2023-09-28 14:46:10 +00:00
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abstract: 'IntroductionTranslation of evidence into clinical practice for use of
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intravenous thrombolysis in acute stroke care has been slow, especially
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across low- and middle-income countries. In Malaysia where the average
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national uptake was poor among the public hospitals in 2018, one
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hospital intriguingly showed comparable thrombolysis rates to
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high-income countries. This study aimed to explore and provide in-depth
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understanding of factors and explanations for the high rates of
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intravenous stroke thrombolysis in this hospital. MethodsThis single
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case study sourced data using a multimethod approach: (1)
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semi-structured in-depth interviews and focus group discussions, (2)
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surveys, and (3) review of medical records. The Tailored Implementation
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of Chronic Diseases (TICD) framework was used as a guide to understand
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the determinants of implementation. Twenty-nine participants comprising
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the Hospital Director, neurologists, emergency physicians, radiologists,
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pharmacists, nurses and medical assistants (MAs) were included. Thematic
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analyses were conducted inductively before triangulated with
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quantitative analyses and document reviews. ResultsFavorable factors
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contributing to the uptake included: (1) cohesiveness of team members
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which comprised of positive interprofessional team dynamics, shared
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personal beliefs and values, and passionate leadership, and (2)
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facilitative work process through simplification of workflow and
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understanding the rationale of the sense of urgency. Patient factors was
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a limiting factor. Almost two third of ischemic stroke patients arrived
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at the hospital outside the therapeutic window time, attributing
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patients'' delayed presentation as a main barrier to the uptake of
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intravenous stroke thrombolysis. One other barrier was the availability
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of resources, although this was innovatively optimized to minimize its
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impact on the uptake of the therapy. As such, potential in-hospital
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delays accounted for only 3.8\% of patients who missed the opportunity
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to receive thrombolysis. ConclusionsDespite the ongoing challenges, the
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success in implementing intravenous stroke thrombolysis as standard of
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care was attributed to the cohesiveness of team members and having
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facilitative work processes. For countries of similar settings, plans to
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improve the uptake of intravenous stroke thrombolysis should consider
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the inclusion of interventions targeting on these modifiable factors.'
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affiliation: 'Hwong, WY (Corresponding Author), Minist Hlth Malaysia, Natl Inst Hlth,
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Inst Clin Res, Bangi, Selangor, Malaysia.
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Hwong, WY (Corresponding Author), Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr
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Hlth Sci \& Primary Care, Utrecht, Netherlands.
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Hwong, Wen Yea; Ng, Sock Wen; Ab Rahman, Norazida; Sivasampu, Sheamini, Minist Hlth
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Malaysia, Natl Inst Hlth, Inst Clin Res, Bangi, Selangor, Malaysia.
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Hwong, Wen Yea, Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci \& Primary
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Care, Utrecht, Netherlands.
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Tong, Seng Fah, Univ Kebangsaan Malaysia, Dept Family Med, Bangi, Selangor, Malaysia.
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Law, Wan Chung; Kaman, Zurainah, Minist Hlth Malaysia, Sarawak Gen Hosp, Dept Med,
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Neurol Unit, Kuching, Malaysia.
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Wong, Sing Keat; Puvanarajah, Santhi Datuk, Minist Hlth Malaysia, Hosp Kuala Lumpur,
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Dept Neurol, Kuala Lumpur, Malaysia.'
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article-number: '1048807'
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author: Hwong, Wen Yea and Ng, Sock Wen and Tong, Seng Fah and Ab Rahman, Norazida
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and Law, Wan Chung and Kaman, Zurainah and Wong, Sing Keat and Puvanarajah, Santhi
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Datuk and Sivasampu, Sheamini
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author-email: amyhwong@crc.gov.my
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author_list:
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- family: Hwong
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given: Wen Yea
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- family: Ng
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given: Sock Wen
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- family: Tong
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given: Seng Fah
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- family: Ab Rahman
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given: Norazida
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- family: Law
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given: Wan Chung
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- family: Kaman
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given: Zurainah
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- family: Wong
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given: Sing Keat
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- family: Puvanarajah
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given: Santhi Datuk
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- family: Sivasampu
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given: Sheamini
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da: '2023-09-28'
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doi: 10.3389/fneur.2022.1048807
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files: []
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issn: 1664-2295
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journal: FRONTIERS IN NEUROLOGY
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keywords: 'acute stroke care; intravenous thrombolysis; developing countries;
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translational research; facilitator; barrier'
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keywords-plus: 'ACUTE ISCHEMIC-STROKE; CARE TEAMS; MANAGEMENT; GUIDELINES; TEAMWORK;
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OUTCOMES; TIMES'
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language: English
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month: NOV 24
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number-of-cited-references: '38'
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papis_id: a766ebd29ffa716f2076aefcd4993777
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ref: Hwong2022strokethrombolysis
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times-cited: '0'
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title: 'Stroke thrombolysis in a middle-income country: A case study exploring the
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determinants of its implementation'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000893743500001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '1'
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volume: '13'
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web-of-science-categories: Clinical Neurology; Neurosciences
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year: '2022'
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