Abstract 159: Acute Ischemic Stroke Quality Indicators: Implementation of Evidence-Based Practice to Improve Compliance

Background and Purpose: Stroke is the leading cause of adult disability in the United States. Compliance with the stroke quality indicators reinforces that a stroke center is adhering to the evidence based standards of care in acute stroke patients. Hardwiring a process in the delivery of care during hospitalization will ensure improved compliance of these quality indicators. Methods: A core multidisciplinary team was formed that included neurointensivists, neurologist, neurointerventional radiologist, pharmacist, emergency room and neuro intensive care staff along with neuroscience administration staff. Directors of the various services impacted by the stroke patients were invited on an ad hoc basis. Retrospective chart reviews were performed to collect data on a monthly basis for the following quality indicators: DVT prophylaxis Discharged on antithrombotics Patients with a-fib receiving anticoagulation Thrombolytic therapy administration Antithrombotic by end of day 2 Discharged on cholesterol meds Dysphagia screening Stroke education Smoking cessation education Assessed for Rehab Overall compliance with these indicators was on target but areas for improvement were noted in the following areas: stroke education, discharged on statin, thrombolytic therapy administration and patients with a-fib receiving anticoagulation. Aggressive action plans for each of these areas were developed and implemented. Initiatives included standardized electronic order sets, electronic admission, consult, history and physical templates with the quality indicators listed. Presentation of compliance results with a review of outliers were part of monthly section meetings. In order to understand process deviations further discussions with section chiefs resulted in investigation and resolution of issues that led to the variances. Hiring of a research registered nurse and a stroke coordinator were added to the existing stroke service team. Results: Dramatic improvement was achieved with no indicator falling below <85.2% (85.2 out 100) for an entire year. Gold Plus achievement level with the American Stroke Association was achieved within a three year period. Target Stroke Honor Role was also achieved during this time period. Conclusions: A cohesive project team was able to identify barriers, recommend process changes and ensure the implementation of change within the institution. Data collection and process revision is ongoing

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Developing and Testing a Bedside Aspiration Screen to Protect Stroke Patients From Aspiration and Mortality: Expanding Nursing Practice and Partnership

Clinical Scholars Review ◽

10.1891/1939-2095.8.1.117 ◽

2015 ◽

Vol 8 (1) ◽

pp. 117-124

Author(s):

Edith K. Huhn-Matesic

Keyword(s):

Acute Stroke ◽

The United States ◽

The Body ◽

Evidence Based ◽

Institute Of Medicine ◽

Stroke Patients ◽

Risk Of Death ◽

Stroke Population ◽

Screening Protocol ◽

Strategic Training

Stroke is the 4th leading cause of death in the United States at a rate of 1 death every 4 min. Stroke patients initially experience dysphagia 42%–76% of the time, putting them at high risk for developing aspiration pneumonia, increasing the risk of death three-fold in the first 30 days following onset of the condition. The Edith-Huhn-Matesic Bedside Aspiration Screen (EHMBAS) was developed as an evidence-based registered nurse (RN) bedside aspiration screening protocol. It represents an example where a strategic training program and multidisciplinary collaboration enabled nurses to broaden their education and scope of practice to improve care to the stroke population on the acute stroke unit. As recommended by the Institute of Medicine (2011) report, nurses advanced the health of stroke patients. The EHMBAS demonstrated strong validity (94% sensitivity) and high interrater reliability (Kappa = .92, p < .001). Pre- and poststaff training survey results verified a significant positive change in knowledge gained, preparedness, and satisfaction with teaching methods. Furthermore, 92.3% of patients surveyed had positive screening experiences. The multidisciplinary stroke team was highly effective at implementing stroke guidelines expeditiously, saving lives in this population. This study was significant in that it contributed to the body of work aimed at establishing a sustainable valid, and reliable evidence-based, bedside aspiration screen that can be promptly completed for acute stroke victims.

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Fibrinolytic and Antithrombotic Therapy

10.1093/oso/9780195155648.001.0001 ◽

2006 ◽

Author(s):

Richard C. Becker ◽

Frederick A. Spencer

Keyword(s):

