OPTIMISTmain logo

OPTIMISTmain is a randomised controlled trial comparing the effects of different intensities of nursing care monitoring for patients with acute ischaemic stroke without critical care needs after thrombolysis treatment.

It is international and multi-centre, aiming to recruit 7,200 patients across 120 sites in the UK, USA, Australia, Mexico and China.

OPTIMISTmain is led by Prof Craig Anderson, Professor of Stroke Medicine in The George Institute, New South Wales, Australia. Diana Day, Senior Lecturer in Advanced Practice at ARU, is the joint country Lead Investigator for the UK.

This project is set in stroke nursing care, looking at how nurses monitor acute stroke patients who have received thrombolysis or thrombectomy (clot busting or clot retrieval treatment) in the immediate hours post stroke.

We are concerned with intercranial haemorrhage, and patient safety is our main outcome.

We are recruiting patients with medium to small strokes requiring thrombolysis treatment. We are using a cluster consent, whereby the participating hospitals give permission to change the monitoring for this defined group of patients, so the patients themselves only need to consent to the use of their data.

Diana was asked to join this study due to background are Consultant Nurse for Stroke at Addenbrooke's Hospital, Cambridge, where she also led the hyperacute stroke research group.

As Clinical Lead, Diana supports the Principal Investigators, answers queries, and sets up sites and interviews, supported by Study Coordinators at Leicester University Stroke Research Unit.

Through her role, she aims to:

  • Optimise patient care.
  • Involve nurses in research by a) raising visibility of research; b) bringing research into the clinical workplace; and c) encouraging and supporting nurse primary investigators at sites – a National Institute Health Research (NIHR) objective.
  • Increase the evidence base.
  • Introduce measures such as process outcome, patient reported experiences (PREMS), and staff interviews on impact and conduct of study on site.

So far, we have opened ten sites in the UK, and are in the process of opening another 20.

If you would like more information, Diana welcomes questions at [email protected]

May 2023

As of May 2023, we:

  • Have recruited 1,454 patients across 46 sites across the UK, Australia, Mexico and China.
  • Are on target to open 30 sites in the UK, our 9th site opened in the second week of May.
  • Have recruited six new nursing Primary Investigators in the UK to lead at individual sites, with more sites opening soon.
  • Have established our monthly UK teleconference.

Ouyang, M., Gonzalez, F., Montalbano, M., Pruski, A., Iacobelli, M., Wang, X., Faigle,R. R., Johnson B. J., Summers, D., Jan, S., Urrutia, V. C., Anderson, C. S. and Liu, H. (2023) 'Abstract WMP13: Implementation Issues Arising From Less-intense Monitoring In Routine Care: Process Evaluation Of The Optimial Post Rtpa-iv Monitoring In Acute Ischemic Stroke (OPTIMISTmain) Study', Stroke, 54. Available at: https://doi.org/10.1161/str.54.suppl_1.WMP13

Faigle, R., Johnson, B., Summers, D., Khatri, P., Anderson, C. S., Urrutia, V. C., OPTIMISTmain Steering Committee (2020) 'Low-Intensity Monitoring After Stroke Thrombolysis During the COVID-19 Pandemic', Neurocrit Care, 33(2), pp. 333-337. Available at: https://doi.org/10.1007/s12028-020-00998-0

Lim, J., Wang, X., Robinson, T., Urrutia, V. C., Johnson, B., Summers, D. V., Day, D., Dowlatshahi,. D, Khatri, P., Lindley, R., Munoz, P., Balicki, G., Jan, S. and Anderson, C. (2019) 'Optimal post Tpa-IV monitoring in ischemic stroke (OPTIMISTmain)', International Journal of Stroke, 14(1), pp. 18-19. Available at: https://doi.org/10.1177/1747493019858233