INTRODUCTIONAlthough pneumonia is a major complication after acute ischaemic stroke (AIS), pneumonia prediction scores have not been extensively validated. This study aimed to compare the discrimination performance of 5 pneumonia prediction scores in AIS patients.

MATERIALS AND METHODSWe retrospectively reviewed all consecutive adult AIS patients whom presented to our emergency department within 4.5 hours of symptom-onset between January 2012 and February 2015. Diagnosis had to be made by a neurologist and infarcts confirmed by neuroimaging. We excluded patients with pneumonia on presentation. Pneumonia predictors were based on the 5 prediction scoring models: Kwon's score, Chumbler's score, Acute Ischaemic Stroke-Associated Pneumonia Score (AIS-APS), ADSscore and ISAN score. The definition of stroke-associated pneumonia was based on the criteria by the Pneumonia in Stroke Consensus Group. Analysis using area under receiver operating characteristics curve (AUROC) was performed.

RESULTSForty (5.5%) out of 731 patients analysed had stroke-associated pneumonia (SAP). ADSscore had the highest discrimination capacity (AUROC 0.88; 95% CI, 0.84 to 0.92), followed by AIS-APS (AUROC 0.87; 95% CI, 0.83 to 0.91), Kwon's score (AUROC 0.86; 95% CI, 0.82 to 0.92), Prestroke Independence, Sex, Age and National Institutes of Health Stroke Scale (ISAN) score (AUROC 0.85; 95% CI, 0.80 to 0.90) and Chumbler's score (AUROC 0.79; 95% CI, 0.74 to 0.84). However, there was no statistical difference of discrimination capacity among ADSscore, AIS-APS and Kwon's score.

CONCLUSIONADS, AIS-APS and Kwon's scores performed comparably in discriminating SAP in AIS patients.

INTRODUCTION: Stroke is a leading cause of death and disability, with the administration of recombinant transcriptase-plasminogen activator (rtPA) improving outcomes in a time-dependent manner. Only 52.3% of eligible stroke patients at our institution received rtPA within 60 minutes of arrival. We aimed to improve the percentage of acute stroke patients receiving rtPA within 60 minutes of arrival at the emergency department (ED). METHODS: This study presents results from the first year of a clinical practice improvement project that implemented quality improvement interventions. The primary outcome measure was percentage of acute ischaemic stroke patients receiving rtPA within 60 minutes of arrival at the ED. Secondary outcome measures included components of total door-to-needle (DTN) time and factors for delay to thrombolysis. Interventions were establishment of standardised acute stroke activation guidelines, screening question at ED registration, prehospital notification of stroke activation, public education, scripting for thrombolysis consent and easy access to equipment. RESULTS: The percentage of patients thrombolysed within 60 minutes increased to 60.6% (p = 0.27), and DTN time decreased from 59 minutes to 54.5 minutes (p = 0.15). This was attributable to reduced door-to-physician time, door-to-imaging time and decision time, although the results were not significant. There was no significant increase in symptomatic intracranial haemorrhage or mortality secondary to stroke. Length of stay was significantly reduced by 1.5 days (p < 0.048). CONCLUSION The interventions resulted in an increasing but non-significant trend of acute stroke patients receiving thrombolysis within 60 minutes. Outcomes will be monitored for a longer duration to demonstrate trends and sustainability.

Introduction: Head and neck cancer (HNC) patients are often malnourished during diagnosis and before treatment. This study determined the prevalence of malnutrition and factors associated with malnutrition among HNC patients. Methods: A crosssectional study among HNC in-patients before radiotherapy was conducted. Malnutrition status of the patients was determined using scored Patient GeneratedSubjective Global Assessment (PG-SGA). Nutritional parameters of muscle mass, fat mass, albumin, energy and protein intakes were collected. Nutrition impact symptoms (NIS) of the patients were assessed using a validated Head and Neck Symptoms Checklist© (HNSC©). Results: Fifty HNC patients were recruited in this study and the age range of patients was 21 to 78 years old, with gender distribution of 78% males and 22% females. More than half of the patients were malnourished, with 20% severely malnourished before radiotherapy. The lack of dietitian referral before treatment was found to significantly affect nutritional status (p=0.027). There was a significant negative relationship between energy intake (r=0.342, p=0.015) and protein intake (r=0.386, p=0.006) with PG-SGA, indicating lower energy and protein intakes related with poor nutritional status. The result showed a significant positive relationship between NIS score (r=0.731, p<0.001) and PG-SGA, indicating the lower the NIS, the better the nutritional status among HNC patients. More than half of the HNC patients had difficulty chewing. Conclusion: A strong association between nutritional status and NIS showed the importance of dietary management in HNC patients. Early identification of the nutritional status of HNC patients can ensure optimal nutritional status to improve treatment outcomes.