Evidence map›Paper›PMID 39507681›Full record

ArticleInternational journal of nursing studies advances2024

From 'strong recommendation' to practice: A pre-test post-test study examining adherence to stroke guidelines for fever, hyperglycaemia, and swallowing (FeSS) management post-stroke.

Kelly Coughlan, Tara Purvis, Monique F Kilkenny, Dominique A Cadilhac, Oyebola Fasugba, Simeon Dale, Kelvin Hill, Megan Reyneke, Elizabeth McInnes, Benjamin McElduff and 5 more

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Article in International journal of nursing studies advances, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Kelly CoughlanNursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Tara PurvisSroke and Ageing Research, School of Clinical Sciences, Monash University. Monash Medical Centre, Block E, Level 5, 246 Clayton Rd, Clayton, VIC 3168, Australia.
Monique F KilkennySroke and Ageing Research, School of Clinical Sciences, Monash University. Monash Medical Centre, Block E, Level 5, 246 Clayton Rd, Clayton, VIC 3168, Australia.
Dominique A CadilhacStroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC 3084, Australia.
Oyebola FasugbaNursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Simeon DaleNursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Kelvin HillStroke Foundation, Level 7/461 Bourke St, Melbourne, VIC 3000, Australia.
Megan ReynekeSroke and Ageing Research, School of Clinical Sciences, Monash University. Monash Medical Centre, Block E, Level 5, 246 Clayton Rd, Clayton, VIC 3168, Australia.
Elizabeth McInnesNursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Benjamin McElduffNursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Jeremy M GrimshawOttawa Health Research Institute, Ottawa Hospital - General Campus, Centre for Practice-Changing Research (CPCR); and University of Ottawa, 501 Smyth Box 511, Ottawa, ON K1H 8L6, Canada.
N Wah CheungCentre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Hawkesbury Road, Westmead, NSW 2145, Australia.
Christopher LeviJohn Hunter Hospital, University of Newcastle. Lookout Rd, New Lambton Heights, NSW 2305, Australia.
Catherine D'EsteSax Institute, Level 3/30C Wentworth St, Glebe, NSW 2037, Australia.
Sandy MiddletonNursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: The Quality in Acute Stroke Care (QASC) Trial demonstrated that assistance to implement protocols to manage Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) post-stroke reduced death and disability. In 2017, a 'Strong Recommendation' for use of FeSS Protocols was included in the Australian Clinical Guidelines for Stroke Management. We aimed to: i) compare adherence to FeSS Protocols pre- and post-guideline inclusion; ii) determine if adherence varied with prior participation in a treatment arm of a FeSS Intervention study, or receiving treatment in a stroke unit; and compare findings with our previous studies. Methods: Pre-test post-test study using Australian acute stroke service audit data comparing 2015/2017 (pre-guideline) versus 2019/2021 (post-guideline) adherence. Primary outcome was adherence to all six FeSS indicators (composite), with mixed-effects logistic regression adjusting for age, sex, stroke type and severity (ability to walk on admission), stroke unit care, hospital prior participation in a FeSS Intervention study, and correlation of outcomes within hospital. Additional analysis examined interaction effects. Results: Overall, 112 hospitals contributed data to ≥1 one Audit cycle for both periods (pre=7011, post=7195 cases); 42 hospitals had participated in any treatment arm of a FeSS Intervention study. Adherence to FeSS Protocols post-guideline increased (pre: composite measure 35% vs post: composite measure 40 %, aOR:1.2 95 %CI: 1.2, 1.3). Prior participation in a FeSS Intervention study (aOR:1.6, 95 %CI: 1.2, 2.0) and stroke unit care (aOR 2.3, 95 %CI: 2.0, 2.5) were independently associated with greater adherence to FeSS Protocols. There was no change in adherence over time based on prior participation in a FeSS Intervention study ( Conclusions: There is evidence of improved adherence to FeSS Protocols following a 'strong recommendation' for their use in the Australian stroke guidelines. Change in adherence was similar independent of hospital prior participation in a FeSS Intervention study, or stroke unit care. However, maintenance of higher pre-guideline adherence for hospitals prior participation in a FeSS Intervention study suggests that research participation can facilitate greater guideline adherence; and confirms superior care received in stroke units. Nevertheless, less than half of Australian patients are being cared for according to the FeSS Protocols, providing impetus for additional strategies to increase uptake.

Indexed as

FeverGuidelinesHyperglycaemiaImplementationStrokeSustainabilitySwallow

Identifiers

PMID39507681
PMCPMC11539718

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.