***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Caring for stroke patients in stroke units , compared with other hospital locations , leads to decreased mortality and disability at one year.1 A trial of a combined acute and rehabilitation ward in Trondheim , Norway , showed that hospital care improved survival and functional outcome at five years.2 The benefits were attributed to the treatment provided in the first few weeks after stroke . The purpose of this study was to examine the effects of care in a non-acute stroke unit on outcome at five years . The methods and findings of 315 patients at one year of our r and omised study comparing a non-acute stroke rehabilitation unit with care on conventional medical and geriatric wards  have been published.3 In the present study , we ascertained survival to five years by using hospital records and death certificates . Survivors were traced to establish their residential status and visited by a research er who was Background Hyperglycaemia , fever , and swallowing dysfunction are poorly managed in the admission phase of acute stroke , and patient outcomes are compromised . Use of evidence -based guidelines could improve care but have not been effectively implemented . Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever , hyperglycaemia , and swallowing dysfunction in patients following acute stroke . Methods and design Metropolitan acute stroke units ( ASUs ) located in New South Wales , Australia will be stratified by service category ( A or B ) and , within strata , by baseline patient recruitment numbers ( high or low ) in this prospect i ve , multicentre , single-blind , cluster r and omised controlled trial ( C RCT ) . ASUs then will be r and omised independently to either intervention or control groups . ASUs allocated to the intervention group will receive : unit-based workshops to identify local barriers and enablers ; a st and ardised core education program ; evidence -based clinical treatment protocol s ; and ongoing engagement of local staff . Control group ASUs will receive only an abridged version of the National Clinical Guidelines for Acute Stroke Management . The following outcome measures will be collected at 90 days post-hospital admission : patient death , disability ( modified Rankin Score ) ; dependency ( Barthel Index ) and Health Status ( SF-36 ) . Additional measures include : performance of swallowing screening within 24 hours of admission ; glycaemic control and temperature control . Discussion This is a unique study of research transfer in acute stroke . Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke . Our C RCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines , an imperative of modern hospital services . Trial Registration Australia New Zeal and Clinical Trial Registry ( ANZCTR ) No : BACKGROUND We assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence -based management of fever , hyperglycaemia , and swallowing dysfunction in acute stroke units ( ASUs ) . METHODS In the Quality in Acute Stroke Care ( QASC ) study , a single-blind cluster r and omised controlled trial , we r and omised ASUs ( clusters ) in New South Wales , Australia , with immediate access to CT and on-site high dependency units , to intervention or control group . Patients were eligible if they spoke English , were aged 18 years or older , had had an ischaemic stroke or intracerebral haemorrhage , and presented within 48 h of onset of symptoms . Intervention ASUs received treatment protocol s to manage fever , hyperglycaemia , and swallowing dysfunction with multidisciplinary team building workshops to address implementation barriers . Control ASUs received only an abridged version of existing guidelines . We recruited pre-intervention and post-intervention patient cohorts to compare 90-day death or dependency ( modified Rankin scale [ mRS ] ≥2 ) , functional dependency ( Barthel index ) , and SF-36 physical and mental component summary scores . Research assistants , the statistician , and patients were masked to trial groups . All analyses were done by intention to treat . This trial is registered at the Australia New Zeal and Clinical Trial Registry ( ANZCTR ) , number ACTRN12608000563369 . FINDINGS 19 ASUs were r and omly assigned to intervention ( n=10 ) or control ( n=9 ) . Of 6564 assessed for eligibility , 1696 patients ' data were obtained ( 687 pre-intervention ; 1009 post-intervention ) . Results showed that , irrespective of stroke severity , intervention ASU patients were significantly less likely to be dead or dependent ( mRS ≥2 ) at 90 days than control ASU patients ( 236 [ 42 % ] of 558 patients in the intervention group vs 259 [ 58 % ] of 449 in the control group , p=0·002 ; number needed to treat 6·4 ; adjusted absolute difference 15·7 % [ 95 % CI 5·8 - 25·4 ] ) . They also had a better SF-36 mean physical component summary score ( 45·6 [ SD 10·2 ] in the intervention group vs 42·5 [ 10·5 ] in the control group , p=0·002 ; adjusted absolute difference 3·4 [ 95 % CI 1·2 - 5·5 ] ) but no improvement was recorded in mortality ( 21 [ 4 % ] of 558 in intervention group and 24 [ 5 % ] of 451 in the control group , p=0·36 ) , SF-36 mean mental component summary score ( 49·5 [ 10·9 ] in the intervention group vs 49·4 [ 10·6 ] in the control group , p=0·69 ) or functional dependency ( Barthel Index ≥60 : 487 [ 92 % ] of 532 patients vs 380 [ 90 % ] of 423 patients ; p=0·44 ) . INTERPRETATION Implementation of multidisciplinary supported evidence -based protocol s initiated by nurses for the management of fever , hyperglycaemia , and swallowing dysfunction delivers better patient outcomes after discharge from stroke units . Our findings show the possibility to augment stroke unit care . FUNDING National Health & Medical Research Council ID 353803 , St Vincent 's Clinic Foundation , the Curran Foundation , Australian Diabetes Society-Servier , the College of Nursing , and Australian Catholic University BACKGROUND AND PURPOSE The efficacy of stroke units has been extensively examined . It is unknown , however , whether the superiority of the stroke unit will remain after the increased focus on stroke treatment in general medicine . This study of patients admitted to the hospital early and with a short length of stay determines the effect and identifies certain important components of a stroke unit . METHODS Five hundred fifty patients aged 60 years or older with acute stroke were allocated by a quasi-r and omized design to a stroke unit or a general medical ward based on date of birth in the month . Patients admitted within 24 hours of onset were enrolled . Outcomes after 7 months were death , proportion needing long-term care , and change in neurological and functional state assessed by the Sc and inavian Stroke Scale and Barthel Index . RESULTS Seven months after admission there was a trend in favor of the stroke unit in all outcome measures , but no significant differences in clinical outcomes were found except for change in the Sc and inavian Stroke Scale score . Recurrent stroke during hospitalization occurred more often in the general medical ward ( P = .03 ) . The stroke unit was significantly more aggressive in mobilization out of bed ( P<.01 ) and use of parenteral fluid ( P<.0001 ) , aspirin ( P<.0001 ) , antipyretics ( P<.0001 ) , and antibiotics ( P<.0001 ) . CONCLUSIONS Our study confirms the benefit of the stroke unit , but the effects on the most reliable clinical outcomes were modest and insignificant . Treatment in this stroke unit hastened recovery . More aggressive rehabilitation and use of parenteral fluid , aspirin , antipyretics , and antibiotics appeared in the stroke unit BACKGROUND AND PURPOSE We have previously shown that treatment in our combined acute and rehabilitation stroke unit ( SU ) improves the outcome during the first 5 years after onset of stroke compared with that for stroke patients treated in general wards ( GW ) . The aim of the present trial was to examine the effects of SU care after 10 years of follow-up . METHODS In a r and omized controlled trial , 110 patients with symptoms and signs of an acute stroke were allocated to the SU and 110 to GW .  No significant differences existed in baseline characteristics between the groups . The outcome after 10 years was measured by the proportion of patients at home , the proportion of patients in an institution , the mortality , and the functional state as assessed by the Barthel Index , in which a Barthel Index score of > /=60 was classified as independent or partly independent and a score of > /=95 was classified as independent . RESULTS After 10 years , 21 ( 19.1 % ) of the patients r and omized to the SU and 9 ( 8.2 % ) of the patients r and omized to the GW were at home ( P=0.0184 ) . Eighty-three ( 75.5 % ) of the patients from the SU and 96 ( 87.3 % ) of the patients from the GW were dead ( P=0.0082 ) , and 6 ( 5.4 % ) and 5 ( 4.5 % ) , respectively , were in an institution ( eg , nursing home ; NS ) . Twenty-two ( 20.0 % ) of the SU patients and 9 ( 8 . 