scholarly journals Fast-Track Systems Improve Timely Carotid Endarterectomy in Stroke Prevention Outpatients

2016 ◽  
Vol 43 (5) ◽  
pp. 648-654 ◽  
Author(s):  
Sophia Gocan ◽  
Aline Bourgoin ◽  
Dylan Blacquiere ◽  
Rany Shamloul ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Symptom Onset ◽  
Stroke Prevention ◽  
Success Factors ◽  
Public Awareness ◽  
Vascular Imaging ◽  
Local Health ◽  
Fast Tracking ◽  
Initial Symptoms ◽  
System Factors

AbstractBackground: For optimal stroke prevention, best practices guidelines recommend carotid endarterectomy (CEA) for symptomatic patients within two weeks; however, 2013 Ontario data indicated that only 9% of eligible patients from outpatient Stroke Prevention Clinics (SPCs) achieved this target. The goal of our study was to identify modifiable system factors that could enhance the quality and timeliness of care among patients needing urgent CEA. Methods: We conducted a retrospective chart review of transient ischemic attack/stroke patients assessed in Champlain Local Health Integrated Network SPCs between 2011 and 2014 who subsequently underwent CEA. Descriptive statistics were used to define patient characteristics, timelines from symptom onset to CEA, and system factors that contributed to delays or improvements in care. Multivariate analysis was used to determine statistically significant variations between groups. Results: Seventy-five records were eligible for study inclusion. Median time from initial symptoms to CEA was 31 days, with 21.3% of patients undergoing surgery within 2 weeks. Significant delays were common in patient presentation and assessment following symptom onset, wait times for vascular imaging and neurological assessment, and time from surgical assessment to CEA completion. Rapid testing and triage, coupled with collaborative initiatives among SPC, surgical, and radiology teams were associated with significantly improved timelines. Conclusions: Success factors for rapid CEA are multifaceted, including system changes that address public awareness of stroke and 911 response, improvements in vascular imaging access, and redesign of clinical services to promote collaboration and fast-tracking of care. Implementation of performance measures to monitor and guide clinical innovations is recommended.

scholarly journals Delays in Carotid Endarterectomy: The Process is the Problem

2013 ◽  
Vol 40 (4) ◽  
pp. 585-589 ◽  
Author(s):  
Dylan Blacquiere ◽  
Michael Sharma ◽  
Prasad Jetty
Keyword(s):  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Symptom Onset ◽  
Primary Care Physicians ◽  
Vascular Imaging ◽  
Symptomatic Carotid ◽  
Specialist Referral ◽  
Symptomatic Carotid Stenosis ◽  
Delayed Referral

Abstract:Background:Current recommendations for carotid endarterectomy (CEA) for symptomatic carotid stenosis state benefit is greatest when performed within two weeks of symptoms. However, only a minority of cases are operated on within this guideline, and no systematic examinations of reasons for these delays exist.Methods:All CEA cases performed at our institution by vascular surgery for symptomatic carotid stenosis after neurologist referral in 2008-2009 were reviewed. Dates of symptom onset, initial presentation, referral to and evaluation by neurology and vascular surgery, vascular imaging, and CEA were collected, and the length of time between each analysed. Reasons for delays were noted where available.Results:Of 36 included patients, 34 had CEA more than two weeks after symptom onset. Median time to CEA from onset was 76 days (IQR, 38-105 days). Longest intervals were between surgeon assessment and CEA (14 days; IQR, 9-21 days), neurology referral and neurologist assessment (9 days; IQR, 2-26 days), vascular imaging and referral to vascular surgery (9 days; IQR, 2-35 days) and vascular surgery referral and assessment (8 days; IQR, 6-15 days). Few patients (44.1%) had reasons for delays identified; of these, process-related delays were related to delayed vascular imaging, delayed referral by primary care physicians, or multiple conflicting referrals.Conclusions:There are significant delays between symptom onset and CEA in patients referred for CEA, with delay highest between specialist referral and evaluation. Strategies to reduce these delays may be effective in increasing the proportion of procedures performed within two weeks of symptom onset.

