scholarly journals Acute stroke care: Experience of a tertiary care center in Delhi, the way to go

2019 ◽  
Vol 405 ◽  
pp. 162
Author(s):  
V. Kumar ◽  
S.K. Saxena ◽  
R. Gupta ◽  
A. Batra ◽  
G. Rajpal
Keyword(s):  
Acute Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Stroke Care ◽  
Tertiary Care Center ◽  
Acute Stroke Care ◽  
Care Experience ◽  
The Way

Abstract 3379: Benefiting the Community; The Impact of Joining a Regional Stroke Network

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nancy D Papesh ◽  
James Gebel
Keyword(s):  
Acute Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Cleveland Clinic ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
The Impact ◽  
Iv Tpa

Background: The Cleveland Clinic Health System (CCHS) consists of a large tertiary care center and 10 regional hospitals. It is organized both clinically and administratively into multispecialty organ based Institutes rather than departments. The CCHS re-introduced a regional initiative to standardize stroke care in 2008. Medina Hospital is a 118-bed community hospital in rural North-eastern Ohio, where there is a high stroke burden and previously minimal IV tPA use. Medina Hospital joined the CCHS Stroke Network in November 2009. Hypothesis: We hypothesized that after joining the formally organized stroke CCHS system of care, the proportion of stroke patients receiving IV tPA and the timeliness of administration of acute thrombolytic therapy would both significantly increase. Methods: Data was analyzed from our prospective participation in the Get with the Guidelines-Stroke and the Ohio Coverdell Stroke Registries. Baseline data regarding quality, outcomes and stroke performance measures were reviewed. CCHS initially supported acute stroke care in early 2010 with a telemedicine cart and then introduced 24/7 emergency, on-site, CCHS neurologist, acute stroke call coverage in late 2010. Standardized CCHS stroke care pathways and order sets were also introduced in 2010. The proportion of stroke patients treated with IV tPA in 2010 and 2011 (post- joining CCHS) was compared to 2009 (2-sided Fisher’s exact test), and door-to-needle times were compared from 2010 to 2011 (unpaired t-test). Results: IV tPA treatment utilization increased from 0/69 patients (0%) in 2009 to 9/67 patients (11.8%) in 2010 [exact p=.0033] and 11/46 (19.3%) in the first 7 months of 2011 [exact p=.0001]. Door-to-needle times improved from a mean of 81.4 (95%CI 66.4 to 96.4) minutes in 2010 to 61.7 (95% CI 52.7 to 70.8) minutes in 2011 (p=.0158). Conclusions: Participation in an organized formal collaborative regional hospital stroke treatment network resulted in dramatic improvements from zero IV tPA utilization to greatly exceeding the national benchmark averages for both percentage treatment with IV tPA and door-to-needle time in a rural area where patients previously had minimal access to acute stroke expertise.

scholarly journals Problems and limitations in thrombolysis of acute stroke patients at a tertiary care center

2015 ◽  
Vol 19 (5) ◽  
pp. 265-269 ◽  
Author(s):  
Sushma Gurav ◽  
Kapil G. Zirpe ◽  
R. S. Wadia ◽  
Manishprasad K. Pathak ◽  
Abhijeet M. Deshmukh ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Stroke Patients

Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate

2020 ◽  
pp. 105566562097727
Author(s):  
Eleonore E. Breuning ◽  
Rebecca J. Courtemanche ◽  
Douglas J. Courtemanche
Keyword(s):  
Health Care ◽  
Young Children ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Support Network ◽  
Tertiary Care Center ◽  
Care Needs ◽  
Care Experience

Purpose: Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents’ experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. Design: In-depth semistructured interviews. Setting: Pediatric tertiary care center. Participants: Parents of children younger than 7 years of age with cleft lip and/or palate. Results: From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents’ reactions to their child’s pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child’s school and peer groups. Conclusions: The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents’ needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.

scholarly journals Acute Stroke Care and Thrombolytic Therapy Use in a Tertiary Care Center in Lebanon

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Mazen J. El Sayed ◽  
Tharwat El Zahran ◽  
Hani Tamim
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Delayed Presentation ◽  
Tertiary Care Center ◽  
Acute Stroke Care ◽  
Symptomatic Intracerebral Hemorrhage

Background. Thrombolytic therapy (rt-PA) is approved for ischemic stroke presenting within 4.5 hours of symptoms onset. The rate of utilization of rt-PA is not well described in developing countries.Objectives. Our study examined patient characteristics and outcomes in addition to barriers to rt-PA utilization in a tertiary care center in Beirut, Lebanon.Methods. A retrospective chart review of all adult patients admitted to the emergency department during a one-year period (June 1st, 2009, to June 1st, 2010) with a final discharge diagnosis of ischemic stroke was completed. Descriptive analysis was done followed by a comparison of two groups (IV rt-PA and no IV rt-PA).Results. During the study period, 87 patients met the inclusion criteria and thus were included in the study. The mean age was found to be 71.9 years (SD = 11.8). Most patients arrived by private transport (85.1%). Weakness and loss of speech were the most common presenting signs (56.3%). Thirty-three patients (37.9%) presented within 4.5 hours of symptom onset. Nine patients (10.3%, 95% CI (5.5–18.5)) received rt-PA. The two groups (rt-PA versus non rt-PA) had similar outcomes (mortality, symptomatic intracerebral hemorrhage, modified Rankin scale scores, and residual deficit at hospital discharge).Conclusion. In our setting, rt-PA utilization was higher than expected. Delayed presentation was the main barrier to rt-PA administration. Public education regarding stroke is needed to decrease time from symptoms onset to ED presentation and potentially improve outcomes further.

