Abstract WMP89: Bilateral Priming Followed by Task Specific Training Can Improve Moderate to Severe Post-Stroke Upper Extremity Hemiparesis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mary E Stoykov ◽  
Daniel M Corcos
Keyword(s):  
Upper Extremity ◽  
Activity Index ◽  
Stroke Survivors ◽  
Specific Training ◽  
Post Intervention ◽  
Transcallosal Inhibition ◽  
Motor Priming ◽  
Point Increase ◽  
Priming Technique

INTRODUCTION: Priming techniques to facilitate improved motor performance have been examined in stroke rehabilitation research. Reported techniques include transcranial electric (TES) or magnetic (TMS) stimulation, both of which are costly and approved only for research purposes. Here, we examine a motor priming technique which is cost-effective and clinically feasible. This priming technique consists of continuous, symmetrical, rhythmic, wrist flexion and extension. A novel device, the “rocker,” is used which has a mechanical linkage promoting symmetry of both arms. Previous studies examining bilateral priming plus task specific training (TST) found the combination to be more effective than TST alone. However, there have been no studies that: 1) compare bilateral priming to a unilateral version of the same, and 2) examine priming in severely impaired stroke survivors. Hypothesis: The objective of this pilot study was to test our hypothesis that bilateral priming combined with task specific training (TST) would be effective in stroke survivors with severe upper limb impairment. Methods: We collected pilot data in 6 individuals with severe upper extremity hemparesis receiving either bilateral priming or unilateral priming followed by TST. The entire intervention was approximately 4 weeks with a total of 30 hours of priming plus training. Participants were tested at pre-/post-intervention, and at 4-week follow-up. Behavioral Measures included a bilateral motor function measure (Chedoke Arm and Hand Activity Index, CAHAI) and a unilateral measure (Fugl-Meyer Test of Upper Extremity Function, FMUE). Transcallosal inhibition (TCI) persistence was measured using TMS. Results: At post intervention, the bilateral priming group demonstrated a 9 point increase (improvement) as compared to the unilateral one (3.67 point increase) in the CAHAI. The FMUE change scores were 6.0 and 3.66 for the bilateral and unilateral priming groups respectively. Gains persisted at 4-week follow-up. Transcallosal inhibition was more normalized in the bilateral priming group at discharge. Conclusion: In conclusion, we found preliminary evidence to support our hypothesis that bilateral priming plus TST is effective for individuals with severe hemiparesis.

scholarly journals Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle

2019 ◽  
Vol 17 (1) ◽  
pp. 113 ◽  
Author(s):  
Nahid Norouzi-Gheidari ◽  
Alejandro Hernandez ◽  
Philippe S. Archambault ◽  
Johanne Higgins ◽  
Lise Poissant ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Intervention Group ◽  
Outpatient Rehabilitation ◽  
Control Group ◽  
Stroke Survivors ◽  
Post Intervention ◽  
Serious Adverse Events ◽  
Traditional Therapy ◽  
Post Stroke

(1) Background: Increasing the amount of therapy time has been shown to improve motor function in stroke survivors. However, it is often not possible to increase the amount of therapy time provided in the current one-on-one therapy models. Rehabilitation-based virtual reality exergame systems, such as Jintronix, can be offered to stroke survivors as an adjunct to traditional therapy. The goal of this study was to examine the safety and feasibility of providing additional therapy using an exergame system and assess its preliminary clinical efficacy. (2) Methods: Stroke survivors receiving outpatient rehabilitation services participated in this pilot randomized control trial in which the intervention group received 4 weeks of exergaming sessions in addition to traditional therapy sessions. (3) Results: Nine subjects in the intervention and nine subjects in the control group completed the study. The intervention group had at least two extra sessions per week, with an average duration of 44 min per session and no serious adverse events (falls, dizziness, or pain). The efficacy measures showed statistically meaningful improvements in the activities of daily living measures (i.e., MAL-QOM (motor activity log-quality of movement) and both mobility and physical domains of the SIS (stroke impact scale) with mean difference of 1.0%, 5.5%, and 6.7% between the intervention and control group, respectively) at post-intervention. (4) Conclusion: Using virtual reality exergaming technology as an adjunct to traditional therapy is feasible and safe in post-stroke rehabilitation and may be beneficial to upper extremity functional recovery.