Carotid endarterectomy: An underutilized means of stroke prevention

1997 ◽  
Vol 84 (2) ◽  
pp. 279-279 ◽  
Author(s):  
D. J. Adam ◽  
A. W. Bradbury ◽  
C. V. Ruckley
Keyword(s):  
Carotid Endarterectomy ◽  
Stroke Prevention

scholarly journals Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e045822
Author(s):  
Lynn V Monrouxe ◽  
Peter Hockey ◽  
Priya Khanna ◽  
Christiane Klinner ◽  
Lise Mogensen ◽  
...  
Keyword(s):  
Medical Students ◽  
Success Factors ◽  
Realist Review ◽  
Physician Assistants ◽  
Realist Evaluation ◽  
Health Practitioner ◽  
Local Health ◽  
Medical Council ◽  
Programme Theory ◽  
Quantitative Evidence

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

scholarly journals Durability of Stroke Prevention with Carotid Endarterectomy and Carotid Stenting

Surgery ◽  
2018 ◽  
Vol 164 (6) ◽  
pp. 1271-1278 ◽  
Author(s):  
Michael A. Thomas ◽  
William H. Pearce ◽  
Heron E. Rodriguez ◽  
Irene B. Helenowski ◽  
Mark K. Eskandari
Keyword(s):  
Carotid Endarterectomy ◽  
Stroke Prevention ◽  
Carotid Stenting

Carotid Endarterectomy: Are We Meeting the Two Week Target?

2009 ◽  
Vol 54 (2) ◽  
pp. 27-29 ◽  
Author(s):  
RV Guest ◽  
JMJ Richards ◽  
SCA Fraser ◽  
RTA Chalmers
Keyword(s):  
Health Services ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Median Time ◽  
Retrospective Review ◽  
Stroke Prevention ◽  
Time Interval ◽  
Median Time Interval ◽  
Timing Of Onset ◽  
Prevention Benefit

Objective It has been recommended that carotid endarterectomy should be carried out within fourteen days of the index event if maximum stroke prevention benefit is to be achieved. The aim of this study was to see whether this target was being met in our region and where in the pathway delays occurred. Methods This was a retrospective review of all patients (n=75) undergoing carotid endarterectomy in 2006 in a regional vascular unit. Eleven patients were excluded as the timing of onset of symptoms was unclear, leaving 64 patients for further analysis. Results The median time-interval from onset of symptoms to surgery was 47 days (interquartile range 32-65 days). Five of 64 patients (4.5%) had a carotid endarterectomy within 14 days. Median time from onset of symptoms to presentation to health services was one day (IQR 0-7 days), from presentation to health services to neurovascular clinic was 16 days (IQR 10-23 days), from neurovascular clinic to vascular surgery clinic was 13 days (IQR 9-24 days), and from vascular surgery clinic to operation was 13 days (IQR 8-22 days). Fifteen of the 51 patients (29%) attending a neurovascular clinic and five of the 57 patients (9%) attending a vascular surgery clinic were seen within 14 days. Conclusion The fourteen-day target is difficult to achieve due to the number of steps in the referral pathway. This delay may be jeopardising outcome. Reduction in the delay to surgery would require a multi-disciplinary approach and should involve education of the general public.

scholarly journals Needs-based decision-making for municipal health promotion – an analysis across 13 European countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Quilling ◽  
M Kuchler ◽  
J Leimann ◽  
S Dieterich ◽  
C Plantz
Keyword(s):  
Decision Making ◽  
Health Promotion ◽  
Success Factors ◽  
European Countries ◽  
Decision Making Process ◽  
Successful Implementation ◽  
Local Health ◽  
Healthy Living ◽  
Living Environments ◽  
Municipal Health

