Can Emergency Medical Services (EMS) Shorten the Time to Stroke Team Activation, Computed Tomography (CT), and the Time to Receiving Antithrombotic Therapy? A Prospective Cohort Study

2020 ◽  
Vol 35 (2) ◽  
pp. 148-151
Author(s):  
Abdullah Alabdali ◽  
Sami Yousif ◽  
Abdullah Alsaleem ◽  
Mazen Aldhubayb ◽  
Nawfal Aljerian
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Emergency Medical Services ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Activation Time ◽  
Emergency Medical ◽  
Stroke Team ◽  
Private Car ◽  
To Receive

AbstractIntroduction:Stroke is a major emergency that can cause a significant morbidity and mortality. Advancement in stroke management in recent years has allowed more patients to be diagnosed and treated by stroke teams; however, stroke is a time-sensitive emergency that requires a high level of coordination, particularly within the prehospital phase. This research is to determine whether patients received by Emergency Medical Services (EMS) at a tertiary health care facility had shorter stroke team activation, time to computed tomography (CT), or time to receive intravenous thrombolytics.Methods:This research is a prospective cohort study of adults with stroke symptoms who required stroke team activation at a tertiary medical facility. The study included all patients received from September 1, 2017 through August 31, 2018. The primary outcome was the time difference to stroke team activation between patients received by EMS compared to patients that arrived by a private method of transportation. The secondary outcomes were the difference in time to CT scan and the time to receive intravenous recombinant tissue plasminogen activator (rtPA).Results:There were 75 (34.1%) patients who had been received by EMS, while 145 (65.9%) patients arrived via private transportation method (private car or by a friend/family member). The mean time to stroke team activation, time to CT, and time to receive thrombolytic therapy for the EMS group were: 8.19 (95% CI, 6.97 - 9.41) minutes; 18 (95% CI, 15.9 - 20.1) minutes; and 13.1 (95% CI, 6.95 - 19.3) minutes, respectively. Those for the private car group, on the other hand, were: 16 (95% CI, 12.4 - 19.6) minutes; 23.39 (95% CI, 19.6 - 27.2) minutes; and nine (95% CI, 4.54 -13.5) minutes, respectively. There was a significantly shorter time to stroke team activation for patients arriving via EMS compared to private car (P ≤ .00), but no significant difference was found on time to CT (P = .259) or time to receive rtPA (P = .100).Conclusion:Emergency Medical Service transportation of stroke patients can significantly shorten the time to stroke team activation, leading to shorter triage and accelerated patient management. However, there was no statistical difference in time to CT or time to receive rtPA. Patients with stroke symptoms may benefit more from EMS transportation compared to private methods of transportation.

scholarly journals Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study

BMJ ◽  
2011 ◽  
Vol 343 (jul18 1) ◽  
pp. d4277-d4277 ◽  
Author(s):  
J. J. Perry ◽  
I. G. Stiell ◽  
M. L. A. Sivilotti ◽  
M. J. Bullard ◽  
M. Emond ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Subarachnoid Haemorrhage ◽  
Prospective Cohort Study ◽  
Prospective Cohort

scholarly journals Non-communicable diseases and use of medication among Syrian refugees: a prospective cohort study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E M Strømme ◽  
J Haj-Younes ◽  
W Hasha ◽  
L T Fadnes ◽  
B Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Continuity Of Care ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Syrian Refugees ◽  
Non Communicable Diseases ◽  
To Receive

Abstract Background Conflict-driven disruption in continuity of care for non-communicable diseases (NCDs) is likely to have adverse public health impact. Yet, data on the prevalence and treatment coverage of NCDs among refugees is scarce. In this study we aim to assess the changes in prevalence of NCDs and use of relevant medication among Syrian refugees from a near-conflict phase in Lebanon to a resettlement phase in Norway. Methods This is a prospective cohort study. Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were changes in NCDs as defined by the WHO and use of relevant medication. We calculated prevalence proportions with confidence intervals and assessed changes in prevalence over time using generalized estimating equations. Results Altogether 353 Syrians participated. The median age was 34 years and 51 percent were women. The overall prevalence of NCDs was 12 (9-16) percent at baseline and 9 (6-12) percent at follow-up. The odds ratio for reporting any NCD at follow-up compared to baseline was 0.68 (0.46, 1.00). Among those reporting NCDs, the prevalence of using either antithrombotic or cholesterol lowering medication, antihypertensives, antidiabetics, or drugs for asthma or chronic obstructive pulmonary disease was 55 (39-70) percent at baseline and 63 (44-80) percent at follow-up. The odds ratio for using relevant medication at follow-up compared to baseline was 1.01 (0.63, 2.05). Conclusions In our study around one tenth of the refugees reported at least one NCD. Nearly half of those reporting NCDs in a conflict-near setting did not seem to receive relevant medication, while the same was true for more than one third of respondents after resettlement. We call for innovative public health approaches and interventions to protect continuity of care for NCDs in settings of conflict-driven exodus. Key messages A high share of Syrian refugees reporting NCDs do not seem to receive relevant medication. The management of NCDs among refugees needs attention in order to avoid negative health effects.

