Relationship Between Time from Ambulance Call to Arrival at Emergency Center and Level of Consciousness at Admission in Severe Stroke Patients

2012 ◽  
Vol 28 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Kazuhiro Ohwaki ◽  
Takehiro Watanabe ◽  
Takayuki Shinohara ◽  
Tadayoshi Nakagomi ◽  
Eiji Yano
Keyword(s):  
Clinical Information ◽  
Stroke Patients ◽  
Publication Type ◽  
Emergency Center ◽  
Severe Stroke ◽  
Level Of Consciousness ◽  
The Mean ◽  
Prehospital Delays ◽  
The Impact ◽  
Mean Time

AbstractIntroductionTimely access to acute medical treatment can be critical for patients suffering from severe stroke. Little information is available about the impact of prehospital delays on the clinical conditions of stroke patients, but it is possible that prehospital delays lead to neurological deterioration. The aim of this study was to examine the impact of prehospital delays related to emergency medical services on the level of consciousness at admission in patients with severe stroke.MethodsThis retrospective study assessed 712 consecutive patients diagnosed with cerebrovascular diseases who were admitted to an intensive care unit in Tokyo, Japan, from April 1998 through March 2008. Data, including the time from the call to the ambulance service to the arrival of the ambulance at the patient location (on-scene), and the time from the arrival of the ambulance on-scene to its arrival at the emergency center were obtained. The following demographic and clinical information also were obtained from medical records: sex, age, and Glasgow Coma Scale (GCS) score at admission.ResultsThe mean time from ambulance call to arrival on-scene was 7 (SD=3) minutes, and the mean time from ambulance call to arrival at the center was 37 (SD=8) minutes. A logistic regression model for predicting GCS scores of 3 and 4 at admission was produced. After adjusting for sex, age, and time from arrival on-scene to arrival at the center, a longer call-to-on-scene time was significantly associated with poor GCS scores (OR = 1.056/min; 95% confidence interval, [CI] = 1.008-1.107). After adjusting for sex and age, a longer call-to-arrival at the center time also was significantly associated with poor GCS scores (OR = 1.020; 95% CI = 1.002-1.038).ConclusionsPrehospital delays were significantly associated with decreased levels of consciousness at admission in patients suffering from a stroke. As level of consciousness is the strongest predictor of outcome, reducing prehospital delays may be necessary to improve the outcomes in patients with severe stroke.OhwakiK, WatanabeT, ShinoharaT, NakagomiT, YanoE. Relationship between time from ambulance call to arrival at emergency center and level of consciousness at admission in severe stroke patients. Prehosp Disaster Med. 2012;28(1):1-4.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

2018 ◽  
Vol 33 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Timmy Li ◽  
Jeremy T. Cushman ◽  
Manish N. Shah ◽  
Adam G. Kelly ◽  
David Q. Rich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Barriers To Care ◽  
Prehospital Care ◽  
Heart Association ◽  
Living Alone ◽  
Stroke Patients ◽  
Publication Type ◽  
Stroke Treatment ◽  
Significant Difference ◽  
The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

Abstract WP46: Blood Pressure, Clinical Improvement And Recanalization Following Acute MCA Occlusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nandakumar Nagaraja ◽  
Steven Warach ◽  
Amie W Hsia ◽  
Sungyoung Auh ◽  
Lawrence L Latour ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Improvement ◽  
Clinical Information ◽  
Collateral Flow ◽  
Stroke Patients ◽  
Mca Occlusion ◽  
The Mean ◽  
The Difference ◽  
Pre Treatment ◽  
B Test

