Abstract 202: Door-to-needle-time at 20 Minutes is Feasible and Safe

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Sille M Henriksen ◽  
Lise L Jeppesen ◽  
Anders Christensen ◽  
Hanne K Christensen
Keyword(s):  
Acute Stroke ◽  
Median Time ◽  
Onset Time ◽  
Trauma Team ◽  
Bleeding Complications ◽  
Time Of Arrival ◽  
Standard Work ◽  
Registration Period ◽  
Significant Difference ◽  
Set Up

Background: Effect size of intravenous fibrinolysis in acute stroke depends on time to treatment, while safety depends on a systematic identification of risk factors for bleeding complications. Fibrinolysis is in Denmark the treatment with most potential of modifying outcome in acute stroke patients both in a quantitative and qualitative perspective. We initiated a quality project aiming at reducing our median door-to-needle-time (DTN). The aim of this study was to obtain median DTN below 20 minutes accepting no increase in bleeding complications. Method: A team including neurologist, radiologist, stroke nurse and radiographer set up a structured patient admission process based on trauma team principles and experience with fibrinolysis. The team has immediate access to both CT and MRI; standard work up is CT + CTA. EMS informs of patients with likely symptoms of acute stroke and the patient is received by the team in a dedicated room. During a 3-month registration period from March to June 2013 an external person registered all cases of acute stroke evaluation. The registration covered time of symptom onset, time of arrival, needle time or decision of no thrombolysis and the distribution of the time used e.g. for blood sampling or CT. For comparison, data from our institution in 2012 was used. Results: A total of 157 patients were evaluated and 148 patients were registered; nine patients (5,7%) missed time registration, however no significant difference in thrombolysis ratio was found between the missing and registered group (p=0,473). Patients had a median age of 67 years and 53,4% was male. Forty-seven patients (31,8%) received fibrinolysis. The overall median time is 16 minutes 58 seconds. For patients receiving fibrinolysis, the DNT was 20 minutes 58 seconds and for patients not receiving treatment the median time to desiscion was 15 minutes 50 seconds. No symptomatic intracranial hemorrhages or other significant bleeding complications occured during the study period. Median DTN in 2012 was 49 minutes. Costs were neutral. Conclusion: DTN time can be reduced to 20 minutes by organizational interventions with no apparent effect on safety. NNT is reduced by 1 with every 20 minutes reduction in DTN so this intervention is likely to be highly clinically significant.

Aerosol generation through pars plana vitrectomy

2020 ◽  
pp. bjophthalmol-2020-317214
Author(s):  
Hasan Naveed ◽  
Fong May Chew ◽  
Hanbin Lee ◽  
Edward Hughes ◽  
Mayank A Nanavaty
Keyword(s):  
Pars Plana Vitrectomy ◽  
Ex Vivo ◽  
Dynamic Changes ◽  
Aerosol Generation ◽  
Significant Difference ◽  
Optical Particle Counter ◽  
Pars Plana ◽  
23 Gauge ◽  
Set Up ◽  
Ex Vivo Study

PurposeTo assess whether pars plana vitrectomy (PPV) is an aerosol-generating procedure (AGP) in an ex vivo experimental model.MethodsIn this ex vivo study on 10 porcine eyes, optical particle counter was used to measure particles ≤10 μm using cumulative mode in the six in-built channels: 0.3 μm, 0.5 μm, 1 μm, 2.5 μm, 5 μm and 10 μm aerosols during PPV. Two parts of the study were as follows: (1) to assess the pre-experimental baseline aerosol count in the theatre environment where there are dynamic changes in temperature and humidity and (2) to measure aerosol generation with 23-gauge and 25-gauge set-up. For each porcine eye, five measurements were taken for each consecutive step in the experiment including pre-PPV, during PPV, fluid–air exchange (FAX) and venting using a flute with 23-gauge set-up and a chimney with 25-gauge set-up. Therefore, a total of 200 measurements were recorded.ResultsWith 23-gauge and 25-gauge PPV, there was no significant difference in aerosol generation in all six channels comparing pre-PPV versus PPV or pre-PPV versus FAX. Venting using flute with 23-gauge PPV showed significant reduction of aerosol ≤1 μm. Air venting using chimney with 25-gauge set-up showed no significant difference in aerosol of ≤1 μm. For cumulative aerosol counts of all particles measuring ≤5 μm, compared with pre-PPV, PPV or FAX, flute venting in 23-gauge set-up showed significant reduction unlike the same comparison for chimney venting in 25-gauge set-up.ConclusionPPV and its associate steps do not generate aerosols ≤10 μm with 23-gauge and 25-gauge set-ups.

scholarly journals Implementation of a deep learning model for automated classification of Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse) in real time