Abstract P219: Somatosensory Impairments at Baseline Limit Motor Recovery in Stroke Survivors Using a BCI

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexander B Remsik ◽  
Shawna Gloe ◽  
Leroy Williams ◽  
PETER L VAN KAN ◽  
Veena A Nair ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Brain Injuries ◽  
Somatosensory System ◽  
Motor Recovery ◽  
Stroke Survivors ◽  
Motor Rehabilitation ◽  
Recovery Potential ◽  
System Integrity ◽  
Upper Extremity Rehabilitation

Objective: This study is part of a clinical trial designed to test the efficacy of an EEG-based BCI intervention for upper extremity motor rehabilitation in stroke survivors. The analyses presented here focus on the effectiveness of BCI intervention as a function of somatosensory integrity. Introduction: Human motor control requires integration of sensory and motor signals in the generation of motor commands. Stroke lesions often result in sensorimotor impairments and survivors may require rehabilitation to regain motor function and capacity. Stroke affects individuals differentially, based on a range of factors, including, but not limited to, lesion location and volume. Such factors may restrain recovery potential. Hypothesis: We tested the hypothesis that stroke survivors with measurable somatosensory impairments realize the same amount of motor recovery as those participants without somatosensory impairments. Methods: N= 23 stroke survivors participated in up to 30 hours of BCI intervention (13.8 ±1.3, mean + SD) for upper extremity rehabilitation, as measured by the ARAT. Participants were grouped post-hoc on presence or absence of somatosensory impairments, as measured by the NIHSS subdomains of Sensory (i.e. cutaneous), and Motor Arm (i.e. proprioceptive) and their group means compared. Results: The hypothesis was not confirmed. Mean ARAT scores at completion and follow up differed between groups (Cutaneous loss: ARAT mean change at completion: 0.9 ± 2.23, p= 0.234; ARAT mean change at follow-up: 1.20 ± 2.860, p = 0.217), (No Cutaneous loss: ARAT mean change at completion: 2.15 ± 6.34, p= 0.244; ARAT mean change at follow-up: 4.39 ± 6.41, p= 0.0297) (Proprioceptive loss: ARAT mean change at completion: 0.867 ± 3.66, p= 0.375, ARAT mean change at follow-up: 2.47 ± 5.38, p= 0.097), (No Proprioceptive loss: ARAT mean change at completion: 3 ± 6.80, p= 0.252, ARAT mean change at follow-up: 4 ± 5.42, p= 0.075). Conclusions: These results suggest that BCI intervention is more effective at delivering motor improvements in participants with less somatosensory impairments. These results are consistent with the view that somatosensory system integrity may be key to BCI motor rehabilitation of brain injuries following stroke.

Abstract TP355: A Valiant Effort to Improve Stroke Education

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Melissa M Meighan ◽  
Joseph C Mojares ◽  
Kathryn M Snow
Keyword(s):  
Health System ◽  
Reading Level ◽  
Staff Nurses ◽  
Stroke Survivors ◽  
Stroke Event ◽  
Post Intervention ◽  
Statistical Tool ◽  
Phone Calls ◽  
Stroke Education

Background and Purpose: Increasing knowledge of pertinent aspects of stroke disease may improve outcomes for stroke survivors and family members. Patients and families are educated in a large integrated health system on Joint Commission required elements of stroke education which include: importance of calling 911, stroke signs and symptoms, disease processes, risk factor management, and follow up. In 2018, despite 95% documented rates of education, 40 to 50% of stroke survivors in the health system replied “No” to three Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs) "staff explained stroke..." questions. The purpose of this project was to improve stroke education as measured by an increase in HCAHPs scores. Methods: Current literature was reviewed. Stroke survivors spoke to a regional stroke coordinator group about their experiences. Staff nurses were surveyed on barriers to stroke education. Based on information from the literature, stroke survivors, staff nurses and neuroscience nursing, neurology and education experts, two interventions were undertaken. A flyer was designed using a well-spaced layout with required stroke education elements written at fourth grade reading level and translated into four common languages in the patient population. Community feedback was integrated after the initial design. A training module for teaching stroke education was completed by 886 nurses in eight facilities. The pre and post intervention HCAHPs scores were aggregated from the eight hospitals. The results were analyzed using a Chi2 statistical tool. Results: Unfortunately, a statistically significant increase in HCAHPs scores was not achieved. For question #1; “staff explained stroke diagnosis”, the percentage yes went from %53 (n=49) to %59 (n=59). Question #2; “staff explained risk factors” went from %52 (n=50) to %43 (n=58). Question #3 “staff explained stroke signs/symptoms” went from %47 (n=48) to %53 (n=69). Conclusion: This work supports literature and local stroke survivor feedback indicating stroke survivors and their families are too overwhelmed in the hospital to absorb education. Resources should be put into follow-up phone calls or other modalities after trauma from the stroke event has subsided.