Nurse Practitioners ◽

Antithrombotic Therapy ◽

The United States ◽

Standards Of Care ◽

Treatment Modalities ◽

Patient Specific ◽

Past Century ◽

Evidence Based ◽

Vascular Medicine ◽

Wide Range

Thrombotic disorders of the circulatory system represent the leading cause of morbidity, motality, and health care expenditure in the United States. Fibrinolytic and Antithrombotic Therapy provides a practical, evidence-based approach to the management of thrombotic disorders for all clinicians involved in the care of patients with these disorders. It provides not only vital conceptual information on fibrinolytic and antithrombotic therapy, but also the means to apply it to everyday decision making and patient care. Focusing on managment guidelines and critical pathways, the text stresses practicality and usability. It will be a valuable resource for the wide range of clinicians involved in the care of patients with these disorders, including cardiologists, emergency physicians, primary care physicians, hematologists, neurologists, intensivists, pharmacists, and nurse practitioners. The origins of mammalian blood coagulation can be traced back over 400 million years. Despite its long history, it is only within the past century that this complex and pivotal teleologic system has begun to be understood. Most recently, the intricacies of hemostasis and pahtologic thrombosis have come to light, leading the way toward new, more effective, and safer treatment modalities. The Second Edition of Fibrinolytic and Antithrombotic Therapy, even more concise and clinically relevant than the First, provides vital, evidence-based information on management of patients with arterial and venous thrombotic disorders. Since the First Edition, the text has been expanded to cover the evolving topics of atherothrombosis, thrombocardiology, hematologic/thrombophilic conditions, and vascular medicine. It includes up-to-date guidelines for antithrombotic and fibrinolytic therapy, and offers concise summaries of current "standards of care." Chapters are dedicated to discussions of patient-specific therapeutics and to the importance of genomics, proteomics, and metabolomics in defining genotype-phenotype relationships, while throughout the book coagulation, inflammation, and vascular medicine are newly examined as elements in an intricatley-linked triad of biochemical and cellular based phenomenology.

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The presence of a right-to-left shunt is associated with dramatic improvement after thrombolytic therapy in acute ischemic stroke patients

Nosotchu ◽

10.3995/jstroke.31.380 ◽

2009 ◽

Vol 31 (5) ◽

pp. 380-382

Author(s):

Kazumi Kimura ◽

Yasuyuki Iguchi ◽

Kensaku Shibazaki ◽

Junya Aoki ◽

Noriko Matsumoto

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Acute Ischemic Stroke ◽

Dramatic Improvement ◽

Stroke Patients

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The Speech-Language Assessment of English Language Learning Students: A Non-Standardized Approach

Perspectives on School-Based Issues ◽

10.1044/sbi14.4.95 ◽

2013 ◽

Vol 14 (4) ◽

pp. 95-101 ◽

Cited By ~ 2

Author(s):

Robert Kraemer ◽

Allison Coltisor ◽

Meesha Kalra ◽

Megan Martinez ◽

Bailey Savage ◽

...

Keyword(s):

Language Learning ◽

Language Impairment ◽

Specific Language Impairment ◽

English Language ◽

Language Assessment ◽

The United States ◽

English Language Learning ◽

Assessment Practices ◽

Evidence Based ◽

English Speaking

English language learning (ELL) children suspected of having specific-language impairment (SLI) should be assessed using the same methods as monolingual English-speaking children born and raised in the United States. In an effort to reduce over- and under-identification of ELL children as SLI, speech-language pathologists (SLP) must employ nonbiased assessment practices. This article presents several evidence-based, nonstandarized assessment practices SLPs can implement in place of standardized tools. As the number of ELL children SLPs come in contact with increases, the need for well-trained and knowledgeable SLPs grows. The goal of the authors is to present several well-establish, evidence-based assessment methods for assessing ELL children suspected of SLI.

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440: Barriers to the Practice of Evidence Based Urology in the United States

The Journal of Urology ◽

10.1016/s0022-5347(18)30693-1 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 147-148

Author(s):

Philipp Dahm ◽

Hubert R. Kuebler ◽

Susan F. Fesperman ◽

Roger L. Sur ◽

Charles D. Scales ◽

...

Keyword(s):

United States ◽

The United States ◽

Evidence Based

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Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽

10.1024/1662-9647/a000127 ◽

2015 ◽

Vol 28 (2) ◽

pp. 67-76

Author(s):

Grace C. Niu ◽

Patricia A. Arean

Keyword(s):

Older Adults ◽

Mental Illness ◽

Brain Plasticity ◽

Late Life ◽

Aging Population ◽

The United States ◽

Future Research ◽

Evidence Based ◽

Late Life Depression ◽

Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

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Fidelity and Its Relationship to Implementation Effectiveness, Adaptation, and Dissemination

10.1093/oso/9780190683214.003.0016 ◽

2017 ◽

Cited By ~ 2

Author(s):

Jennifer D. Allen ◽

Rachel C. Shelton ◽

Karen M. Emmons ◽

Laura A. Linnan

Keyword(s):

Public Health ◽

Treatment Strategies ◽

Implementation Fidelity ◽

Population Level ◽

The United States ◽

Dissemination And Implementation ◽

Evidence Based ◽

Health Gains ◽

Significant Public Health ◽

Research Continuum

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.