Development and implementation of acute stroke care pathway in a tertiary care hospital in India: A cluster-randomized study

2016 ◽  
Vol 64 (7) ◽  
pp. 39 ◽  
Author(s):  
Kameshwar Prasad ◽  
Neha Rai ◽  
Rohit Bhatia ◽  
Deepti Vibha ◽  
MamtaBhushan Singh ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Tertiary Care Hospital ◽  
Care Pathway ◽  
Randomized Study ◽  
Tertiary Care ◽  
Stroke Care ◽  
Care Hospital ◽  
Acute Stroke Care ◽  
Cluster Randomized

Abstract TP296: Telestroke Associated With Increased Levels of Acute Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Glenn D Graham ◽  
Jane A Anderson ◽  
Katherine E Murphy ◽  
Laurie Plue ◽  
Linda Williams ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Financial Incentives ◽  
Care Center ◽  
Stroke Care ◽  
Urgent Care ◽  
Acute Stroke Care ◽  
Chi Square ◽  
Stroke Services ◽  
Va Hospitals ◽  
Stroke Facilities

Introduction/Hypothesis: Telestroke may be used to augment hospitals’ acute stroke services. The Department of Veterans Affairs launched a National TeleStroke Program (NTSP) in September 2017 that provides emergency stroke consultative services at 30 VA hospitals as of August 2019. NTSP uses a virtual hub/spoke model, with transfer to community hospitals when required. We examined the hypothesis that NTSP sites would be overrepresented among VA medical centers increasing their level of acute stroke care between 2012 and 2019. Methods: All VA hospitals with an emergency department or urgent care center were required to submit their stroke policies in 2012 certifying the level of acute stroke care offered: VA primary stroke centers provide alteplase evaluation and treatment 24/7/365, limited hours stroke facilities provide alteplase evaluation and treatment typically during business hours, or supporting stroke facilities which transfer all stroke patients for acute care. Re-attestation was required in 2019, with an additional category of comprehensive stroke center added, reflecting availability of both alteplase and endovascular thrombectomy 24/7/365. All submitted documents were reviewed by a single stroke neurologist and the level of acute stroke services was tabulated. Results: Of the 115 VA hospitals submitting complete documents, 25 increased their level of acute stroke care, and only 2 decreased their level of acute stroke care between 2012 and 2019. Sixteen of 30 NTSP sites (53%) enhanced acute stroke care in 2019 vs. 2012, compared to 9 of 85 hospitals (11%) not using telestroke. The difference was highly significant (p < 0.0001, Chi-square test). Conclusions: In a large, national health care system less driven by financial incentives than most US medical care, adoption of telestroke services was successful in enhancing local VA hospital stroke care. This difference was especially apparent at smaller, rural VA hospitals with limited access to VA neurology services and (in some cases) non-VA care options.

scholarly journals CNS Francis McNaughton Memorial Prize

2015 ◽  
Vol 42 (S1) ◽  
pp. S9-S9
Author(s):  
JC Furlan ◽  
J Fang ◽  
FL Silver
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Normal Limit ◽  
Care Center ◽  
Hemoglobin Concentration ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Degree Of Disability ◽  
Stroke Center

Background: This study examines whether abnormal blood hemoglobin concentration (bHB) is associated with worse clinical outcomes and poorer prognosis after acute ischemic stroke. Methods: We included data from the Registry of the Canadian Stroke Network on consecutive patients with ischemic stroke who were admitted between July/2003 and March/2008. Patients were divided into groups as follows: low bHB, normal bHB, and high bHB. Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurological Scale: <8), greater degree of disability at discharge (modified Rankin score: 3-6), and 30-day and 90-day mortality. Results: Higher bHB than the superior normal limit is associated with greater degree of impairment (OR=1.45, 95%CI: 1.06-1.95, p=0.0195) and disability (OR=1.49, 95%CI: 1.03-2.15, p=0.0331), and higher 30-day mortality (HR=1.98, 95%CI: 1.44-2.74, p<0.0001) after adjustment for major potential confounders. The Kaplan-Meier curves indicate that abnormal bHB is associated with higher mortality after acute ischemic stroke (p<0.0001). Lower bHB than the inferior normal limit is associated with longer stay in the acute stroke care center (OR=1.11, 95%CI: 1.02-1.22, p=0.017). Conclusions: Polycythemia on the initial admission is associated with poorer prognosis regarding the degree of impairment and disability, and 30-day mortality after an acute ischemic stroke. Anemia on admission is associated with longer stay in the acute stroke center.

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