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Upper Limb Motor Recovery in Stroke: A Randomized Controlled Trial

Stroke ◽  
2021 ◽  
Author(s):  
Peiming Chen ◽  
Tai-Wa Liu ◽  
Patrick W.H. Kwong ◽  
Claudia K.Y. Lai ◽  
Raymond C.K. Chung ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Controlled Trial ◽  
Motor Recovery ◽  
Mean Difference ◽  
Post Intervention ◽  
Electrical Nerve Stimulation

Background and Purpose: Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. Methods: This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. Results: Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P =0.004), Placebo-TENS+TOT (mean difference, 2.63; P <0.001), and Control groups (mean difference, 3.11; P <0.001) at post-intervention. Both Bi-TENS+TOT (mean difference, 3.39; P <0.001) and Uni-TENS+TOT (mean difference, 1.26; P =0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. Conclusions: Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03112473.

scholarly journals Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Myriam Villeneuve ◽  
Anouk Lamontagne
Keyword(s):  
Training Program ◽  
Upper Extremity ◽  
Chronic Stroke ◽  
Manual Dexterity ◽  
Stroke Survivors ◽  
Home Practice ◽  
Long Term Effects ◽  
Extremity Function ◽  
Upper Extremity Function

Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke.

Rehabilitation of upper extremity by telerehabilitation combined with exergames in chronic stroke survivors: Preliminary findings from a feasibility clinical trial (Preprint)

2021 ◽  
Author(s):  
Dorra Rakia Allegue ◽  
Johanne Higgins ◽  
Shane N Sweet ◽  
Philippe S Archambault ◽  
Francois Michaud ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Upper Extremity ◽  
Conventional Therapy ◽  
Chronic Stroke ◽  
Control Group ◽  
Stroke Survivors ◽  
Post Intervention ◽  
Experimental Group ◽  
At Home

BACKGROUND Exergames are increasingly used among stroke survivors with chronic UE sequelae, to continue exercising at home, after discharge, and maintain activity level. The use of virtual reality exergames combined with telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in chronic stroke survivors while allowing for ongoing monitoring with a clinician. OBJECTIVE 1) To determine the feasibility of using VirTele with chronic stroke survivors at home; 2) To explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation, in chronic stroke survivors, compared with conventional therapy (GRASP: Graded Repetitive Arm Supplementary Program). METHODS This is a feasibility clinical trial including a two-arm trial design. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility measurements included the number and active time spent on exergame sessions, frequency and time spent by the clinician during videoconferencing sessions, satisfaction with the technology, and resource utilization (equipment, technical support). Outcome measurements included the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Motor Activity log-30 (MAL), Stroke Impact Scale-16 (SIS), and Treatment Self-Regulation Questionnaire-15 (TSRQ) and were administered to both groups at four-time points: T1: before starting the intervention; T2: post-intervention; T3: one-month post-intervention and T4: two-months post-intervention. RESULTS A total of 11 stroke survivors were randomized and allocated to the treatment group. At the COVID-19 onset, participants pursued the allocated treatment for 3-months. VirTele intervention dose was captured in term of time spent on exergames (mean-8 weeks: 16.6 hours; SD 3.0 and mean-third month: 9.3 hours; SD 7.1), frequency of use of exergames (total-mean: 62,5; range: 49-84 sessions), and total number of successful repetitions (mean-8weeks: 13 683; SD 2367 and mean-third month:12035,5; SD 9508,46) and frequency of video-conference- sessions (total mean: 6,6 , range: 3-11 sessions). The technical issues included loss of passwords, Internet issues, updates of the system, and problems with the avatar. Overall, most stroke survivors found the technology easy to use and quite useful, except for one participant. For the FMA-UE and MAL, both groups exhibited an improvement in more than 50% of the participants, maintained over time. Regarding the SIS scores, the control group reported improvement in activities of daily life (60% (3/5)), hand function (100% (5/5)), and mobility (40% (2/5)), while the experimental group reported varied and non-conclusive results. For the TSRQ, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score, while in the control group this improvement was shown in only one participant. CONCLUSIONS VirTele intervention constitutes another therapeutic alternative, in addition to the conventional therapy to deliver an intense personalized rehabilitation program in chronic stroke survivors with UE sequelae. CLINICALTRIAL ClinicalTrials.gov NCT03759106; http://clinicaltrials.gov/show/NCT03759106. INTERNATIONAL REGISTERED REPORT RR2-10.2196/14629

