Abstract WP247: Paramedic Perspectives on Prehospital Stroke Care: A Qualitative Analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
J A Oostema ◽  
Maria Tecos ◽  
Deborah Sleight ◽  
Brian Mavis
Keyword(s):  
Qualitative Analysis ◽  
Focus Groups ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Structured Interview ◽  
Time Frame ◽  
System Level ◽  
Stroke Patients ◽  
Interview Format ◽  
The Right

Introduction: Ischemic stroke patients who arrive by emergency medical service (EMS) receive faster emergency department evaluations and improved rates of thrombolytic treatment. However, EMS stroke recognition and compliance with prehospital stroke quality measures are inconsistent. We hypothesized that EMS stroke care is influenced by a complex interaction of knowledge, beliefs, and system-level variables that influence behavior. Methods: Focus groups of paramedics from a single urban/suburban county were assembled to discuss their experiences identifying and transporting stroke patients. Focus groups were conducted using a semi-structured interview format and audio recorded. Transcripts of focus groups were qualitatively analyzed to identify themes, subthemes, and patterns of paramedic responses. The Clinical Practice Guidelines Framework provided the initial coding scheme, which was modified during the coding process by three coders using grounded theory methods, who came to consensus on which codes to apply. Results: Three focus groups (n=13) were conducted to reach theme saturation. Overall, paramedics reported high confidence in clinical gestalt for assessing stroke patients and a strong desire to “do the right thing,” but were unfamiliar with published guidelines. Paramedics identified variability in the clinical presentations of stroke, inadequate or inconsistent hospital guidance, and lack of feedback regarding care as principle barriers to ideal prehospital stroke care. Participants reported conflicting hospital guidance regarding the appropriate time frame for a high priority transport and hospital prenotification. Feedback regarding final diagnosis was viewed as critical for developing improved clinical acumen. Direct to CT protocols were cited as an effective way to integrate EMS into hospital stroke response. Conclusion: In this qualitative analysis, paramedics expressed a desire for clear, hospital-directed guidance and consistent feedback regarding outcomes for suspected stroke patients.

Abstract P651: Should I Stay or Go: Seeking Stroke Care During Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kathyrn J Libby ◽  
Linda Couts ◽  
Paige Schoenheit-Scott ◽  
Lindsay L Olson-Mack ◽  
Amelia Kenner Brininger ◽  
...  
Keyword(s):  
San Diego ◽  
Arrival Time ◽  
Stroke Care ◽  
Time Frame ◽  
San Diego County ◽  
Stroke Patients ◽  
Discharge Data ◽  
Hospital Arrival ◽  
The Impact ◽  
At Home

Introduction: On March 16, 2020 San Diego County implemented a stay at home order in response to COVID-19 pandemic; followed by the state of California instituting a shelter in place order. Locally, San Diego County’s stroke receiving centers (SRC) determined a 30% drop in stroke code activations between March-April 2020 compared to the same time in 2019 indicating a possible delay in seeking care. Utilizing discharge data, we sought to understand the impact of the stay at home order on the timeliness of seeking care. Hypothesis: We hypothesized an increase in last known normal (LKN) to hospital arrival time and a decrease in alteplase (tPA) and endovascular therapy (EVT) treatment rates between March 16-June 30 2020 compared to March 16-June 30 2019. Methods: AIS patients presenting to one of 16 SRC in San Diego County between March 16-June 30 in 2019 and 2020, discharged from the hospital or treated in the ED and transferred to another facility were included. Patients arriving as transfers from another facility were excluded. Results: In 2019, of 1,342 AIS cases LKN time was recorded for 85.6% of cases; of 1,092 cases in 2020 86.4% of cases had a LKN. Average LKN to arrival was 20.5 hours in 2019 and 32.4 hours in 2020 (p = .001, 95% CI [4.79, 18.93]). In 2019, 209 (15.6%) received tPA and 91 (6.8%) had EVT. In 2020, 144 (13.2%) received tPA and 75 (6.9%) had EVT. Odds that a case in 2019 received tPA was 1.21 times that of cases in 2020 (p=.09). Odds that a case in 2019 had EVT was .99 times that of cases in 2020 (p=.93). Conclusion: Ischemic stroke patients arriving between March 16-June 30, 2020 had a longer LKN to arrival time compared to the same time frame in 2019. The longer time to arrival may have been due to patients waiting longer to seek care, as anecdotal information from patients eluded to. The odds of receiving tPA or EVT treatment in 2020 compared to 2019 were not statistically significant. This may be due to patients experiencing acute symptoms accessing healthcare at the same rate in 2020 as 2019. Analysis of percent of patients arriving within 4 hours of LKN and average NIHSS are important next steps to determine this. Regardless, during a time of community crisis, it is important to broadcast community messaging focusing on the importance of seeking emergency care for stroke-like symptoms.