Background: Blood pressure (BP) drop in the first 24 hours after stroke onset may occur in response to vessel recanalization. Clinical improvement could be due to recanalization or better collateral flow with persistent occlusion. We hypothesize that patients with combination of significant improvement on the NIHSS and a drop in BP at 24hr post tPA is associated with recanalization. Methods: We included intravenous t-PA patients from the Lesion Evolution of Stroke Ischemia On Neuroimaging (LESION) registry who had pre-treatment and 24 hour MRA scan, NIHSS scores at those times and an M1 MCA occlusion at baseline, but excluded those on pressors, pre tPA SBP<120 and tandem ICA occlusion. We classified recanalization status on the 24 hour MRA as none, partial or complete. We abstracted all BP measurements for the first 24 hours from the chart and calculated BP drop as the difference of the triage pre-tPA BP and the average of the last 3 hour readings preceding the 24 hour MRI. NIHSS improvement was defined as ≥4points improvement on NIHSS or NIHSS of 0 at 24hour. Patients with combination of drop in BP and NIHSS improvement were compared with others for recanalization status on 24hr MRA by Kendall Tau-b test. Results: Seventeen patients met the study criteria. There were 13 women, the mean age was 76 years and the median baseline NIHSS was 15. On the 24 hour MRA, 3, 8 and 6 patients had none, partial and complete recanalization, respectively. Patients with NIHSS improvement and a SBP drop ≥20 mmHg were more like to have recanalization at 24 hrs (57% Vs 0%, p=0.03). Similar patterns were seen for patients with NIHSS improvement and DBP drop ≥5mmHg (50% Vs 0%, p=0.04) or MAP drop ≥20mmHg (50% Vs 0%, p=0.04). Complete recanalization was only associated with the combination of NIHSS improvement with SBP drop ≥ 20mmHg (66% Vs 0%, p=0.04). A significant association was not found for recanalization with NIHSS improvement alone or drop in BP alone. Conclusion: There is an association of clinical improvement and BP drop in patients who recanalize. Bedside clinical information may be useful in the management of stroke patients.

Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

2021 ◽  
pp. 001857872110375
Author(s):  
Frank A. Fanizza ◽  
Jennifer Loucks ◽  
Angelica Berni ◽  
Meera Shah ◽  
Dennis Grauer ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Medication Adherence ◽  
Hcv Treatment ◽  
Clinical Pharmacists ◽  
The Mean ◽  
Group 2 ◽  
Cure Rates ◽  
The Impact ◽  
Mean Time ◽  
Group 1

Background: Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Objectives: Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. Methods: We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). Results: The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; P < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; P < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Conclusion: Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.

Telephone Calls to an Infectious Diseases Fellow

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 753-754
Author(s):  
Mark F. Cotton
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Time Allocation ◽  
Primary Care Physicians ◽  
First Year ◽  
Educational Value ◽  
The Mean ◽  
Telephone Calls ◽  
The Impact ◽  
Mean Time

Objective. There is no information on the impact and nature of telephone calls directed to subspecialists. The main objective was to document prospectively all calls directed to a first-year infectious diseases fellow, to determine their content, origin, educational value, and time allocation. Results. Three hundred fifty-nine calls were received over a 71-day period from March 24 through May 20, 1992. The mean number of daily calls was 5.1 ± 3.3. Mean time per call was 7 ± 5.4 minutes. Cumulatively, 41.7 hours were spent responding to telephone calls. The subgroup with the most calls (44.3%) was from pediatricians in practice. Seventy percent of calls were for advice about case management. Forty percent of calls were considered educational to the fellow. Conclusions. This study confirms the importance of the infectious disease subspecialist as a resource for primary care physicians.

Quality of febrile neutropenia management in a regional cancer center emergency department.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 104-104
Author(s):  
Priyanka Kapil ◽  
Katherine Enright
Keyword(s):  
Emergency Department ◽  
Febrile Neutropenia ◽  
Antibiotic Therapy ◽  
Cancer Site ◽  
Cancer Center ◽  
Time To Initiation ◽  
The Mean ◽  
The Impact ◽  
Mean Time