Association between multimodality measures of aortic stenosis severity and quality-of-life improvement outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Michael A Catalano ◽  
Shahryar G Saba ◽  
Bruce Rutkin ◽  
Greg Maurer ◽  
Jacinda Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Multivariable Analysis ◽  
Calcium Score ◽  
Post Intervention ◽  
Transcatheter Aortic Valve

Abstract Aims Up to 40% of patients with aortic stenosis (AS) present with discordant grading of AS severity based on common transthoracic echocardiography (TTE) measures. Our aim was to evaluate the utility of TTE and multi-detector computed tomography (MDCT) measures in predicting symptomatic improvement in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods and results A retrospective review of 201 TAVR patients from January 2017 to November 2018 was performed. Pre- and post-intervention quality-of-life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Pre-intervention measures including dimensionless index (DI), stroke volume index (SVI), mean transaortic gradient, peak transaortic velocity, indexed aortic valve area (AVA), aortic valve calcium score, and AVA based on hybrid MDCT-Doppler calculations were obtained and correlated with change in KCCQ-12 at 30-day follow-up. Among the 201 patients studied, median KCCQ-12 improved from 54.2 pre-intervention to 85.9 post-intervention. In multivariable analysis, patients with a mean gradient &gt;40 mmHg experienced significantly greater improvement in KCCQ-12 at follow-up than those with mean gradient ≤40 mmHg (28.1 vs. 16.4, P = 0.015). Patients with MDCT-Doppler-calculated AVA of ≤1.2 cm2 had greater improvements in KCCQ-12 scores than those with computed tomography-measured AVA of &gt;1.2 cm2 (23.4 vs. 14.1, P = 0.049) on univariate but not multivariable analysis. No association was detected between DI, SVI, peak velocity, calcium score, or AVA index and change in KCCQ-12. Conclusion Mean transaortic gradient is predictive of improvement in quality-of-life after TAVR. This measure of AS severity may warrant greater relative consideration when selecting the appropriateness of patients for TAVR.

scholarly journals EXPRESS: Telehealth coaching to improve self-management for secondary prevention after stroke: A randomized controlled trial of Stroke Coach

2021 ◽  
pp. 174749302110176
Author(s):  
Brodie M Sakakibara ◽  
Scott A Lear ◽  
Susan I Barr ◽  
Charles Goldsmith ◽  
Amy Schneeberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Controlled Trial ◽  
Cognitive Status ◽  
Self Management ◽  
Community Living ◽  
Memory Training ◽  
Stroke Survivors ◽  
Post Intervention ◽  
Lifestyle Behaviour ◽  
Mild Stroke

Background: Stroke Coach is a lifestyle coaching telehealth program to improve self-management of stroke risk factors. Aims: To examine the efficacy of Stroke Coach on lifestyle behaviour and risk factor control among community-living stroke survivors within one-year post stroke. Methods: Participants were randomized to Stroke Coach or an attention control Memory Training group. Lifestyle behaviour was measured using the Health Promoting Lifestyle Profile II. Secondary outcomes included specific behavioural and cardiometabolic risk factors, health-related quality of life (HRQoL), cognitive status, and depressive symptoms. Measurements were taken at baseline, post-intervention (6 months), and retention (12 month). Linear mixed-effects models were used to test the study hypotheses (p<0.05). All analyses were intention-to-treat. Results: The mean age of the Stroke Coach (n=64) and Memory Training (n=62) groups was 67.2 and 69.1 years, respectively. The majority of participants (n = 100) had mild stroke (modified Rankin Scale = 1 or 2), were active, with controlled blood pressure (mean = 129/79 mmHg) at baseline. At post-intervention, there were no significant differences in lifestyle (b = -2.87; 95%CI -8.03 to 2.29; p=0.28). Glucose control, as measured by HbA1c (b = 0.17; 95%CI 0.17 to 0.32; p=0.03), and HRQoL, measured using SF-36 Physical Component Summary (b = -3.05; 95%CI -5.88 to -0.21; p=0.04), were significantly improved in Stroke Coach compared to Memory Training, and the improvements were maintained at retention. Conclusion: Stroke Coach did not improve lifestyle behaviour, however, there were improvements to HbA1c and HRQoL among community-living stroke survivors with mild stroke-related disability. (ClinicalTrials.gov identifier: NCT02207023)

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P&lt; 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P&lt; 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P&lt; 0.001), pregnancy (39.0% vs 79.6%; P&lt; 0.001), syphilis (3.4% vs 89.8%; P&lt; 0.001), hepatitis B (15.3% vs 95.5%; P&lt; 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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