Hillcrest Hospital is a comprehensive-care hospital on Mayfield Road in Mayfield Heights, Ohio, United States. It is part of the Cleveland Clinic Health System. The hospital currently has 500 registered beds, and serves as a level II trauma center for eastern Cuyahoga, Geauga, Lake, and Portage counties.
Patients with intensive care unit-acquired weakness often fail to reach preadmission baseline values of functional ability at the time of hospital discharge. Progressive mobilization is the use of mobility early in the inpatient stay with intent to maintain muscle mass and strength. The nurse is uniquely positioned to encourage mobilization as a primary caregiver who can oversee patient mobility outside of scheduled rehabilitation sessions. The adverse effects of immobilization involve several complex mechanisms that contribute to protein imbalance, muscle deterioration, and progressive weakness that impacts body systems. Immobility may lead to functional decline and the development of intensive care unit-acquired weakness that impacts patients for years to months after discharge from the hospital. The multidisciplinary health care team may enable mobility by adopting mobility care bundles, using mobility score tools, embracing mobility assist devices, encouraging time spent outside of patient rooms, using descriptive mobility criteria to identify mobility strategies, and employing mobility coordinators.
PURPOSE:This study aims to evaluate differences in the safety profile between alteplase or tenecteplase for suspected acute ischemic stroke (AIS) at Cleveland Clinic Health System (CCHS) facilities in Ohio and Florida. METHODS:This was a multi-center, single-enterprise, retrospective review of patients that received alteplase (January 1, 2020 - January 10, 2022) or tenecteplase (February 1, 2022 - September 20, 2023) for suspected AIS at CCHS Ohio or Florida. The composite primary outcome consisted of conversion to intracranial hemorrhage (ICH), angioedema, and/or non-ICH critical site bleeding at 24 h post-treatment, and in-hospital all-cause mortality. Secondary outcomes include incidence of symptomatic ICH, any ICH, angioedema, or critical site bleed within 24 h, and in-hospital all-cause mortality. RESULTS:A total of 863 patients were identified with 476 receiving alteplase and 387 receiving tenecteplase. Total, 115 total patients (13 %) experienced the primary safety composite outcome (95 % CI = 0.2 [-4.4 to 4.8]), and 64 patients (7 %) experienced any ICH with 42 (5 %) being symptomatic. Of total ICH transformations, 37 (8 %) received alteplase and 27 (7 %) received tenecteplase (95 % CI = -0.8 [-4.3 to 2.7]; however, symptomatic ICH included 26 patients (5 %) treated with alteplase and 16 (4 %) with tenecteplase (95 % CI = -1.3 [-4.2 to 1.5]). CONCLUSION:No statistical difference was observed in the primary composite outcome when treated with tenecteplase and alteplase for AIS treatment. There was no observed safety risk between tenecteplase and alteplase in patients treated for AIS at CCHS in Florida and Ohio. DISCLOSURE:The individuals involved do not have anything to disclose concerning potential or actual financial or personal relationships with commercial entities (or their competitors) that may be referenced in this study. MESH TERMS:Tissue plasminogen activator, tenecteplase, ischemic stroke, intracranial hemorrhage, retrospective studies.
