scholarly journals A Qualitative Study of Risks Related to Interhospital Transfer of Patients with Nontraumatic Intracranial Hemorrhage

2019 ◽  
Vol 28 (6) ◽  
pp. 1759-1766
Author(s):  
Emily B. Finn ◽  
Meredith J. Campbell Britton ◽  
Alana P. Rosenberg ◽  
John E. Sather ◽  
Evie G. Marcolini ◽  
...  
2018 ◽  
Vol 27 (11) ◽  
pp. 3345-3349
Author(s):  
Anne Zepeski ◽  
Stacey Rewitzer ◽  
Enrique C Leira ◽  
Karisa Harland ◽  
Brett A. Faine

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jessica M. Ray ◽  
Ambrose H. Wong ◽  
Emily B. Finn ◽  
Kevin N. Sheth ◽  
Charles C. Matouk ◽  
...  

2012 ◽  
Vol 17 (3) ◽  
pp. 324-333 ◽  
Author(s):  
Ashley R. Catalano ◽  
H. R. Winn ◽  
Errol Gordon ◽  
Jennifer A. Frontera

2017 ◽  
Vol 70 (4) ◽  
pp. S116-S117
Author(s):  
M.F. Yip ◽  
J.E. Sather ◽  
K.N. Sheth ◽  
C.C. Matouk ◽  
R. Littauer ◽  
...  

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 70-79
Author(s):  
Henry Zhao ◽  
Karen Smith ◽  
Stephen Bernard ◽  
Michael Stephenson ◽  
Henry Ma ◽  
...  

Background and Purpose: Severity-based assessment tools may assist in prehospital triage of patients to comprehensive stroke centers (CSCs) for endovascular thrombectomy (EVT), but criticisms regarding diagnostic inaccuracy have not been adequately addressed. This study aimed to quantify the benefits and disadvantages of severity-based triage in a large real-world paramedic validation of the Ambulance Clinical Triage for Acute Stroke Treatment (ACT-FAST) algorithm. Methods: Ambulance Victoria paramedics assessed the prehospital ACT-FAST algorithm in patients with suspected stroke from November 2017 to July 2019 following an 8-minute training video. All patients were transported to the nearest stroke center as per current guidelines. ACT-FAST diagnostic accuracy was compared with hospital imaging for the presence of large vessel occlusion (LVO) and need for CSC-level care (LVO, intracranial hemorrhage, and tumor). Patient-level time saving to EVT was modeled using a validated Google Maps algorithm. Disadvantages of CSC bypass examined potential thrombolysis delays in non-LVO infarcts, proportion of patients with false-negative EVT, and CSC overburdening. Results: Of 517 prehospital assessments, 168/517 (32.5%) were ACT-FAST positive and 132/517 (25.5%) had LVO. ACT-FAST sensitivity and specificity for LVO was 75.8% and 81.8%, respectively. Positive predictive value was 58.8% for LVO and 80.0% when intracranial hemorrhage and tumor (CSC-level care) were included. Within the metropolitan region, 29/55 (52.7%) of ACT-FAST-positive patients requiring EVT underwent a secondary interhospital transfer. Prehospital bypass with avoidance of secondary transfers was modeled to save 52 minutes (95% CI, 40.0–61.5) to EVT commencement. ACT-FAST was false-positive in 8 patients receiving thrombolysis (8.1% of 99 non-LVO infarcts) and false-negative in 4 patients with EVT requiring secondary transfer (5.4% of 74 EVT cases). CSC bypass was estimated to over-triage 1.1 patients-per-CSC-per-week in our region. Conclusions: The overall benefits of an ACT-FAST algorithm bypass strategy in expediting EVT and avoiding secondary transfers are estimated to substantially outweigh the disadvantages of potentially delayed thrombolysis and over-triage, with only a small proportion of EVT patients missed.


2017 ◽  
Vol 37 ◽  
pp. 162-172 ◽  
Author(s):  
Folafoluwa O. Odetola ◽  
Renee R. Anspach ◽  
Yong Y. Han ◽  
Sarah J. Clark

Author(s):  
Le Meizhao ◽  
Ye Ming ◽  
Song Xiaoming ◽  
Xu Jiazhang

“Hydropic degeneration” of the hepatocytes are often found in biopsy of the liver of some kinds of viral hepatitis. Light microscopic observation, compareted with the normal hepatocytes, they are enlarged, sometimes to a marked degree when the term “balloning” degeneration is used. Their cytoplasm rarefied, and show some clearness in the peripheral cytoplasm, so, it causes a hydropic appearance, the cytoplasm around the nuclei is granulated. Up to the present, many studies belive that main ultrastructural chenges of hydropic degeneration of the hepatocytes are results of the RER cristae dilatation with degranulation and disappearance of glycogen granules.The specimens of this study are fixed with the mixed fluid of the osmium acidpotassium of ferricyanide, Epon-812 embed. We have observed 21 cases of biopsy specimens with chronic severe hepatitis and severe chronic active hepatitis, and found that the clear fields in the cytoplasm actually are a accumulating place of massive glycogen. The granules around the nuclei are converging mitochondria, endoplasm reticulum and other organelles.


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