Barriers and enablers to successful hyperacute ischemic stroke care
Bibliographic record
Abstract
Stroke is a leading cause of adult disability. Thrombolysis, and Endovascular Therapy (EVT) significantly reduce disability of ischemic stroke patients (85% of strokes). However, in Newfoundland and Labrador (NL), thrombolysis rates were low, and EVT only began in 2022. In addition, NL had a higher incidence of stroke, with worse outcomes than the rest of Canada. Due to the availability of data, this study used a mixed methods approach to investigate stroke care processes in the Eastern Health (EH) region of Newfoundland and Labrador (NL) and three other Canadian regions (Central zone Nova Scotia (NS), Southeastern Ontario (SEO) and Calgary zone Alberta) to identify policy recommendations to improve hyperacute stroke care. First, two time series analyses compared indicators between stroke centres between each region. In addition, case studies in each region were completed to provide a subjective view of their hyperacute ischemic stroke care. Using literal replication, the case studies recorded semi-structured interviews with stroke care professionals. For data triangulation, stroke care documents and archival data were requested. Through thematic analysis, the goal was to understand critical success factors to optimize efficient hyperacute ischemic stroke care. Finally, using cross-case synthesis, regions were compared using matrices to understand how they differ. The Health Science Centre (HSC) in EH showed impressive improvements from 2016/2017 to 2020/2021 with thrombolysis rates rising from 9.6% to 19.0%, nearing their target of 21.0%. In addition, HSC had similar indicators compared to the three Comprehensive Stroke Centres (CSCs) in the other regions. The four Primary Stroke Centres (PSCs) of EH have not shown the same improvement. However, SEO and Calgary reported Belleville and Red Deer as highly functioning PSCs due to their strong stroke champions, nursing leadership, and team culture. As the cases presented similar care models, I have concluded that EH PSC programs must standardize and map out processes supporting efficient treatment and improve early communication. Passionate leaders are also required to motivate teams and find time for change management and continuous quality improvement. The policy implications of the results suggest ways to improve hyperacute stroke care in NL: 1) Develop a provincial stroke program to standardize stroke care across the province, monitor performance, and collaborate with the air and ground ambulance system, 2) Expand EVT to a full-time service serving eligible patients across the province and expand the EVT treatment time window, and 3) Focus on continuous quality improvement with electronic collection of variables that measure the elements of the stroke care pathway, aiming to minimize delays in time to treatment.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.006 | 0.006 |
| Scholarly communication | 0.007 | 0.003 |
| Open science | 0.001 | 0.009 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".