{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:33:39Z","timestamp":1791304419333,"version":"4.3.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100023401","name":"European Stroke Organisation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100023401","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100023401","name":"European Stroke Organisation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100023401","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Poor adoption of stroke guidelines is a problem internationally. The Quality in Acute Stroke Care (QASC) trial demonstrated significant reduction in death and disability with facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing (FeSS Protocols) following stroke. We aimed to determine real-world effectiveness of supported implementation of the FeSS Protocols across Europe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a multi-country, multi-centre, pre-test\/post-test study (2017\u20132021) comparing post implementation data with historically collected pre-implementation data. Hospital clinical champions, supported by the Angels Initiative conducted multidisciplinary workshops discussing pre-implementation medical record audit results, barriers and facilitators to FeSS Protocol implementation, developed action plans and provided education, with ongoing support co-ordinated remotely from Australia. Prospective audits were conducted 3-month after FeSS Protocol introduction. Pre-to-post analysis and country income classification comparisons were adjusted for clustering by hospital and country controlling for age\/sex\/stroke severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Data from 64 hospitals in 17 countries (3464 patients pre-implementation and 3257 patients post-implementation) showed improvement pre-to-post implementation in measurement recording of all three FeSS components, all p\u2009&amp;lt;\u20090.0001: fever elements (pre: 17%, post: 51%; absolute difference 33%, 95% CI 30%, 37%); hyperglycaemia elements (pre: 18%, post: 52%; absolute difference 34%; 95% CI 31%, 36%); swallowing elements (pre: 39%, post: 67%; absolute difference 29%, 95% CI 26%, 31%) and thus in overall FeSS Protocol adherence (pre: 3.4%, post: 35%; absolute difference 33%, 95% CI 24%, 42%). In exploratory analysis of FeSS adherence by countries\u2019 economic status, high-income versus middle-income countries improved to a comparable extent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion:<\/jats:title>\n                    <jats:p>Our collaboration resulted in successful rapid implementation and scale-up of FeSS Protocols into countries with vastly different healthcare systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873221126027","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T02:22:21Z","timestamp":1666664541000},"page":"132-147","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe): A pre-test\/post-test implementation study"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7201-4394","authenticated-orcid":false,"given":"Sandy","family":"Middleton","sequence":"first","affiliation":[{"name":"Nursing Research Institute, St Vincent\u2019s Health Network Sydney, St Vincent\u2019s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia 1"},{"name":"School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon","family":"Dale","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent\u2019s Health Network Sydney, St Vincent\u2019s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia 1"},{"name":"School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"McElduff","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent\u2019s Health Network Sydney, St Vincent\u2019s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia 1"},{"name":"School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Coughlan","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent\u2019s Health Network Sydney, St Vincent\u2019s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia 1"},{"name":"School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"McInnes","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent\u2019s Health Network Sydney, St Vincent\u2019s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia 1"},{"name":"School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Mikulik","sequence":"additional","affiliation":[{"name":"International Clinical Research Centre, Neurology Department, St. Ann\u2019s University Hospital and Masaryk University, Brno, Czech Republic 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fischer","sequence":"additional","affiliation":[{"name":"Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Van der Merwe","sequence":"additional","affiliation":[{"name":"Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-682X","authenticated-orcid":false,"given":"Dominique","family":"Cadilhac","sequence":"additional","affiliation":[{"name":"Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"D\u2019Este","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia 6"},{"name":"Sax Institute, Sydney, Australia 7"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Levi","sequence":"additional","affiliation":[{"name":"John Hunter Health and Innovation Precinct, HNE LHD, New Lambton, NSW, Australia 8"},{"name":"Department of Medicine, University of Newcastle, Callaghan, NSW, Australia 9"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M","family":"Grimshaw","sequence":"additional","affiliation":[{"name":"University of Ottawa, Ottawa, ON, Canada 10"},{"name":"Ottawa Hospital Research Institute, Ottawa, ON, Canada 11"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Grecu","sequence":"additional","affiliation":[{"name":"International Clinical Research Centre, Neurology Department, St. Ann\u2019s University Hospital and Masaryk University, Brno, Czech Republic 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Quinn","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital, Randwick, Australia 12"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngai Wah","family":"Cheung","sequence":"additional","affiliation":[{"name":"Centre for Diabetes and Endocrinology Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia 13"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tereza","family":"Kol\u00e1\u010dn\u00e1","sequence":"additional","affiliation":[{"name":"Fakultn\u00ed nemocnice Motol, Prague, Czech Republic 14"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Medukhanova","sequence":"additional","affiliation":[{"name":"National Center for Neurosurgery, Nur-Sultan, Kazakhstan 15"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estela","family":"Sanjuan Menendez","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Hospital Universitari, Barcelona, Spain 16"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Salselas","sequence":"additional","affiliation":[{"name":"ULSNE Macedo de Cavaleiros, Macedo de Cavaleiros, Portugal 17"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Messchendorp","sequence":"additional","affiliation":[{"name":"University Medical Center Groningen, Groningen, Netherlands 18"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0282-2185","authenticated-orcid":false,"given":"Anne-Kathrin","family":"Cassier-Woidasky","sequence":"additional","affiliation":[{"name":"Saarland University of Applied Sciences, Saarbr\u00fccken, Germany 19"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelina","family":"Skrzypek-Czerko","sequence":"additional","affiliation":[{"name":"Medical University of Gda\u0144sk, Gdansk, Poland 20"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merce","family":"Slavat-Plana","sequence":"additional","affiliation":[{"name":"Health Department, Agency for Health Quality and Assessment (AQuAS), CIBER Epidemiolog\u00eda y Salud P\u00fablica, CIBERESP, Stroke Programme, Barcelona, Spain 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