that there is interest and capacity for improving stroke rehabilitation practices and for stroke guideline development in Africa.

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Stroke Rehabilitation and Patients with Multimorbidity: A Scoping Review Protocol

Journal of Comorbidity ◽

10.15256/joc.2015.5.47 ◽

2015 ◽

Vol 5 (1) ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Michelle L.A. Nelson ◽

Linda Kelloway ◽

Deirdre Dawson ◽

J. Andrew McClure ◽

Kaileah A. McKellar ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Stroke Rehabilitation ◽

Mixed Methods Research ◽

Best Practice ◽

Healthcare Delivery ◽

Stroke Care ◽

Current Evidence ◽

Medical Diagnoses

Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing “best practice” stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy's Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.

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Canadian best practice recommendations for stroke care (updated 2008)

Canadian Medical Association Journal ◽

10.1503/cmaj.081148.r2 ◽

2008 ◽

Vol 179 (12) ◽

pp. S1-S25 ◽

Cited By ~ 100

Author(s):

P. Lindsay ◽

M. Bayley ◽

C. Hellings ◽

M. Hill ◽

E. Woodbury ◽

...

Keyword(s):

Best Practice ◽

Stroke Care ◽

Practice Recommendations

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Abstract 3500: Implementing Best Practice Recommendations to Address Urinary Incontinence after Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3500 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Sarah Donaldson ◽

Erik Leci ◽

Matthew Meyer ◽

Shannon Janzen ◽

Norine Foley ◽

...

Keyword(s):

Urinary Incontinence ◽

Clinical Practice ◽

Best Practice ◽

Stroke Care ◽

Intermittent Catheterization ◽

Bladder Training ◽

Rehabilitation Unit ◽

Practice Recommendations ◽

Number Of Patients ◽

Training Protocol

Background and Purpose: Urinary incontinence following stroke is known to have a detrimental effect on rehabilitation progress, resulting in a slower rate of recovery and less functional independence at discharge. Canadian Best Practice Recommendations for Stroke Care (2010) and the American Stroke Association Clinical Practice Guidelines (2005) recommend that a bladder training program, including timed and prompted toileting on a consistent schedule, be implemented in patients who are incontinent of urine following a stroke. Canadian Best Practice Recommendations for Stroke Care (2010) further recommend intermittent catheterization as an intervention to address urinary incontinence. The aim of the present study was to assess the extent to which the Canadian guidelines are being incorporated into clinical practice. Methods: A retrospective chart review was conducted for consecutive stroke admissions to a neuro-rehabilitation unit in Ontario, Canada over a period of six months. Charts were reviewed for the occurrence of urinary incontinence, whether intermittent catheterization was performed, any mention of bladder training and the documentation of a bladder training protocol. Results: One hundred and four charts were reviewed, after excluding four patients that could not be assessed for urinary incontinence due to other medical conditions. Thirty-three patients were reported to be incontinent of urine during their stay in the rehabilitation unit. Intermittent catheterization was performed for 11 patients (33.3%) with urinary incontinence. Bladder training was indicated as a therapy that was used in the rehabilitation of 16 patients (48.5%). However, a formal bladder training protocol followed by the nursing staff was only documented in 5 patients (15.2%). Conclusions: The rehabilitation of urinary incontinence following stroke is an important issue, with a substantial number of patients failing to receive the recommended therapy. There is a need to develop strategies to promote the application of best-practice recommendations to address urinary incontinence.

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Balancing evidence and opinion in stroke care: the 2008 best practice recommendations

Canadian Medical Association Journal ◽

10.1503/cmaj.081536 ◽

2008 ◽

Vol 179 (12) ◽

pp. 1247-1249 ◽

Cited By ~ 14

Author(s):

M. Bayley ◽

P. Lindsay ◽

C. Hellings ◽

E. Woodbury ◽

S. Phillips ◽

...

Keyword(s):

Best Practice ◽

Stroke Care ◽

Practice Recommendations

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Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care Guidelines, Update 2015

International Journal of Stroke ◽

10.1177/1747493015622461 ◽

2016 ◽

Vol 11 (2) ◽

pp. 239-252 ◽

Cited By ~ 34

Author(s):

Leanne K Casaubon ◽

Jean-Martin Boulanger ◽

Ev Glasser ◽

Dylan Blacquiere ◽

Scott Boucher ◽

...

Keyword(s):

Best Practice ◽

Stroke Care ◽

Practice Recommendations ◽

Care Guidelines

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Neuropsychology in Multidisciplinary Stroke Care: Clinical Feasibility of the NINDS-CSN Vascular Cognitive Impairment Harmonization Standards

International Scholarly Research Notices ◽

10.1155/2014/216024 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Dong Y. Han ◽

Amelia J. Anderson ◽

Jana E. Jones ◽

Bruce P. Hermann ◽

Justin A. Sattin

Keyword(s):

Patient Satisfaction ◽

Cognitive Impairment ◽

Neuropsychological Testing ◽

Stroke Care ◽

Vascular Cognitive Impairment ◽

Turnaround Time ◽

Cognitive Assessments ◽

Provider Satisfaction ◽

Assessment Protocol ◽

Neuropsychological Assessments

As a significant number of stroke victims exhibit cognitive impairment, neuropsychological assessments can enhance poststroke management by identifying pertinent cognitive sequelae and providing salient care recommendations. However, due to operational differences between traditional neuropsychology and stroke services, neuropsychological assessments often remain underutilized in stroke care. We developed a novel care model that incorporated neuropsychological testing into a comprehensive stroke program using the modified vascular cognitive impairment (VCI) half-hour assessment protocol proposed by the National Institute of Neurological Disorders and Stroke—Canadian Stroke Network (NINDS-CSN). The test batteries were administered during the patients’ acute admissions and then again upon follow-up in the multidisciplinary stroke clinic. Patient and provider satisfaction was then evaluated. Surveys revealed high provider satisfaction with improved clinic efficacy, improved data turnaround time, and with value neuropsychology services added to the comprehensive stroke program. Results from the 18-item industry standard Press-Ganey surveys showed all scores above 4.4/5.0 for patient satisfaction. This clinic garnered high provider and patient satisfaction after the first year. The (modified) NINDS-CSN VCI assessment protocol demonstrated clinical feasibility, suggestive of an efficient method of providing focused neuropsychological services in a clinical setting that otherwise prohibits traditional, comprehensive cognitive assessments.

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