wow-inequalities/02-data/intermediate/wos_sample/e41679066b7c99677075d9c416091a34-hwong-wen-yea-and-n/info.yaml

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