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that speech pathologists manage. Further, it is anticipated that this protocol will have high translatability and, as such, has the potential to be integrated and adapted across other speech pathology workplaces to enhance patient outcomes, both nationally and internationally. Already, the protocol has generated significant interest from other hospital sites throughout Australia. This protocol represents a “beginning” and it will be further modified in response to patient, staff, and organisational responses. As Ely et al. (2001, p. 454) have stated, “Clinical practice protocols should not represent rigid rules but, rather, guides to patient care. Moreover, the protocols may evolve over time as clinical and institutional experience with them increases”. References Ahmed, N., Wahlgren, N., Brainin, M., Castillo, J., Ford, G. A., & Kaste, M., et al. (2009). Relationship of blood pressure, antihypertensive therapy, and outcome in ischaemic stroke treated with intravenous thrombolysis: Retrospective analysis from Safe Implementation of Thrombolysis in Stroke – International Stroke Thrombolysis Register. Stroke , 4 0 (7), 2442–2449. Altman, K., Yu, G., & Schaefer, S. (2010). Consequence of dysphagia in the hospitalized patient: Impact on prognosis and hospital resources. Archives of Otolaryngology Head and Neck Surgery , 126 (8), 784–789. Butcher, K., Christensen, S., Parsons, M., De Silva, D., Ebinger, M., Levi, C., et al. (2010). Post thrombolysis blood pressure elevation is associated with haemorrhagic transformation. Stroke , 41 (1), 72–77. Cabre, M., Serra-Prat, M., & Palomera, E. (2010). Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing , 39 , 39–45. Chouinard, J., Lavigne, E., & Villeneuve, C. (1998). Weight loss, dysphagia, and outcome in advanced dementia. Dysphagia , 13 , 151-155. Ely, E. W., Meade, M. O., Haponik, E. F., Kollef, M. H., Cook, D. J, Guyatt, G. H., & Stoller, J. K. (2001). Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: Evidence-based clinical practice guidelines. Chest , 20 (6), 454–463. Flowers, H., Silver, L., Fang, J., Rochon, E., & Martino R. (2013). The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. Journal of Communication Disorders , 46 (3), 238–248. Foley, N. C., Martin, R. E., Salter, K. L., & Teasell, R. W. (2009). A review of the relationship between dysphagia and malnutrition following stroke. Journal of Rehabilitation Medicine , 41 (9), 707–713. Flynn D., Ford, G. A., Stobbart, L., Rodgers , H., Murtagh, M. J., & Thomson , R. G. (2013). A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: Lessons for tool developers. BMC Health Services Research , 13 (225), 1–13. Graham, G. D., (2003). Tissue plasminogen activator for acute stroke in clinical practice: A meta-analysis of safety data. Stroke , 34 (12), 2847–2850. Harrison, M. J. G., (1989). The influence of haematocrit in cerebral circulation. Cerebrovascular and Brain Metabolism Reviews , 1 , 55–67. Hinchley, J. A., Shepard, T., Furie, K., Smith, D., Wang, D., & Tonn, S., (2005). Formal dysphagia screening protocols prevent pneumonia. Stroke , 36 (9), 1972–1926.

Kidd, D., Lawson, J., Nesbitt, R., & McMahon, J. (1995). The natural history and clinical consequences of aspiration in acute stroke. Quarterly Journal of Medicine , 88 , 409– 413. Kohn, L.T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system . Washington, DC: Institute of Medicine. Korpiel, M. R. (1995). Issues related to clinical pathways: Managed care, implementation, and liability. Journal of Burn Care and Rehabilitation , 16 , 191–195. Low, J., Wyles, C., Wilkinson, T., & Saisbury, R. (2001). The effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy. Dysphagia , 16 (2), 123–127. Mann, G., Hankey, G. J., & Cameron, D. (2000). Swallowing disorders after acute stroke: Prevalence and diagnostic accuracy. Cerebrovascular Diseases , 10 , 380–86. Marik, P. E., & Kaplan, D. (2003). Aspiration pneumonia and dysphagia in the elderly. Chest , 124 , 328–336. Marsh, K., Bertanou, E., Suominen, H., Ventankachalam, M. (2010). An economic evaluation of speech and language therapy . Matrix Evidence for the Royal College of Speech and Language Therapists, UK. Martin, C. M., Doig, G. S., Heyland, D. K., Morrison, T., Sibbald, W. J. (2004). Multicentre, cluster randomized clinical trial of algorithms for critical-care enteral and parenteral therapy. Canadian Medical Association Journal , 170 (2), 197–204. Martino, R., Foley, N., Bhogal, S., Diamant, N., Speechley, M., & Teasell R. (2005). Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke , 36 , 2756–63. National Stroke Foundation (NSF). (2009). National stroke audit acute services organisational survey report . Melbourne: Author. National Stroke Foundation (NSF) (2010). Clinical guidelines for stroke management . Melbourne: Author. National Stroke Foundation (NSF). (2012) National action plan for stroke . Melbourne: Author. Odderson, I. R., Keaton, J. C., & McKenna , B. S. (1995). Swallow management in patients on an acute stroke pathway: Quality is cost effective. Archives of Physical Medicine and Rehabilitation , 76 , 1130–1133. Owen, J. E., Walker, R. J., Edgell, L., Collie, J., Douglas, L., Hewitson, T. D., & Becker, G. J. (2006). Implementation of a pre-dialysis clinical pathway for patients with chronic kidney disease. International Journal for Quality in Healthcare , 18 (2), 145–151. Panella, M., Moran, N., & Di Stanislao, F. (1997). A methodology for the development of clinical pathways: The experience of TriHealth Inc (in Italian). Quality Assurance , 1 , 1–16. Pearson, S. D., Goulart-Fisher, D., & Lee, T. H. (1995). Critical pathways as a strategy for improving care: Problems and potential. Annals of Internal Medicine , 12 , 941–948. Perry, L., & Love C. (2001). Screening for dysphagia and aspiration in acute stroke: A systematic review. Dysphagia , 16 , 7–18. Ramsey, D. J., Smithard, D, G., Kalra, L. (2003). Early assessments of dysphagia and aspiration risks in acute stroke patients. Stroke , 34 (5), 1252–1257. Simpson, M. A., Dewey, H. M., & Parsons, M. W. (2010). Thrombolysis for acute stroke in Australia: Outcomes

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JCPSLP Volume 16, Number 2 2014

Journal of Clinical Practice in Speech-Language Pathology