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Song-Quan Ong ◽  
Hamdan Ahmad ◽  
Gomesh Nair ◽  
Pradeep Isawasan ◽  
Abdul Hafiz Ab Majid
Keyword(s):  
Deep Learning ◽  
Aedes Aegypti ◽  
Real Time ◽  
Aedes Albopictus ◽  
Automated Classification ◽  
Expert Performance ◽  
Deep Convolutional Neural Networks ◽  
Significant Difference ◽  
Set Up

AbstractClassification of Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse) by humans remains challenging. We proposed a highly accessible method to develop a deep learning (DL) model and implement the model for mosquito image classification by using hardware that could regulate the development process. In particular, we constructed a dataset with 4120 images of Aedes mosquitoes that were older than 12 days old and had common morphological features that disappeared, and we illustrated how to set up supervised deep convolutional neural networks (DCNNs) with hyperparameter adjustment. The model application was first conducted by deploying the model externally in real time on three different generations of mosquitoes, and the accuracy was compared with human expert performance. Our results showed that both the learning rate and epochs significantly affected the accuracy, and the best-performing hyperparameters achieved an accuracy of more than 98% at classifying mosquitoes, which showed no significant difference from human-level performance. We demonstrated the feasibility of the method to construct a model with the DCNN when deployed externally on mosquitoes in real time.

scholarly journals Clinical Efficacy of a New Robot-assisted Gait Training System for Acute Stroke Patients

2021 ◽  
Author(s):  
Andy Chien ◽  
Fei-Chun Chang ◽  
Nai-Hsin Meng ◽  
Pei-Yu Yang ◽  
Ching Huang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Acute Stroke ◽  
Quality Index ◽  
Pittsburgh Sleep Quality Index ◽  
Gait Training ◽  
Training System ◽  
Control Group ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Significant Difference

Abstract Purpose Robot-assisted gait rehabilitation has been proposed as a plausible supplementary rehabilitation strategy in stroke rehabilitation in the last decade. However, its exact benefit over traditional rehabilitation remain sparse and unclear. It is therefore the purpose of the current study to comparatively investigate the clinical benefits of the additional robot-assisted training in acute stroke patients compared to standard hospital rehabilitation alone. Methods Ninety acute stroke patients (< 3 month) were recruited. All participants received the standard hospital neurorehabilitation comprises 45–60 min sessions daily for 3 weeks. Sixty patients also received an additional 30 min of robot-assisted gait training with the HIWIN MRG-P100 gait training system after each of the standard neurorehabilitation session. Outcome measures included: 1. Berg Balance Scale (BBS); 2. Brunnstrom Stage; 3. Pittsburgh Sleep Quality Index and 4. Taiwanese Depression Questionnaire (TDQ) which were assessed pre-treatment and then after every five training sessions. Results Both groups demonstrated significant improvement pre- and post-treatment for the BBS (robotic group p = 0.023; control group p = 0.033) but no significant difference (p > 0.1) between the groups were found. However, the robotic training group had more participants demonstrating larger BBS points of improvement as well as greater Brunnstrom stage of improvement, when compared to the control group. No significant within and between group statistical differences (p > 0.3) were found for Pittsburgh Sleep Quality Index and Taiwanese Depression Questionnaire. Conclusion The addition of robotic gait training on top of standard hospital neurorehabilitation for acute stroke patients appear to produce a slightly greater improvement in clinical functional outcomes, which is not transferred to psychological status.

scholarly journals 162 An Examination of Scar Modelling and Assessment Methods for the Evaluation of Scar Treatments

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Mistry
Keyword(s):  
Assessment Tools ◽  
Randomised Control Trial ◽  
Silicone Gel ◽  
Scar Assessment ◽  
Significant Difference ◽  
Gel Treatment ◽  
Current Assessment ◽  
Set Up ◽  
Silicone Gel Sheeting

Abstract Introduction Scarring is the final common pathway for healing within the skin. Scars can be itchy, painful, tight, and disfiguring. Despite advances in surgery there is currently no reliably effective treatment for reducing or preventing scarring. The primary aim of this research is to assess the currently available models for scarring and evaluate/further develop the utility of current assessment tools, in an effort to design a pilot randomised control trial (RCT) for silicone gel treatment of scars. Method A systematic review of scar models in humans and animals. Examination of currently used subjective and objective scar assessment tools in a plastic surgery scar clinic. A retrospective cohort study assessing long-term scar outcomes in paediatric burn patients. Results Limitations and drawbacks of many existing methods to assess scar treatments were found. No statistically significant difference in long-term scarring outcomes was found between paediatric burns patients treated surgically versus conservatively. A RCT for silicone gel sheeting in the treatment of scars was set up and successful in recruitment. Conclusions Here, we have demonstrated difficulties in establishing a scientific scar treatment model; and created a pilot study that will help to provide high-quality evidence for the efficacy of silicone gel sheeting as a treatment for scars.