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Fiduciary Principles in Contemporary Common Law Systems

The Oxford Handbook of Fiduciary Law ◽

10.1093/oxfordhb/9780190634100.013.31 ◽

2019 ◽

pp. 564-582

Author(s):

Matthew Conaglen

Keyword(s):

United States ◽

Common Law ◽

The United States ◽

Good Faith ◽

Fiduciary Duty ◽

Standards Of Care ◽

Duty Of Care ◽

Fiduciary Duties ◽

Similarities And Differences ◽

Fiduciary Relationships

This chapter examines the principles of fiduciary doctrine that are found in contemporary common law systems. More specifically, it considers the current similarities and differences between various jurisdictions such as England, Australia, Canada, and the United States. The similarities focus on the duties of loyalty, care and skill, and good faith, as well as when fiduciary duties arise and the kinds of interests that are protected by recognition of fiduciary relationships. The chapter also discusses the issue of differences between various jurisdictions with regard to the duty of care and skill before concluding with an analysis of differences between remedies that are made available in the various contemporary common law jurisdictions when a breach of fiduciary duty arises. It shows that the regulation of fiduciaries appears to be reasonably consistent across common law jurisdictions and across various types of actors, even as such actors are expected to meet differing standards of care. Statute plays a key role in the regulation of various kinds of fiduciary actors, especially corporate directors.

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Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420971895 ◽

2020 ◽

Vol 13 ◽

pp. 175628642097189

Author(s):

Clare Lambert ◽

Durgesh Chaudhary ◽

Oluwaseyi Olulana ◽

Shima Shahjouei ◽

Venkatesh Avula ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Rural Population ◽

The United States ◽

Competing Risk ◽

Stroke Recurrence ◽

Composite Outcome ◽

Stroke Patients ◽

Central Pennsylvania ◽

All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

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Implementation of NAVIGATE Coordinated Specialty Care for First Episode Psychosis: the Michigan Experience

CNS Spectrums ◽

10.1017/s1092852920002928 ◽

2021 ◽

Vol 26 (2) ◽

pp. 177-178

Author(s):

Eric D. Achtyes ◽

Kari Kempema ◽

Zhehui Luo ◽

Katharine N. Thakkar ◽

Catherine Adams ◽

...

Keyword(s):

Mental Health ◽

Clinical Symptoms ◽

The United States ◽

First Episode Psychosis ◽

Specialty Care ◽

First Episode ◽

Control Group ◽

Evidence Based ◽

Block Grant ◽

Episode Psychosis

AbstractStudy ObjectivesCoordinated specialty care (CSC) is widely accepted as an evidence-based treatment for first episode psychosis (FEP). The NAVIGATE intervention from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study is a CSC intervention which offers a suite of evidence-based treatments shown to improve engagement and clinical outcomes, especially in those with shorter duration of untreated psychosis (DUP). Coincident with the publication of this study, legislation was passed by the United States Congress in 2014–15 to fund CSC for FEP via a Substance Abuse and Mental Health Services Administration (SAMHSA) block grant set-aside for each state. In Michigan (MI) the management of this grant was delegated to Network180, the community mental health authority in Kent County, with the goal of making CSC more widely available to the 10 million people in MI. Limited research describes the outcomes of implementation of CSC into community practices with no published accounts evaluating the use of the NAVIGATE intervention in a naturalistic setting. We describe the outcomes of NAVIGATE implementation in the state of MI.MethodsIn 2014, 3 centers in MI were selected and trained to provide NAVIGATE CSC for FEP. In 2016 a 4th center was added, and 2 existing centers were expanded to provide additional access to NAVIGATE. Inclusion: age 18–31, served in 1 of 4 FEP centers in MI. Data collection began in 2015 for basic demographics, global illness (CGI q3 mo), hospital/ED use and work/school (SURF q3 mo) and was expanded in 2016 to include further demographics, diagnosis, DUP, vital signs; and in 2018 for clinical symptoms with the modified Colorado Symptom Inventory (mCSI q6 mo), reported via an online portal. This analysis used data until 12/31/19. Mixed effects models adjusted by age, sex and race were used to account for correlated data within patients.ResultsN=283 had useable demographic information and were included in the analysis. Age at enrollment was 21.6 ± 3.0 yrs; 74.2% male; 53.4% Caucasian, 34.6% African American; 12.9 ± 1.7 yrs of education (N=195). 18 mo retention was 67% with no difference by sex or race. CGI scores decreased 20% from baseline (BL) to 18 mo (BL=3.5, N=134; 15–18 mo=2.8, N=60). Service utilization via the SURF was measured at BL (N=172) and 18 mo (N=72): psychiatric hospitalizations occurred in 37% at BL and 6% at 18 mo (p<0.01); ER visits occurred in 40% at BL and 13% at 18 mo (p<0.01). 44% were working or in school at BL and 68% at 18 mo (p<0.01). 21% were on antipsychotics (AP) at BL (N=178) and 85% at 18 mo (N=13) with 8% and 54% on long acting injectable-AP at BL and 18 mo, respectively. Limitations include missing data and lack of a control group.ConclusionThe implementation of the NAVIGATE CSC program for FEP in MI resulted in meaningful clinical improvement for enrollees. Further support could make this evidence-based intervention available to more people with FEP.FundingSupported by funds from the SAMHSA Medicaid State Block Grant set-aside awarded to Network180 (Achtyes, Kempema). The funders had no role in the design of the study, the analysis or the decision to publish the results.

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