104 Background: ASCO's current guidelines for febrile neutropenia (FN) management support antibiotic administration within one hour of presentation to the emergency department (ED). Prompt initiation of antibiotic therapy is vital to decrease the likelihood of adverse outcomes. Many studies, however, have reported significant delays in antibiotic initiation with mean wait times far exceeding ASCO's guidelines. We aimed to assess the quality of FN management at a regional cancer centre ED. Methods: Patients undergoing chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada between 04/12 - 03/13 were identified using electronic medical records. Patients were excluded if there was no record of chemotherapy delivery within 30 days prior to ED visit. ICD-10 codes and chart data were used to identify patients who had presented for either fever or infection. The primary outcome measures were three major quality of health indicators; time to assessment by a physician, Canadian Triage and Acuity Scale (CTAS) score, and time to initiation of intravenous antibiotics. Results: In total 239 records were included in the analysis. CTAS score was concordant with recommendation for FN (level 1-2) in 85% of patients and did not vary based on primary cancer site (p = 0.17). The mean time to physician assessment was 97.2 min and the mean time to initiation of IV antibiotics was 194.7 min. Overall, 14.6% of patients received their first dose of antibiotic therapy within the recommended 1 hour window. Conclusions: Our audit identified a large margin for improvement in the time to initiation of antibiotic therapy for chemotherapy patients with suspected FN. Prompt recognition and initiation of standardized treatment pathways for FN in the ED may improve the time to initiation of antibiotic therapy. In an attempt to address this gap in quality we have developed and distributed a standardized wallet-sized fever card to all patients receiving cytotoxic chemotherapy within our regional cancer program. This card contains information pertaining to the current chemotherapy treatment and recommended ED treatment protocols for FN. An evaluation of the impact of these cards is ongoing.

scholarly journals The impact of angling experience on the efficiency of float fishing using different hook types

2019 ◽  
Vol 27 (1) ◽  
pp. 41-46
Author(s):  
Tomasz K. Czarkowski ◽  
Andrzej Kapusta
Keyword(s):  
The Mean ◽  
Catch Rates ◽  
Time Required ◽  
The Impact ◽  
Mean Time

Abstract The aim of the study was to compare the catch efficiency of novice and experienced anglers float fishing with different hook types. The mortality of fish that were caught and released was determined based on the experience of the angler and the type of hook used. The mean catch rates of the experienced angler was 46.7 fish per hour, while that of the novice angler was 33.7 fish per hour. The landing efficiency of fish using hooks with micro-barbs was higher than that with barbless hooks. Angling experience had a significant impact on the mean time required to unhook caught fish and also on the mortality of the fish released. The lowest mortality was noted in fish caught by experienced anglers fishing with barbless hooks. The results of the study suggest that angling experience does not have a great impact on parameters characterizing the quality of angling catches. The efficiency of float fishing performed by novice and experienced anglers was similar. Differences were noted in the time required to unhook the fish and in the mortality of the fish released.

Edaravone Therapy Could be a Substitute for Decompressive Craniotomy/Craniectomy for Large Ischemic Stroke in Remote Areas with no Neurosurgeons

2021 ◽  
Vol 9 (1) ◽  
pp. 1
Author(s):  
Seidu A. Richard
Keyword(s):  
Ischemic Stroke ◽  
National Institutes Of Health ◽  
High Morbidity ◽  
Large Artery ◽  
Stroke Patients ◽  
Success Story ◽  
Severe Stroke ◽  
Remote Areas ◽  
Decompressive Craniotomy ◽  
The Impact

The incidence of stroke has been a major task for medics and relatives globally. Stroke is the second most frequent disease with high morbidity as well as mortality worldwide. This is a very short and focus review on edaravone therapy. Due to the success story of edaravone in the management of stroke, it could be beneficial for severe stroke patients. The impact of edaravone was highest in the most severely afflicted stroke patients with National Institutes of Health Stroke Scale (NIHSS) scores ≥15 during admission. Large-artery atherosclerosis or cardioembolism stroke subtypes had the highest NIHSS scores. On the other hand, decompressive craniectomy is the resection of part of the skull so that edematous brain tissue can herniate outside. It is thus advocated that, edaravone therapy could be a substitute for decompressive craniotomy for large ischemic stroke in remote facilities with no neurosurgeons.