2 % ) of the GW patients had a Barthel Index score of > /=60 ( P=0.0118 ) , and 14 ( 12.7 % ) and 6 ( 5.4 % ) , respectively , had a score of > /=95 ( P=0.0606 ) . CONCLUSIONS For the first time it has been shown that SU care improves survival and functional state and increases the proportion of patients able to live at home 10 years after their stroke . Treatment in combined acute and rehabilitation SU seems to have important long-term effects on outcome for stroke patients In a prospect i ve controlled trial we compared the clinical outcome for unselected acute stroke patients in a non-intensive stroke unit ( n = 110 ) and in general medical wards ( n = 183 ) . The patients were comparable in age , marital state and functional impairment on admission .  Case fatality rates over the first year after the stroke were similar in the two groups . By three months after the stroke , 15 % of the survivors initially admitted to the stroke unit and 39 % of those admitted to general medical wards remained hospitalized ( p less than 0.001 ) . The corresponding figures by one year after the cerebrovascular accident were 12 % and 28 % , respectively ( p less than 0.05 ) . A greater proportion of surviving stroke unit patients was independent in walking ( 0.10 greater than p greater than 0.05 ) , personal hygiene ( p less than 0.05 ) and dressing ( p less than 0.001 ) . Essential features of the stroke unit are team work headed by a stroke nurse , staff , patient and family education and very early onset of rehabilitation . We conclude that this strategy improves functional outcome and reduces the need for long-term hospital care BACKGROUND AND PURPOSE We have previously shown that treatment in our combined acute and rehabilitation Stroke Unit improves outcome during the first year after onset of stroke compared with stroke patients treated in general wards . The aim of the present trial was to examine the long-term effects of the stroke unit care . METHODS In a r and omized controlled trial , 110 patients with symptoms and signs of an acute stroke were allocated to the Stroke Unit and 110 to general wards .  No significant differences existed in baseline characteristics between the two groups . The outcome after 5 years was measured by the proportion of patients at home , the proportion of patients in an institution , the mortality , and the functional state assessed by Barthel Index . RESULTS After 5 years , 38 ( 34.5 % ) of the patients r and omized to the Stroke Unit and 20 ( 18.2 % ) of the patients r and omized to the general wards were at home ( P = .006 ) . Sixty-five ( 59.1 % ) of the patients from the Stroke Unit and 78 ( 70.9 % ) of the patients from the general wards were dead ( P = .041 ) , while 7 ( 6.4 % ) and 12 ( 10.9 % ) , respectively , were in an institution ( e.g. , nursing home ) ( P = NS ) . Functional state was significantly better for patients treated in the Stroke Unit . CONCLUSIONS For the first time it is shown that stroke unit care improves long-term survival and functional state and increases the proportion of patients able to live at home 5 years after the stroke . Combined acute and rehabilitation stroke units appear to be an effective way of organizing treatment for acute stroke patients Background and Purpose — The benefits of stroke unit management may vary according to stroke subtype . A post hoc analysis of the influence of stroke subtype on stroke unit effectiveness was undertaken by using prospect i ve data collected in a r and omized controlled trial . Methods — Two hundred sixty-seven patients with moderately severe ischemic stroke ( 164 with large-vessel infa rcts and 103 with lacunar infa rcts ) were r and omly allocated to treatment in stroke units or in general medical wards with specialist stroke team support .  Mortality , institutionalization , neurological , functional , and quality -of-life scores and re source use were assessed at 3 and again at 12 months after stroke onset . An intention-to-treat analysis was undertaken , and logistic regression was used to evaluate 
    Output:
    
Outcomes appeared to be independent of patient age , sex , initial stroke severity , stroke type , and duration of follow-up .
We found moderate- quality evidence that stroke patients who receive organised inpatient ( stroke unit ) care are more likely to be alive , independent , and living at home one year after the stroke .
The apparent benefits were independent of patient age , sex , initial stroke severity , or stroke type , and were most obvious in units based in a discrete stroke ward .
We observed no systematic increase in the length of inpatient stay , but these findings had considerable uncertainty