The impact of tele-neurologists on acute stroke care at an advanced primary stroke centre

2020 ◽  
pp. 1357633X2092103
Author(s):  
Scott Gutovitz ◽  
Jonathan Leggett ◽  
Leslie Hart ◽  
Samuel M Leaman ◽  
Heather James ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Care Guidelines ◽  
Stroke Center ◽  
The Impact ◽  
Stroke Centre

Introduction We evaluated the impact of tele-neurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center. Methods This observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016–28 February, 2017; tele-neurology: 1 April, 2017–31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups. Results Nine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 tele-neurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups ( p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the tele-neurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among tele-neurology (64 min (51.5–83.5)) than bedside neurology patients (45 min (34–69); p < 0.0001). There was no difference in door-to-IR times (mean ± SD) between bedside neurology (87.2 ± 33.3 min) and tele-neurology (90.4 ± 33.4 min; p = 0.67). Discussion At this facility, our tele-neurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.

scholarly journals The experiences of DMS trained GPs and direct entrants in their first 5 years post CCT: a qualitative analysis

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702749
Author(s):  
Jodie Blackadder-Weinstein ◽  
Michael Smith
Keyword(s):  
Focus Group ◽  
Qualitative Analysis ◽  
Focus Groups ◽  
Structured Interview ◽  
Medical Services ◽  
Apprenticeship Model ◽  
Gp Training ◽  
Initial Focus

BackgroundIn developing the Ministry of Defence (MoD) First5 network, a database of all Tri-Service doctors in their First5 years post receiving their certificate of completion of training (CCT). However, on building the database, up to 23% of doctors, trained by the MoD were no longer regular service military personal within 5 years of completing their GP training.AimTo explore the experience of Defence Medical Services (DMS) trained GPs and direct entrants in in their First5 years post CCT.MethodAn invitation was extended to all GPs currently in the DMS and all those that trained in the Defence Deanery, who gained their CCT between 2011 and 2018. An initial focus group of was conducted, the themes then contributed to the semi-structured interview questions.ResultsFive themes were identified from the focus groups and interviews: Is the apprenticeship model dead? What is my role again? ‘I just don’t think they got the best care they could’ve’. The importance of autonomy and innovation. Should I stay or should I go now?ConclusionDMS should work to establish an environment in which all military First5s have autonomy over their practice; the ability innovate; and a forum in which they can share. This must go hand-in-hand with newly qualified military GPs being supported in their management and administrative learning, while being mentored by an engaged colleague to help understand ‘what’s next’ in their portfolio career.

Priorities for High Quality Care in Rheumatoid Arthritis: Results of Patient, Health Professional, and Policymaker Perspectives

2020 ◽  
pp. jrheum.201044
Author(s):  
Claire E. H. Barber ◽  
Diane Lacaille ◽  
Marc Hall ◽  
Victoria Bohm ◽  
Linda C. Li ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Qualitative Analysis ◽  
Focus Groups ◽  
Quality Care ◽  
Structured Interview ◽  
High Quality ◽  
Strategic Objectives ◽  
High Quality Care ◽  
Measurement Framework ◽  
Vision Statement

