PDF(Sci-hub)
Abstract：
BACKGROUND: Although the efficacy of tissue plasminogen activator (tPA) for acute ischemic stroke is well established, rates of tPA use remain low. For clinicians, advocates, and policy-makers seeking to increase tPA treatment rates, it is important to understand what interventions exist and their relative effectiveness.
METHODS: We searched PubMed and EMBASE to identify all studies published between 1995 and January 8, 2015 documenting interventions to increase the use of tPA with broadly inclusive criteria. The principal summary measure was the percentage change in rate of tPA administration. Random effects meta-analytic models were built to summarize the effect of intervention compared to control overall and for intervention characteristics.
RESULTS: The search yielded 1457 results of which 25 met eligibility criteria. We identified 14 pre-post studies, ten randomized controlled trials, and one quasi-experiment. Included studies targeted their interventions at emergency medical services (EMS) (n = 14), telemedicine (n = 6), and public education (n = 6). In a random effects model, tPA administration was significantly higher in the intervention arm across all studies limiting enrollment to ischemic stroke patients (n = 16) with a risk ratio (RR) of 1.80 (95% confidence interval [CI], 1.45-2.22). A trend towards increased tPA administration was observed for all intervention approaches: risk ratio of 1.73 (95% CI, 1.44-2.09) for EMS, 1.58 (95% CI, 0.72-3.47) for telemedicine, and 1.89 (95% CI, 0.77-4.65) for public education, the latter not restricted to ischemic stroke patients.
CONCLUSIONS: Interventions to increase tPA use appear to have considerable effectiveness. Our findings support the use of such interventions to improve stroke outcomes.
METHODS: We searched PubMed and EMBASE to identify all studies published between 1995 and January 8, 2015 documenting interventions to increase the use of tPA with broadly inclusive criteria. The principal summary measure was the percentage change in rate of tPA administration. Random effects meta-analytic models were built to summarize the effect of intervention compared to control overall and for intervention characteristics.
RESULTS: The search yielded 1457 results of which 25 met eligibility criteria. We identified 14 pre-post studies, ten randomized controlled trials, and one quasi-experiment. Included studies targeted their interventions at emergency medical services (EMS) (n = 14), telemedicine (n = 6), and public education (n = 6). In a random effects model, tPA administration was significantly higher in the intervention arm across all studies limiting enrollment to ischemic stroke patients (n = 16) with a risk ratio (RR) of 1.80 (95% confidence interval [CI], 1.45-2.22). A trend towards increased tPA administration was observed for all intervention approaches: risk ratio of 1.73 (95% CI, 1.44-2.09) for EMS, 1.58 (95% CI, 0.72-3.47) for telemedicine, and 1.89 (95% CI, 0.77-4.65) for public education, the latter not restricted to ischemic stroke patients.
CONCLUSIONS: Interventions to increase tPA use appear to have considerable effectiveness. Our findings support the use of such interventions to improve stroke outcomes.
摘要：
背景：尽管组织纤溶酶原激活剂（tPA）对急性缺血性卒中的疗效已得到证实，tPA使用率仍然很低。对于临床医生来说，倡导者,和寻求提高tPA治疗率的政策制定者，重要的是要了解存在哪些干预措施及其相对有效性。
方法：我们搜索了PubMed和EMBASE，以确定1995年至2015年1月8日发表的所有研究，这些研究记录了增加tPA使用的干预措施，具有广泛的包容性标准。主要汇总测量是tPA施用率的百分比变化。建立随机效应元分析模型，以总结干预与对照组的总体效果和干预特征。
结果：搜索产生了1457个结果，其中25个符合资格标准。我们确定了14项事后研究，十项随机对照试验，和一个准实验。纳入的研究针对他们在紧急医疗服务(EMS)的干预措施(n=14)，远程医疗(n=6)，和公共教育(n=6)。在随机效应模型中，在所有限制纳入缺血性卒中患者（n=16）的研究中，干预组的tPA给药明显更高，风险比（RR）为1.80（95％置信区间[CI]，1.45-2.22)。所有干预方法都观察到tPA给药增加的趋势：EMS的风险比为1.73（95％CI，1.44-2.09），远程医疗1.58（95%CI，0.72-3.47），公共教育为1.89（95%CI，0.77-4.65），后者不限于缺血性卒中患者。
结论：增加tPA使用的干预措施似乎具有相当大的效果。我们的研究结果支持使用此类干预措施来改善卒中结局。
方法：我们搜索了PubMed和EMBASE，以确定1995年至2015年1月8日发表的所有研究，这些研究记录了增加tPA使用的干预措施，具有广泛的包容性标准。主要汇总测量是tPA施用率的百分比变化。建立随机效应元分析模型，以总结干预与对照组的总体效果和干预特征。
结果：搜索产生了1457个结果，其中25个符合资格标准。我们确定了14项事后研究，十项随机对照试验，和一个准实验。纳入的研究针对他们在紧急医疗服务(EMS)的干预措施(n=14)，远程医疗(n=6)，和公共教育(n=6)。在随机效应模型中，在所有限制纳入缺血性卒中患者（n=16）的研究中，干预组的tPA给药明显更高，风险比（RR）为1.80（95％置信区间[CI]，1.45-2.22)。所有干预方法都观察到tPA给药增加的趋势：EMS的风险比为1.73（95％CI，1.44-2.09），远程医疗1.58（95%CI，0.72-3.47），公共教育为1.89（95%CI，0.77-4.65），后者不限于缺血性卒中患者。
结论：增加tPA使用的干预措施似乎具有相当大的效果。我们的研究结果支持使用此类干预措施来改善卒中结局。
