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A complement a day keeps the Fox(p3) away

机译：每天补充一次即可使Fox（p3）远离

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Background: Use of alteplase improves outcome in some patients with stroke. Several types of barrier frequently prevent its use. We assessed whether a standardised, barrier-assessment, multicomponent intervention could increase alteplase use in community hospitals in Michigan, USA. Methods: In a cluster-randomised controlled trial, we selected adult, non-specialty, acute-care community hospitals in the Lower Peninsula of Michigan, USA. Eligible hospitals discharged at least 100 patients who had had a stroke per year, had less than 100 000 visits to the emergency department per year, and were not academic comprehensive stroke centres. Using a computer-generated randomisation sequence, we selected 12 matched pairs of eligible hospitals. Within pairs, the hospitals were allocated to intervention or control groups with restricted randomisation in January, 2007. Between January, 2007, and December, 2007, intervention hospitals implemented a multicomponent intervention that included qualitative and quantitative assessment of barriers to alteplase use and ways to address the findings, and provided additional support. The primary outcome was change in alteplase use in patients with stroke in emergency departments between the pre-intervention period (January, 2005, to December, 2006) and the post-intervention period (January, 2008, to January, 2010). Physicians in participating hospitals and the coordinating centre could not be masked to group assignment, but were masked to progress made in paired control hospitals. External medical reviewers who were masked to group assignment assessed outcomes. We did intention-to-treat (ITT) and target-population (without one pair that was excluded after randomisation) analyses. This trial is registered at ClinicalTrials.gov, number NCT00349479. Findings: All 24 hospitals completed the study. Overall, 745 of 40 823 patients with stroke received intravenous alteplase treatment. In the ITT analysis, the proportion of patients with stroke who were admitted and treated with alteplase increased between the pre-intervention and post-intervention periods in intervention hospitals (89 [1·25%] of 7119 patients to 235 [2·79%] of 8419) to a greater extent than in control hospitals (99 [1·25%] of 7946 to 194 [2·10%] of 9222), but the difference between groups was not significant (relative risk [RR] 1·37, 95% CI 0·96-1·93; p=0·08). In the target-population analysis, the increase in alteplase use in intervention hospitals (59 [1·00%] of 5882 to 191 [2·62%] of 7288) was significantly greater than in control hospitals (65 [1·09%] of 5957 to 120 [1·72%] of 6989; RR 1·68, 95% CI 1·09-2·57; p=0·02), but was still clinically modest. Interpretation: The intervention did not significantly increase alteplase use in patients with ischaemic stroke. The increase in use of alteplase in the target population was significant, but smaller than the effect to which the study was powered. Additional strategies to increase acute stroke treatment are needed. Funding: National Institutes of Health National Institute of Neurological Disorders and Stroke.
机译：背景：使用阿替普酶可改善某些中风患者的预后。几种类型的屏障经常阻止其使用。我们评估了标准化，障碍评估，多组分干预是否可以增加美国密歇根州社区医院对阿替普酶的使用。方法：在一项集群随机对照试验中，我们选择了美国密歇根州下半岛的成人，非专业，急诊社区医院。符合条件的医院每年出院至少100名中风患者，每年去急诊室就诊少于10万，并且不是学术综合性中风中心。使用计算机生成的随机序列，我们选择了12对匹配的合格医院。在成对的情况下，医院于2007年1月被随机分配到干预组或对照组。在2007年1月至2007年12月之间，干预医院实施了多成分干预，其中包括对阿替普酶使用的障碍和治疗方法进行定性和定量评估解决调查结果，并提供其他支持。主要结果是在干预前（2005年1月至2006年12月）和干预后（2008年1月至2010年1月）期间急诊科中风患者使用阿替普酶的变化。参与医院和协调中心的内科医师不能掩盖小组任务，但掩盖了配对对照医院取得的进展。隐瞒小组任务的外部医学评审员评估了结果。我们进行了意向性治疗（ITT）和目标人群（无一对随机分组后被排除）分析。该试验已在ClinicalTrials.gov上注册，编号为NCT00349479。结果：所有24家医院都完成了研究。总体上，在40 823名中风患者中，有745名接受了静脉阿替普酶治疗。在ITT分析中，干预医院在干预前和干预后之间增加了接受阿替普酶治疗的中风患者比例（从7119例患者中的89例[1·25％]增至235例[2·79％] [8419]中的[％]比对照医院更大（7946中的99 [1·25％]至9222中的194 [2·10％]），但两组之间的差异并不显着（相对风险[RR] 1· 37，95％CI 0·96-1·93; p = 0·08）。在目标人群分析中，干预医院使用阿替普酶的增加量（5882的59 [1·00％]增加到7288的191 [2·62％]）明显大于对照医院（65 [1·09％]从5957的120％升至6989的120 [1·72％]; RR 1·68，95％CI 1·09-2·57; p = 0·02），但临床上仍不高。解释：在缺血性中风患者中，干预并未显着增加阿替普酶的使用。目标人群中阿替普酶的使用增加是显着的，但小于该研究的效果。需要增加急性中风治疗的其他策略。经费：国立卫生研究院国立神经系统疾病和中风研究所。

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