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

Abstract P850: Four C’s Are Vital in Improving Door to Thrombolytic Administration

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Betty A McGee ◽  
Melissa Stephenson
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Median Time ◽  
Survival Data ◽  
Stroke Patients ◽  
Eligibility Criteria ◽  
Before And After ◽  
Administration Time ◽  
System Data ◽  
The Impact

Background and Purpose: Thrombolytic therapy is a key link in the stroke chain of survival. Data suggests that four components are vital in decreasing door to thrombolytic administration in acute stroke patients eligible for treatment. Analysis of system data, pre and post implementation of a Door to Needle Project, afforded the opportunity to assess. Hypothesis: We assessed the hypothesis that commitment, collaboration, communication, and consistency (referred to as Four C’s) are vital in improving door to thrombolytic administration time in ischemic stroke patients. Methods: In this quantitative study, we utilized case data collected by a quality improvement team serving five emergency departments within a healthcare system. We retrospectively reviewed times of thrombolytic administration from admission to the emergency department in acute ischemic stroke patients. Cases were included based on eligibility criteria from American Heart Association’s Get With the Guidelines. Times from 2019 were compared with times through April 2020, before and after implementation of the project, which had multidisciplinary process interventions that reinforced the Four C’s. Results: The data revealed a 13.5 % reduction in median administration time. Cases assessed from 2019 had a median time of 52 minutes from door to thrombolytic administration, 95% CI [47.0, 59.0], n = 52. Cases assessed through April 2020 had a median time of 45 minutes from door to thrombolytic administration, 95% CI [39.0, 57.5], n = 18. Comparing cases through April 2020 to those of 2019, there were improvements of 38.1% fewer cases for administration in greater than 60 minutes and 27.8% fewer cases for administration in greater than 45 minutes. Conclusion: The hypothesis that Four C’s are vital in improving door to thrombolytic administration was validated by a decrease in median administration time as well as a reduction in cases exceeding targeted administration times. The impact to clinical outcomes is significant as improving administration time directly impacts the amount of tissue saved. Ongoing initiatives encompassing the Four C’s, within a Cerebrovascular System of Care, are essential in optimizing outcomes in acute stroke patients.

Abstract 102: Adding Computed Tomography Angiography (CTA) to the Acute Stroke Evaluation: A Single-center Experience

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Matthew E Ehrlich ◽  
Heather L Turner ◽  
Lillian J Currie ◽  
Max Wintermark ◽  
Bradford B Worrall ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Medical Center ◽  
Single Center Experience ◽  
Intracranial Vessel ◽  
Vessel Imaging ◽  
Stroke Team ◽  
Significant Difference ◽  
Increase Risk ◽  
Baseline Creatinine ◽  
The University

Objective: To evaluate the safety and utility of CTA acquisition during initial acute stroke evaluation. We hypothesized CTA would not increase risk of renal injury or delay therapy. Design/Methods: We performed a pilot study of CTA acquisition in the acute stroke evaluation at the University of Virginia Medical Center in the first three quarters of 2014. We extracted data from Acute Stroke Team Leader consultations with additional chart review. We collected door-to-CT read times, door-to-needle times, baseline creatinine (Cr) values on presentation, and Cr values 24-48 hours after stroke alert evaluation. Differences in means of these variables were compared between those receiving CTA versus non-contrasted head CT (NCHCT) only. Additionally, we captured CTA results immediately relevant to treatment decisions. Results: Of 289 patients, 157 had CTA completed while 132 had only NCHCT. In the CTA group, 18 patients (11.5%) were treated with IV tissue plasminogen activator (tPA) compared to 11 (8.3%) in the NCHCT group, with no significant difference between groups (p=0.377). There was no difference between mean door-to-CT-read times between the NCHCT (43.07 minutes) and CTA (41.46 minutes) groups (p=0.70). Likewise, there was no significant difference in mean door-to-needle times between the NCHCT (81.36 minutes) and CTA (68.11 minutes) groups (p=0.577). There was a difference between mean Cr values on presentation (1.39mg/dL NCHCT, 1.06mg/dL CTA; p=0.004), but there was no difference between the groups at 24-48 hours (p=0.059) and no difference between the mean change in Cr values (p=0.489). No patients developed a new requirement for hemodialysis. CTA imaging revealed 14 patients with vascular anomalies, and 53 patients with severe stenosis or occlusion of a major cervical or intracranial vessel. One patient in the CTA group and none in the NCHCT group had intravascular intervention. Conclusions: Overall, CTA during acute stroke evaluations were safe and may offer clinical utility, without delaying evaluation or therapy delivery. Additional cost of acute CTA acquisition is negligible given it replaces MRA typically performed later, following admission, as standard vessel imaging. Further prospective study is required.

