Changing attitudes to the management of ischaemic stroke between 1997 and 2004: a survey of New Zealand physicians

Abstract

Aim: In 1997, a survey of New Zealand physicians' opinions on the management of stroke was carried out. Since then, there have been a number of advances in stroke therapy. We have repeated the 1997 survey to assess changes in physicians' opinions on stroke management.Methods: A questionnaire was sent to 293 physicians responsible for patients admitted with acute stroke to hospitals throughout New Zealand. It included questions on the management of acute stroke and secondary prevention and was based on the 1997 questionnaire.Results: Responses were received from 211 physicians of whom 174 (82%) managed patients with an acute stroke. The number of respondents who thought that stroke units were efficacious has increased (57% in 1997 to 89%, P < 0.001). The use of aspirin acutely (P < 0.001) and intravenous tissue plasminogen activator (P = 0.006) has also increased. In 2004, antihypertensive therapy for secondary stroke prevention would be commenced if the blood pressure was 150/90 by 98% of respondents and 140/90 by 70% of respondents. In 2004, a statin would be commenced if the total cholesterol level was 4.0 mmol/L by 56% of respondents and 5.0 mmol/L by 91% of respondents.Conclusions: This survey has shown important changes in the management of ischaemic stroke over the past 7 years.

Knowledge and Attitude of Sudanese Emergency Registrars Towards the Use of Tissue Plasminogen Activator in the Management of Acute Ischemic Stroke

“…Knowledge about tPA in the management of AIS at the emergency department was poor, average, and good in 54(36%), 55 (36.7%), and 41 (27.3%) individuals, respectively. However, there was no significant difference in overall knowledge based on age; nevertheless, good and average knowledge levels were considerably higher among females, level 3 and level 4 of training, and years of experience 5-10 years (P value 0.05); a similar result was reported by Brown et al [17].…”

“…Prior studies suggest emergency physicians are resistant to the use of tPA in stroke [17,18]. A 2005 survey of members of the American College of Emergency Physicians found that even in the ideal setting (defined as CT scanner availability, neuroradiology and neurology support, administrative support, appropriate candidate, etc), 40% of respondents were either "unlikely" or "uncertain" to use tPA [18].…”

Agreement with evidence for tissue Plasminogen Activator use among emergency physicians: a cross-sectional survey

“…However, the latter survey was limited to emergency physicians from community hospitals participating in a cluster randomised controlled trial [ 11 ]. A 2004 New Zealand (NZ) survey indicated 73% of physicians rarely or never administer tPA treatment [ 12 ]. This sample included a range of health-care providers, limiting the generalisability of findings to the emergency context.…”

Brain Attack : Time to Act Now

“…In our opinion, the most important factor resulting in delay in reaching hospital in golden period is the lack of pain in stroke. Attitude of medical professionals toward stroke is equally appalling, a sentiment echoed by stroke specialists worldover [16]. It is not unusual for physicians to admit cases of stroke to general medical ward rather than an intensive care unit, as the patient's general condition is seemingly stable.…”