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1.  Understanding the reasons behind the low utilisation of thrombolysis in stroke 
The Australasian Medical Journal  2013;6(3):152-167.
Background
Thrombolysis remains the only approved therapy for acute ischaemic stroke (AIS); however, its utilisation is reported to be low.
Aims
This study aimed to determine the reasons for the low utilisation of thrombolysis in clinical practice.
Method
Five metropolitan hospitals comprising two tertiary referral centres and three district hospitals conducted a retrospective, cross-sectional study. Researchers identified patients discharged with a principal diagnosis of AIS over a 12-month time period (July 2009–July 2010), and reviewed the medical record of systematically chosen samples.
Results
The research team reviewed a total of 521 records (48.8% females, mean age 74.4 ± 14 years, age range 5-102 years) from the 1261 AIS patients. Sixty-nine per cent of AIS patients failed to meet eligibility criteria to receive thrombolysis because individuals arrived at the hospital later than 4.5 hours after the onset of symptoms. The factors found to be positively associated with late arrival included confusion at onset, absence of a witness at onset and waiting for improvement of symptoms. However, factors negatively associated with late arrival encompassed facial droop, slurred speech and immediately calling an ambulance. Only 14.7% of the patients arriving within 4.5 hours received thrombolysis. The main reasons for exclusion included such factors as rapidly improving symptoms (28.2%), minor symptoms (17.2%), patient receiving therapeutic anticoagulation (6.7%) and severe stroke (5.5%).
Conclusion
A late patient presentation represents the most significant barrier to utilising thrombolysis in the acute stroke setting. Thrombolysis continues to be currently underutilised in potentially eligible patients, and additional research is needed to identify more precise criteria for selecting patients for thrombolysis.
doi:10.4066/AMJ.2013.1607
PMCID: PMC3626030  PMID: 23589739
Tissue Plasminogen Activator (tPA); Alteplase; Thrombolysis; Stroke; Cerebrovascular accident
2.  Assessing the quality, suitability and readability of internet-based health information about warfarin for patients 
The Australasian Medical Journal  2012;5(3):194-203.
Background
Warfarin is a high-risk medication where patient information may be critical to help ensure safe and effective treatment. Considering the time constraints of healthcare providers, the internet can be an important supplementary information resource for patients prescribed warfarin. The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients' increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet.
Method
Previously validated tools were used to evaluate the quality, suitability and readability of patient information about warfarin on selected websites.
Results
The initial search yielded 200 websites, of which 11 fit selection criteria, comprising seven non-commercial and four commercial websites. Regarding quality, most of the non-commercial sites (six out of seven) scored at least an ‘adequate’ score. With regard to suitability, 6 of the 11 websites (including two of the four commercial sites) attained an ‘adequate’ score. It was determined that information on 7 of the 11 sites (including two commercial sites) was written at reading grade levels beyond that considered representative of the adult patient population with poor literacy skills (e.g. school grade 8 or less).
Conclusion
Despite the overall ‘adequate’ quality and suitability of the internet derived patient information about warfarin, the actual usability of such websites may be limited due to their poor readability grades, particularly in patients with low literacy skills.
doi:10.4066/AMJ.2012862
PMCID: PMC3433734  PMID: 22952566
Warfarin; internet; health information; quality; suitability; readability

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