Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Impact Of A Training Program And Organization On The Management Of Stroke In The Acute Phase (AVC-II)
Brief Summary: Acute stroke management represents a true medical emergency that requires prompt diagnosis and urgent treatment. In a previous exhaustive cohort study conducted in the Rhône region, France (AVC69) (Porthault et al. 2013) the investigators observed that only a small percentage of patients could access to thrombolysis in time. In this cohort of 1306 patients treated in one of the emergency department of the Rhone region for a suspected stroke, 84% of patients reached hospital through an emergency department instead of going directly to a stroke unit. Among those patients, only 2% were finally thrombolysed. A significant part of patients arrived in the emergency department too late to be thrombolysed. However, among the subset of ischemic stroke patients who reach emergency department less than 3 hours after symptoms onset, and who had no clinical or radiological exclusion criteria for thrombolysis, only 15 % were thrombolysed. The hypothesis was that an intervention designed to improve ED professional's knowledge and skills and to develop together efficient clinical pathway would decrease door-to imaging time and consequently door-to needle time and eventually improve overall thrombolysis rate.

The investigators have conducted a cluster randomized controlled stepped wedge trial. All adult patients with suspected stroke arriving in one of the participating ED were included in the study along five successive four-month periods. The program featured: development of written materials (booklets) and video (film), and one day session of standardized training for trainers, at least one nurse and one physician of all EDs, with formal presentation to improve knowledge, and simulation to improve skills for using the "FAST" tool (nurses) and the "NIHSS" score (ED physicians). Additionally, a clinical pathway was developed to adapt general evidence based guidelines to the local organization. The primary outcome is the door-to imaging time.


Options:
A: Arm Label: Enhanced complex oral health care intervention; Type: EXPERIMENTAL; Interventions: Other: Enhanced complex oral health care | Arm Label: Usual oral health care; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: OTHER; Name: Enhanced complex oral health care; Assigned to Arm(s): Enhanced complex oral health care intervention
B: Arm Label: Improvement intervention; Type: OTHER; Interventions: Behavioral: improvement intervention | Arm Label: no intervention; Type: OTHER; Interventions: Behavioral: no intervention | Intervention Type: BEHAVIORAL; Name: improvement intervention; Assigned to Arm(s): Improvement intervention | Intervention Type: BEHAVIORAL; Name: no intervention; Assigned to Arm(s): no intervention
C: Arm Label: an intervention arm; Type: EXPERIMENTAL; Interventions: Behavioral: Behaviour Change Wheel model guided intervention | Arm Label: a control arm; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: Behaviour Change Wheel model guided intervention; Assigned to Arm(s): an intervention arm
D: Arm Label: Pre-intervention group (Control group); Type: N/A; Interventions: N/A | Arm Label: Post-intervention group (Training course group); Type: N/A; Interventions: Other: training of emergency professionals to acute stroke management | Intervention Type: OTHER; Name: training of emergency professionals to acute stroke management; Assigned to Arm(s): Post-intervention group (Training course group)

Answer: D