title: Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention: QASC Trial (Quality in Acute Stroke Care) Follow-Up.
abstract: Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005-2010). We now examine long-term all-cause mortality.
  
  
  
  Mortality was ascertained using Australia's National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber-White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates.
  
  
  
  One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival (>20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.58-1.07;P=0.13; adjusted HR, 0.77; 95% CI, 0.59-0.99;P=0.045). Older age (75-84 years; HR, 4.9; 95% CI, 2.8-8.7;P<0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3-1.9;P<0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49-0.99;P=0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths.
  
  
  
  Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care.
  
  
  
  URL: http://www.anzctr.org.au. Unique identifier: ACTRN12608000563369.
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.). sandy.middleton@acu.edu.au.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Kelly
authors.initials: K
authors.lastname: Coughlan
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: George
authors.initials: G
authors.lastname: Mnatzaganian
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Nancy
authors.initials: N
authors.lastname: Low Choy
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Simeon
authors.initials: S
authors.lastname: Dale
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Asmara
authors.initials: A
authors.lastname: Jammali-Blasi
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Chris
authors.initials: C
authors.lastname: Levi
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ward
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hiller
authors.affiliation: From the Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, St Vincent's Hospital, New South Wales (S.M., K.C., S.D., A.J.-B.); College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia (G.M.); School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Queensland (N.L.C.); John Hunter Hospital and Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, New South Wales, Australia (C.L.); Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital-General Campus, Centre for Practice-Changing Research (CPCR), Ontario, Canada and Department of Medicine, University of Ottawa, Ontario, Canada (J.M.G.); School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ontario, Canada and Nulungu Research Institute, University of Notre Dame Australia, Western Australia (J.W.); Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Australia and Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia (D.A.C.); School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia (P.M.); Health Sciences, Faculty of Health Sciences, Swinburne University of Technology, Victoria, Australia and School of Public Health, University of Adelaide, South Australia, Australia (J.E.H.); and National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, Australian National University, Australian Capital Territory (C.D.).
authors.forename: Catherine
authors.initials: C
authors.lastname: D'Este
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002985:Clinical Protocols; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000150:complications / Q000401:mortality* / Q000628:therapy*
keywords: fever; hyperglycemia; implementation; mortality; stroke; swallowing