Abstract NS11: Using a Template in the Electronic Medical Record to Improve Communication Between Emergency Medical Services and the Emergency Department for Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Melissa Richardson ◽  
Christopher Rankin
Keyword(s):  
Emergency Medical Services ◽  
Medical Record ◽  
Point Of Care ◽  
Hospital Setting ◽  
Medical Services ◽  
Emergency Medical ◽  
Stroke Team ◽  
Get With The Guidelines ◽  
To Receive ◽  
Early Stroke

Background: In the advent of electronic medical records (EMR), emergency departments (ED) are challenged to include communication with inbound Emergency Medical Services (EMS) within the medical record. Using standardized documentation to guide and capture this critical communication may impact early activation of the stroke team and improve ‘Door to CT’ times. Starting with the “Pre-Notification” measure in Get With the Guidelines (GWTG), our team set out to improve this measure, then evaluate its impact on early stroke team activation and imaging timelines. Purpose: To utilize a standardized template in the EMR to improve the GWTG Pre-Notification measure by 30% and evaluate its impact on early stroke team activation and imaging. Methods: Initially, the team agreed that clear criteria for stroke team activation were needed. Once established, a standardized template was designed within the EMR. This included point of care glucose, neurological symptoms, cardiac rhythm, time ‘last known well’, and establishment of IV access/labs drawn. The communication nurses, designated to receive incoming EMS calls, were instructed on the use of this standardized template to guide and record communication for incoming stroke patients. Education and feedback were also provided to EMS providers so that they could anticipate required information and ensure that appropriate care occurred in the pre-hospital setting. Results: The “Pre-Notification Measure” improved from 29%-77%, early stroke team activation improved from 45% - 73%, and median ‘Door to CT’ time improved from 25 minutes - 18 minutes. (Figure). Conclusions: Using a standardized template in the EMR improves expectations of care for the ED and EMS providers. This translates into better scores for the GWTG “Pre-Notification” measure, as well early stroke team activation and imaging timelines.

Prospective cohort study of cancer patients diagnosed with incidental venous thromboembolism on routine computed tomography scans

2017 ◽  
Vol 25 (5) ◽  
pp. 1571-1577 ◽  
Author(s):  
Carmen P. Escalante ◽  
Gregory W. Gladish ◽  
Wei Qiao ◽  
Ali Zalpour ◽  
Binara Assylbekova ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Computed Tomography Scans

scholarly journals Caries Increment and Salivary Microbiome during University Life: A Prospective Cohort Study

2020 ◽  
Vol 17 (10) ◽  
pp. 3713 ◽  
Author(s):  
Yoko Uchida-Fukuhara ◽  
Daisuke Ekuni ◽  
Md Monirul Islam ◽  
Kota Kataoka ◽  
Ayano Taniguchi-Tabata ◽  
...  
Keyword(s):  
Cohort Study ◽  
Dental Caries ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Oral Microbiome ◽  
Caries Increment ◽  
University Life ◽  
To Receive ◽  
The Relationship

The purpose of this 3-year prospective cohort study was to explore the relationship between an increase in dental caries and oral microbiome among Japanese university students. We analyzed 487 students who volunteered to receive oral examinations and answer baseline (2013) and follow-up (2016) questionnaires. Of these students, salivary samples were randomly collected from 55 students at follow-up and analyzed using next-generation sequencing. Students were divided into two groups: increased group (Δdecayed, missing, and filled teeth (ΔDMFT) score increased during the 3-year period) and non-increased group (ΔDMFT did not increase). Thirteen phyla, 21 classes, 32 orders, 48 families, 72 genera, and 156 species were identified. Microbial diversity in the increased group (n = 14) was similar to that in the non-increased group (n = 41). Relative abundances of the family Prevotellaceae (p = 0.007) and genera Alloprevotella (p = 0.007) and Dialister (p = 0.039) were enriched in the increased group compared with the non-increased group. Some bacterial taxonomic clades were differentially present between the two groups. These results may contribute to the development of new dental caries prevention strategies, including the development of detection kits and enlightenment activities for these bacteria.

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