Abstract Introduction In contradiction to many recommendations, municipal health promotion often does not address identified needs. In order to create healthy living environments, all the 13 countries participating in Work package 6 - healthy living environments (WP6) of the EU Joint Action Health Equity Europe have been implementing feasible actions since autumn 2019 based on a country-specific needs analysis. They were supported on a theoretical level by the contents of the WP6 Implementation Template. The aim is to find out if and how the decision-making process from needs-based planning to the implementation of these measures in municipal health promotion was successful. Methods In order to gain an insight into the process 'from needs to action' and to obtain information about the methodological approach to implementation, guideline-based interviews were conducted with the project partners of WP6. These, as well as accompanying questionnaire-based interim reports, were evaluated comparatively in terms of content analysis according to Mayring and with regard to concrete evaluation criteria, obstacles and success factors during individual steps that can be transferred to the Public Health Action Cycle. Results The interim reports of the participating countries show that the step from an identified problem and related needs to a concrete, tailored action is often difficult. The relevant aspects mentioned above will be analysed more detailed during the interviews. It is to be expected that further insights can be gained from this, especially on successful implementation processes. Conclusions The mix of reports and interviews with participants from different European countries offers a broad view of the decision-making process in local health promotion and makes obstacles and success factors transparent for other actors in this field.

Carotid Endarterectomy Based on Duplex Ultrasonography: A Safe Approach Associated with Long-term Stroke Prevention

2000 ◽  
Vol 34 (2) ◽  
pp. 125-136 ◽  
Author(s):  
Russell H. Samson ◽  
Dennis F. Bandyk ◽  
David P. Showalter ◽  
Jonathan P. Yunis
Keyword(s):  
Carotid Endarterectomy ◽  
Stroke Prevention ◽  
Duplex Ultrasonography ◽  
Safe Approach

scholarly journals Clinical utility of a screening protocol for blunt cerebrovascular injury using computed tomography angiography

2017 ◽  
Vol 126 (4) ◽  
pp. 1033-1041 ◽  
Author(s):  
Michael K. Tso ◽  
Myunghyun M. Lee ◽  
Chad G. Ball ◽  
William F. Morrish ◽  
Alim P. Mitha ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Antiplatelet Agents ◽  
Vascular Imaging ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Trauma Population ◽  
Asymptomatic Patients ◽  
Before And After ◽  
Screening Protocol ◽  
Ischemic Complications

OBJECTIVE Blunt cerebrovascular injury (BCVI) occurs in approximately 1% of the blunt trauma population and may lead to stroke and death. Early vascular imaging in asymptomatic patients at high risk of having BCVI may lead to earlier diagnosis and possible stroke prevention. The objective of this study was to determine if the implementation of a formalized asymptomatic BCVI screening protocol with CT angiography (CTA) would lead to improved BCVI detection and stroke prevention. METHODS Patients with vascular imaging studies were identified from a prospective trauma registry at a single Level 1 trauma center between 2002 and 2008. Detection of BCVI and stroke rates were compared during the 3-year periods before and after implementation of a consensus-based asymptomatic BCVI screening protocol using CTA in 2005. RESULTS A total of 5480 patients with trauma were identified. The overall BCVI detection rate remained unchanged postprotocol compared with preprotocol (0.8% [24 of 3049 patients] vs 0.9% [23 of 2431 patients]; p = 0.53). However, postprotocol there was a trend toward a decreased risk of stroke secondary to BCVI on a trauma population basis (0.23% [7 of 3049 patients] vs 0.53% [13 of 2431 patients]; p = 0.06). Overall, 75% (35 of 47) of patients with BCVI were treated with antiplatelet agents, but no patient developed new or progressive intracranial hemorrhage despite 70% of these patients having concomitant traumatic brain injury. CONCLUSIONS The results of this study suggest that a CTA screening protocol for BCVI may be of clinical benefit with possible reduction in ischemic complications. The treatment of BCVI with antiplatelet agents appears to be safe.

Carotid Endarterectomy versus Medical Therapy in Stroke Prevention

2017 ◽  
Vol 67 (2) ◽  
pp. 713-720
Author(s):  
Yazeed Musaad Alkhuzim ◽  
Hanouf Abdullah Alnofaie ◽  
Abaad Ayed Al-Mutairi
Keyword(s):  
Carotid Endarterectomy ◽  
Medical Therapy ◽  
Stroke Prevention
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