Objective To elucidate the essential elements of high-quality rheumatoid arthritis (RA) care in order to develop a vision statement and a set of strategic objectives for a national RA quality framework. Methods Focus groups and interviews were conducted by experienced qualitative researchers using a semi-structured interview or focus group guide with healthcare professionals, patients, clinic managers, healthcare leaders and policy makers to obtain their perspectives on elements essential to RA care. Purposive sampling provided representation of stakeholder types and regions. Recorded data was transcribed verbatim. Two teams of 2 coders independently analyzed the de-identified transcripts using thematic analysis. Strategic objectives and the vision statement were drafted based on the overarching themes from the qualitative analysis and finalized by a working group. Results A total of 54 stakeholders from 9 Canadian provinces participated in the project (3 focus groups and 19 interviews). Seven strategic objectives were derived from the qualitative analysis representing the following themes: 1) early access and timeliness of care, 2) evidence-informed high-quality care for the ongoing management of RA and comorbidities, 3) availability of patient self-management tools and educational materials for shared decision-making, 4) multidisciplinary care, 5) patient outcomes, and 6) patient experience and satisfaction with care, and 7) Equity, which emerged as an overarching theme. The ultimate vision obtained was “Ensuring patient-centered, high quality care for people living with rheumatoid arthritis”. Conclusion The seven strategic objectives identified highlight priorities for RA quality of care to be used in developing the National RA Quality Measurement Framework.

SELF ASSESSMENT TO KNOW UNDERSTANDING MATHEMATIC CONCEPT

2018 ◽  
Vol 3 (1) ◽  
pp. 14-21
Author(s):  
Deni Iriyadi
Keyword(s):  
Qualitative Study ◽  
Qualitative Analysis ◽  
Resolution Limit ◽  
Self Assessment ◽  
Limit Concept ◽  
Research Instrument ◽  
Definition Of ◽  
The Right

This research is a qualitative study aimed to determine the students' understanding of the concept of matter limit. The subjects were students of class XI IPA 1 SMA Negeri 1 Watampone. The concept includes the definition of the limit. Data obtained using a research instrument in the form of self-assessment and then proceed with the interview subjects were selected based on the results of self-assessment has been done before. Analysis using qualitative analysis of students' understanding of the concept of the limit concept. The results of this study indicate that students' understanding of concepts some of which are not / do not understand especially regarding definitions limit. In addition students are also wrong about the resolution limit. Students who understand the concept of limit dinyakatakan them restate concepts, including examples and classify the sample to non-completion of function and limit the right results.

Construct Validity

2017 ◽  
Author(s):  
Richard McCleary ◽  
David McDowall ◽  
Bradley J. Bartos
Keyword(s):  
Time Series ◽  
Construct Validity ◽  
Hypothesis Test ◽  
Secondary Data ◽  
Time Frame ◽  
Primary Data ◽  
Optimal Time ◽  
Intervention Model ◽  
Right Hand ◽  
The Right

Chapter 8 focuses on threats to construct validity arising from the left-hand side time series and the right-hand side intervention model. Construct validity is limited to questions of whether an observed effect can be generalized to alternative cause and effect measures. The “talking out” self-injurious behavior time series, shown in Chapter 5, are examples of primary data. Researchers often have no choice but to use secondary data that were collected by third parties for purposes unrelated to any hypothesis test. Even in those less-than-ideal instances, however, an optimal time series can be constructed by limiting the time frame and otherwise paying attention to regime changes. Threats to construct validity that arise from the right-hand side intervention model, such as fuzzy or unclear onset and responses, are controlled by paying close attention to the underlying theory. Even a minimal theory should specify the onset and duration of an impact.

scholarly journals A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 41-42
Author(s):  
E Johnson ◽  
M Carbonneau ◽  
D Campbell-Scherer ◽  
P Tandon ◽  
A Hyde
Keyword(s):  
Focus Groups ◽  
Gastrointestinal Disease ◽  
Pragmatic Trial ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Care Utilization ◽  
Implementation Barriers ◽  
Mortality And Morbidity ◽  
Order Set

Abstract Background Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta. Aims As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation. Methods We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively. Results Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process. Conclusions Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites. Funding Agencies Alberta Innovates

scholarly journals New Perspectives in Stroke Management: Old Issues and New Pathways