Research from China finds no significant difference in impact of public service motivation (PSM) in public and private sectors

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Employee Performance ◽  
Intention To Leave ◽  
Public And Private ◽  
Content Type ◽  
The Public ◽  
Significant Difference ◽  
Set Up ◽  
The Impact

Purpose The authors assumed PSM would be higher in the public sector, but they set up a trial to find out if this was the case. Design/methodology/approach To test their theories, the authors conducted two independent surveys. The first consisted of 220 usable responses from public sector employees in Changsha, China. The second survey involved 260 usable responses from private sector employees taking an MBA course at a university in the Changsha district. A questionnaire was used to assess attitudes. Findings The results found no significant difference between the impact of public sector motivation (PSM) on employee performance across the public and private sectors. The data showed that PSM had a significant impact on self-reported employee performance, but the relationship did not differ much between sectors. Meanwhile, it was in the private sector that PSM had the greatest impact on intention to leave. Originality/value The authors said the research project was one of the first to test if the concept of PSM operated in the same way across sectors. It also contributed, they said, to the ongoing debate about PSM in China.

Abstract P141: Global Impact of Covid-19 Pandemic on Acute Stroke and Mechanical Thrombectomy - An International Survey

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dileep R Yavagal ◽  
Vasu Saini ◽  
Violiza Inoa ◽  
Hannah E Gardener ◽  
Sheila O Martins ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
High Volume ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Treatment Practices ◽  
Global Impact ◽  
Significant Difference ◽  
The World ◽  
The Impact

Introduction: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on thrombectomy practice. Methods: A 19-item questionnaire survey aimed to identify the changes in stroke volumes and treatment practices seen during COVID-19 pandemic was designed using Qualtrics software. It was sent to stroke and neuro-interventional physicians around the world who are part of the executive committee of a global coalition, Mission Thrombectomy 2020 (MT2020) between April 5 th to May 15 th , 2020. Results: There were 113 responses across 25 countries. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during COVID-19 pandemic compared to immediately preceding months (Figure 1A-B). This overall median decrease was despite a median increase in stroke volume in 4 European countries which diverted all stroke patients to only a few selected centers during the pandemic. The intubation policy during the pandemic for patients undergoing MT was highly variable across participating centers: 44% preferred intubating all patients, including 25% centers that changed their policy to preferred-intubation (PI) vs 27% centers that switched to preferred-conscious-sedation (PCS). There was no significant difference in rate of COVID-19 infection between PI vs PCS (p=0.6) or if intubation policy was changed in either direction (p=1). Low-volume (<10 stroke/month) compared with high-volume stroke centers (>20 strokes/month) are less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers are more likely to report them to be inadequate (58% vs 92%). Conclusion: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic.

Abstract 14873: Is There Difference in Clinical Outcomes Following Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) between Hospitals With and Without Onsite Cardiac Surgery Backup?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tomonori Akasaka ◽  
Seiji Hokimoto ◽  
Noriaki Tabata ◽  
Kenji Sakamoto ◽  
Kenichi Tsujita ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Bleeding Complications ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
The Impact

Background: Based on 2011 ACCF/AHA/SCAI PCI guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, recent data suggests that there is no significant difference in clinical outcomes following primary or elective PCI between hospitals with and without onsite cardiac surgery. The proportion of PCI centers without onsite cardiac surgery comprises approximately more than half of all PCI centers in Japan. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI to ACS. Methods: From Aug 2008 to March 2011, subjects (n=2288) were enrolled from the Kumamoto Intervention Conference Study (KICS), which is a multicenter registry, and enrolling consecutive patients undergoing PCI in 15 centers in Japan. Patients were assigned to two groups treated in hospitals with (n=1954) or without (n=334) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored other events those were non-cardiovascular deaths, bleeding complications, revascularizations, and emergent CABG. Results: There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery (9.6%vs9.5%; P=0.737). There was also no significant difference when events in primary endpoint were considered separately. In other events, only revascularization was more frequently seen in hospitals with onsite cardiac surgery (22.1%vs12.9%; P<0.001). Kaplan-Meier analysis for primary endpoint showed that there was no significant difference between two groups (Log Rank P=0.943). By cox proportional hazards model analysis for primary endpoint, without onsite cardiac surgery was not a predictive factor for primary endpoint (HR 0.969, 95%CI 0.704-1.333; P=0.845). We performed propensity score matching analysis to correct for the disparate patient numbers between two groups, and there was also no significant difference for primary endpoint (6.9% vs 8.0%; P=0.544). Conclusions: There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.

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