Abstract W MP78: Intravascular Volume Delpetion in Hypertensive ED Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Christopher Lewandowski ◽  
Joseph Miller ◽  
Lauren Rodriquez ◽  
Julian Suszanski ◽  
Jessica Levely
Keyword(s):  
Pilot Study ◽  
Volume Expansion ◽  
Clinical Information ◽  
High Serum ◽  
Volume Status ◽  
Stroke Patients ◽  
Volume Depletion ◽  
Clinical Indicators ◽  
Laboratory Markers ◽  
The Mean

Objective: The hypertensive response in acute stroke may mask patients who could be volume depleted. Our objective was to determine the incidence of stroke patients that are volume depleted despite hypertension. This is a pilot study using sonographic markers of volume status as compared to common clinical indicators of volume status. Methods: This was a prospective cohort study of suspected ischemic stroke patients with a NIHSS ≥ 4 and symptoms onset < 24 hours. Exclusion criteria were pregnancy, age < 18, or ICH. Trained investigators performed a sonographic assessment of volume status. An IVC collapsibility index (IVC-CI) > 50% was used to define volume depletion. Investigators collected demographic and clinical information, and laboratory markers of dehydration (elevated blood urea nitrogen to creatinine ratio, hemoconcentration or high serum osmolality). A standardized questionnaire was given to treating clinicians who were blinded to the IVC-CI. They indicated their assessment of the patient's volume status. The analysis excluded subjects ultimately diagnosed with a stroke mimic. Analysis incorporated descriptive and regression statistics using SAS 9.3. The local IRB approved the study. Results: 23 subjects were enrolled, 4 had stroke mimics and were excluded from analysis. Mimics consisted of psychogenic disorders and myelopathy. The mean age was 64 years, 89% were Black, 68% female, and 95% had preexisting HTN. The mean NIHSS was 9.2, the mean time from symptom onset 309 minutes and the mean presenting SBP 170 ± 31 mmHg. 68% of subjects had a cortical infarct on MRI and the remaining had lacunar infarcts. The mean IVC-CI was 70 ± 21% and 84% (95% CI 68 - 100%) of subjects had IVC-CI > 50%. Laboratory markers of dehydration were present in 5% of subjects. Treating physicians classified 29% as subjects as hypovolemic. There was no correlation between IVC-CI and SBP, NIHSS, infarct location or laboratory markers of dehydration (r = 0.04 - 0.29, p > 0.23). Conclusions: This pilot study suggests that despite being hypertensive, the majority of ED stroke patients have US indications of volume depletion and may be able to tolerate volume expansion. Future studies may identify which patients have improvement in cerebral perfusion with volume expansion.

scholarly journals Improved Arrangement and Capacity for Medication Transactions: A Pilot Study to Determine the Impact of New Technology on Medication Storage and Accessibility

2018 ◽  
Vol 53 (5) ◽  
pp. 338-343
Author(s):  
Matthew Kelm ◽  
Udobi Campbell
Keyword(s):  
New Technology ◽  
Medication Administration ◽  
Product Performance ◽  
Satisfaction Survey ◽  
Pharmacy Technician ◽  
The Mean ◽  
Medication Storage ◽  
New Generation ◽  
The Impact ◽  
Mean Time

Purpose: A new-generation automated dispensing cabinet (ADC) deployment is described. Methods: A single-center retrospective-prospective pilot product performance study was conducted, and prospective nurse satisfaction survey and pharmacy technician product performance feedback survey were performed to determine the impact of new technology on medication storage and accessibility. The study measured efficiency of the 9:00 am medication pull for nursing users, assessment of nursing perceptions of medication administration pre- and postinstallation of the cabinetry, pharmacy technician perceptions of working with the cabinetry, and assessment of the efficiency of the pharmacy technician restock process. Results: In total, 2981 total nursing medication retrieval processes for the 9 am standard medication administration time (SMAT) time were analyzed: 1321 in the preoptimization phase and 1660 in the postoptimization phase. Analysis of the mean time per transaction confirmed a significant improvement from 10.5 to 10.3 seconds per transaction ( P = .026) in the postoptimization configuration. The modified assessment of nursing satisfaction survey demonstrated increased satisfaction with many aspects of the new-generation cabinetry. Pharmacy technician survey data highlighted beneficial aspects of the device, while restock data showed an increase in the time spent restocking the cabinet from 11.5 seconds in the preoptimization phase compared with 21.3 seconds in the postoptimization phase ( P < .0001). Conclusion: ADC installation and inventory optimization had a statistically significant improvement in the mean time per nursing transaction. Nursing and pharmacy technician surveys demonstrated a trend of enhanced satisfaction with the platform.

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