2021 ◽  
Vol 11 (6) ◽  
pp. 767
Author(s):  
Fabio Pilato ◽  
Rosalinda Calandrelli ◽  
Fioravante Capone ◽  
Michele Alessiani ◽  
Mario Ferrante ◽  
...  
Keyword(s):  
Time Window ◽  
Enhanced Recovery ◽  
Current Knowledge ◽  
Oral Anticoagulants ◽  
Chronic Phase ◽  
Stroke Care ◽  
New Drugs ◽  
Stroke Patients ◽  
Social Burden ◽  
Novel Approaches

Stroke is a leading cause of disability and death worldwide and social burden is huge in terms of disabilities, mortality and healthcare costs. Recently, in an acute stroke setting, renewed interest in disease-modifying therapies and novel approaches has led to enhanced recovery and the reduction of long-term disabilities of patients who suffered a stroke. In the last few years, the basic principle “time is brain” was overcome and better results came through the implementation of novel neuroimaging tools in acute clinical practice, allowing one to extend acute treatments to patients who were previously excluded on the basis of only a temporal selection. Recent studies about thrombectomy have allowed the time window to be extended up to 24 h after symptoms onset using advanced neuroradiological tools, such as computer tomography perfusion (CTP) and magnetic resonance imaging (MRI) to select stroke patients. Moreover, a more effective acute management of stroke patients in dedicated wards (stroke units) and the use of new drugs for stroke prevention, such as novel oral anticoagulants (NOACs) for atrial fibrillation, have allowed for significant clinical improvements. In this editorial paper, we summarize the current knowledge about the main stroke-related advances and perspectives and their relevance in stroke care, highlighting recent developments in the definition, management, treatment, and prevention of acute and chronic complications of stroke. Then, we present some papers published in the Special Issue “Clinical Research on Ischemic Stroke: Novel Approaches in Acute and Chronic Phase”.

scholarly journals A First Case Report of Orbital Extra-Adrenal Paraganglioma in Cat

2021 ◽  
Vol 8 (5) ◽  
pp. 86
Author(s):  
Leonardo Leonardi ◽  
Raluca Ioana Rizac ◽  
Ilaria Pettinari ◽  
Luca Mechelli ◽  
Carlo De Feo
Keyword(s):  
Parasympathetic Nervous System ◽  
Neuron Specific Enolase ◽  
Final Diagnosis ◽  
Neuroendocrine Cells ◽  
Neuroendocrine Neoplasm ◽  
Glial Fibrillary Acid Protein ◽  
Veterinary Clinic ◽  
First Case ◽  
The Right ◽  
Extra Adrenal Paraganglioma

Paraganglioma is a rare neuroendocrine neoplasm originating from paraganglia and consisting of neuroendocrine cells of the sympathetic and parasympathetic nervous system. Extra-adrenal paraganglioma occurs with a low incidence in both humans and animals. This report presents the first case of paraganglioma in a cat with orbital primary location. An 18-year-old spayed female European domestic shorthair cat of 3.60 kg body weight was evaluated in a private veterinary clinic in Perugia, Italy, for a pronounced exophthalmos of the right eye. The cat underwent surgery for the enucleation of the right eye and of the mass. The biopsy samples of the removed tissue were fixed in 10% buffered neutral formalin for histological and immunohistochemical evaluations. Therefore, specific markers were used for immunohistochemical investigations, such as anti-neuron specific enolase (NSE), anti-synaptophysin, anti-glial fibrillary acid protein, anti-cytokeratin and anti-chromogranin. The results of these investigations allowed establishing the final diagnosis of ocular extra-adrenal paraganglioma of the cat.

scholarly journals Is Lateropulsion Really Related with a Specific Lesion of the Brain?

2021 ◽  
Vol 11 (3) ◽  
pp. 354
Author(s):  
Kyoung Lee ◽  
Sang Yoo ◽  
Eun Ji ◽  
Woo Hwang ◽  
Yeun Yoo ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Parietal Lobe ◽  
Inferior Frontal Gyrus ◽  
Brain Lesions ◽  
Vertical Posture ◽  
Lesion Volume ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
The Right ◽  
Right Hemisphere Stroke

Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients.

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