This thesis deals with a part of the treatment process in patients with acute ischemic stroke. Specifically, it examines the time interval from patient entry to a healthcare facility to initiation of treatment with intravenous thrombolysis - so called Door-to- Needle Time. The theoretical part describes the stroke and its division according to etiology. Furthermore, there are summarized clinical studies that have taken place in the world since the 1960s to the present, the development of care for patients with stroke in Czech Republic, recommended procedures of professional organizations in Czech Republic and the identification and management of treatment of stroke patients. In conclusion, the theoretical part summarizes the studies focused on the reduction of the Door-to-Needle Time, which took place in the world and in the Czech Republic. The aim of the practical part is to evaluate work procedures and conditions of health teams of individual stroke centers and to identify causes of Door-to-Needle Time median differences. The chosen method of research is a quantitative questionnaire survey in the form of an online Google Forms questionnaire sent to the leading members of these teams. Based on the research results, factors affecting reduction of Door-to-Needle Time median consists in to deepen and...

Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra. / Tid till behandling är livsviktigt för människor som får en stroke. På olika platser i världen har man därför sett värdet i att införskaffa en specialambulans för stroke (stroke-ambulans) som har specialutrustning och specialpersonal som kan utföra intravenös behandling (trombolys). Då det är uppenbart att dess involvering i vården skulle hjälpa åtminstone en viss andel patienter används ofta ingen utvecklad metod eller analys av var och hur denna stroke-ambulans ska placeras. Genom att noggrant undersöka läget i Skåne län om hur denna placeringen kan gå till, är vårt mål att genom vår metod, som bygger på optimering av förväntade transporttider, upplysa beslutstagare om olika perspektiv man bör ta hänsyn till. Vår metod kan användas över olika geografiska områden.Vi föreslår en optimeringsmetod som utgår från två olika perspektiv: effektivitet och jämlikhet. Metoden visar att beroende på vilket perspektiv man väljer, kan den optimala placeringen för ett givet område variera kraftigt. Det är därför viktigt att beslutstagare av placering för stroke-ambulanser har tydliga och väl genomtänkta mål. Dessa mål bör även innefatta de lokala sjukhusens mål när det kommer till förbättring av behandlingstiden för strokepatienter, s.k. door-to-needle-time (DTN) då dessa i vissa fall kan göra större förbättringar än vad en införskaffning av en stroke-ambulans skulle göra. / The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would. / The time to treatment is vital for people who suffer from a stroke. Therefore, in different places in the world, the value of acquiring a specially developed ambulance for a stroke (i.e., a Mobile Stroke Unit, MSU) with special equipment and specialists who can perform intravenous treatment (thrombolysis) has been identified. Since it is clear that an MSU’s involvement in health care would aid at least a certain proportion of the patients, the MSU is often purchased and placed without any developed method or analysis of where and how this MSU is to be placed. By carefully examining the situation in Skåne Municipality of how this placement could be performed, we will inform decision makers about different perspectives that should be taken into consideration, including other areas than Skåne.Our optimization method showed that depending on what perspective you are investing, efficiency or equality, the optimal placement for any given area can vary greatly. It is therefore importantthat decision-makersofMSUpurchaseshaveclearandwell-thought-outgoals.These goals should also include the goals of the local hospitals when it comes to improving the treatment time for stroke patients, door-to-needle (DTN), as the DTN may in some cases make greater improvements than a purchase of an MSU would.

Tissue plasminogen activator (tPA) is most effective the faster it is able to be administered to a patient that has been affected by stroke. A Stroke Code is a strategy that acute care facilities implement to reduce the time from diagnosing a stroke to administering tPA. The purpose of this study was to determine if the initiation of a Stroke Code in an acute care hospital reduces the door-to-needle time for patients affected by a stroke. In particular, does a Stroke Code reduce door-to-needle times. The research was conducted using data from April 1, 2014 to December 31, 2014 (pre-Stroke Code period) and September 1, 2015 to December 31, 2016 (post-Stroke Code period). The population of this study was treated at Holston Valley Medical Center in Kingsport, Tennessee. The analysis revealed a decrease in door-to-needle times after a Stroke Code was implemented at the acute care facility.

This study addresses the specific barriers related to time delays in the treatment of patients who suffered acute myocardial infarction at the Al Ain Hospital accident and emergency unit in the United Arab Emirates. A comprehensive background of the UAE is given for the benefit of students who have limited access to the background and challenges facing medical and nursing personnel in providing thrombolythic therapy to patients who suffered from acute myocardial infarction. The study will contribute to the continuous quality management and improvement of overall nursing and medical care of the AMI patient who is eligible for thrombolysis. An extensive literature review addresses the clinical manifestations and treatment of the patient suffering from AMI as well as the adverse effects of time delays in treatment during the acute phase of the disease. The researcher selected a quantitative, non-experimental descriptive and retrospective study. Data was collected by a structured instrument to gather the desired responses from the files of 457 selected patients admitted to the Al Ain Hospital. This study emphasizes the need to improve patient care by all health care personnel in an accident and emergency unit to prevent the delays in treatment in life threatening conditions such as myocardial infarction ensuring optimal and prompt time to thrombolyse. The improvement of awareness and commitment by health care providers such as nurses, doctors and ambulance personnel, can be achieved through education and training, commitment and dedication, absolute cooperation, collaboration and constant update on performance. Regular audits are essential with regard to door-to-needle time and performance of all health care providers. This study ultimately show that time constrains in attending to patients presenting with myocardial infarction should be addressed in utmost urgency. / Health Studies / M. A. (Health Studies)

This study addresses the specific barriers related to time delays in the treatment of patients who suffered acute myocardial infarction at the Al Ain Hospital accident and emergency unit in the United Arab Emirates. A comprehensive background of the UAE is given for the benefit of students who have limited access to the background and challenges facing medical and nursing personnel in providing thrombolythic therapy to patients who suffered from acute myocardial infarction. The study will contribute to the continuous quality management and improvement of overall nursing and medical care of the AMI patient who is eligible for thrombolysis. An extensive literature review addresses the clinical manifestations and treatment of the patient suffering from AMI as well as the adverse effects of time delays in treatment during the acute phase of the disease. The researcher selected a quantitative, non-experimental descriptive and retrospective study. Data was collected by a structured instrument to gather the desired responses from the files of 457 selected patients admitted to the Al Ain Hospital. This study emphasizes the need to improve patient care by all health care personnel in an accident and emergency unit to prevent the delays in treatment in life threatening conditions such as myocardial infarction ensuring optimal and prompt time to thrombolyse. The improvement of awareness and commitment by health care providers such as nurses, doctors and ambulance personnel, can be achieved through education and training, commitment and dedication, absolute cooperation, collaboration and constant update on performance. Regular audits are essential with regard to door-to-needle time and performance of all health care providers. This study ultimately show that time constrains in attending to patients presenting with myocardial infarction should be addressed in utmost urgency. / Health Studies / M. A. (Health Studies)