Abstract WP367: Comparison of Standard Emergency Room Care with Tele-Stroke Evaluation in Acute Intracerebral Hemorrhage Management

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Sierra C Ford ◽  
Zahra A Ajani ◽  
Qiaoling Chen ◽  
Vedasto S Sorreda ◽  
Grace M Tu ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Wilcoxon Test ◽  
Reversal Agent ◽  
Exact Test ◽  
Anticoagulation Reversal ◽  
Patient Demographics ◽  
Chi Squared ◽  
Anticoagulant Reversal ◽  
Ct Head ◽  
Emergency Room Care

Introduction: Intracerebral hemorrhage (ICH) management includes rapid blood pressure (BP) control and correction of any coagulopathy. It is unknown if the addition of tele-medicine (TM) assessment by vascular neurologists would improve time to intervention of these factors. We hypothesized that TM assessment would improve the time to BP control and anticoagulation reversal compared to standard emergency physician management with telephone neurosurgical consultation (ED). Methods: Charts were retrospectively reviewed for all patients with a primary ICD-9 diagnosis of ICH who presented directly to the ED between 8/15/2013 and 5/30/2015, in three urban primary stroke centers in a Southern California integrated healthcare system that utilizes a internalized tele-stroke system. Patients who were transferred from outside hospitals were excluded. Data collected were patient demographics and specific time points to assess door to BP reduction and anticoagulant reversal initiation. These were compared for patients evaluated by ED vs TM using Fisher’s exact test, Chi-squared test, and Wilcoxon test. Results: Data for 105 ED and 19 TM patients were compared. There was no difference in gender (54.8% male), median age (67 yrs {IQR 58.5-80 yrs}), and median presenting BP (180/93 {IQR 157-207/79.5-108}). Patients seen by TM had a significantly shorter median time from onset to presentation (102.5 min {IQR 37-191 min}) compared to patients evaluated by ED (171 min {IQR 60-492 min}). Patients seen by TM were more likely to have NIHSS documented, faster times to CT head completion and interpretation, higher rates of BP agent administration with faster times to BP agent order and administration, faster time to BP control (both less than systolic 160 and 140), and faster times for anticoagulation reversal order and administration. Conclusion: TM assessment of patients with ICH improves time to BP control and anticoagulation reversal agent initiation.

scholarly journals Molecular epidemiological typing of Neisseria gonorrhoeae isolates identifies a novel association between genogroup G10557 (G7072) and decreased susceptibility to cefixime, Germany, 2014 to 2017

2020 ◽  
Vol 25 (41) ◽  
Author(s):  
Sebastian Banhart ◽  
Klaus Jansen ◽  
Susanne Buder ◽  
Thalea Tamminga ◽  
Sébastien Calvignac-Spencer ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Neisseria Gonorrhoeae ◽  
Molecular Typing ◽  
Dual Therapy ◽  
Epidemiological Typing ◽  
Exact Test ◽  
Patient Demographics ◽  
Chi Squared ◽  
Novel Association ◽  
Sequence Types

Background Emerging antimicrobial resistance (AMR) challenges gonorrhoea treatment and requires surveillance. Aim This observational study describes the genetic diversity of Neisseria gonorrhoeae isolates in Germany from 2014 to 2017 and identifies N. gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroups associated with AMR or some patient demographics. Methods 1,220 gonococcal isolates underwent AMR testing and NG-MAST. Associations between genogroups and AMR or sex/age of patients were statistically assessed. Results Patients’ median age was 32 years (interquartile range: 25–44); 1,078 isolates (88.4%) originated from men. In total, 432 NG-MAST sequence types including 156 novel ones were identified, resulting in 17 major genogroups covering 59.1% (721/1,220) of all isolates. Genogroups G1407 and G10557 (G7072) were significantly associated with decreased susceptibility to cefixime (Kruskal–Wallis chi-squared: 549.3442, df: 16, p < 0.001). Their prevalences appeared to decline during the study period from 14.2% (15/106) to 6.2% (30/481) and from 6.6% (7/106) to 3.1% (15/481) respectively. Meanwhile, several cefixime susceptible genogroups’ prevalence seemed to increase. Proportions of isolates from men differed among genogroups (Fisher’s exact test, p < 0.001), being e.g. lower for G25 (G51) and G387, and higher for G5441 and G2992. Some genogroups differed relative to each other in affected patients’ median age (Kruskal–Wallis chi-squared:  47.5358, df:  16, p < 0.001), with e.g. G25 (G51) and G387 more frequent among ≤ 30 year olds and G359 and G17420 among ≥ 40 year olds. Conclusion AMR monitoring with molecular typing is important. Dual therapy (ceftriaxone plus azithromycin) recommended in 2014 in Germany, or only the ceftriaxone dose of this therapy, might have contributed to cefixime-resistant genogroups decreasing.

A cool modality to restore sinus rhythm

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Yasin ◽  
A Sugrue ◽  
M Van Zyl ◽  
A Ladejobi ◽  
J Tri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Temperature ◽  
Sinus Rhythm ◽  
Animal Experiments ◽  
Funding Source ◽  
Atrial Pacing ◽  
Exact Test ◽  
Chi Squared ◽  
Cool Device ◽  
Atrial Defibrillation

Abstract Background Slowing electrical conduction by cooling the myocardium can be used for defibrillation. We previously demonstrated the efficacy of a small cold device placed in oblique sinus (OS) in terminating atrial fibrillation (AF). However, the parameters needed to achieve effective atrial defibrillation are unknown. Purpose Assess effect of the size of cooled myocardium on frequency of AF termination in acute canine animal models. Methods Sternotomy was performed under general anesthesia in 10 acute canine experiments. AF was induced using rapid atrial pacing and intra-myocardial epinephrine and acetylcholine injections. Once AF sustained for at least 30s, either a cool (7–9°C) or placebo (body temperature) device was placed in the OS. Four device sizes were tested; ½X½, ¾X¾, and 1X1 inch devices and two ¾X¾ inch devices placed side by side simultaneously. Time to AF termination was recorded. Chi-squared or Fisher's exact test were used to compare the frequency of arrhythmia termination with cooling versus placebo. Results A total of 166 applications were performed (89 cool vs 77 placebo) in 10 animal experiments. Overall, AF terminated in 82% of the cooling applications vs. 67.5% of placebo (P=0.03, Figure 1). For the ½X½ inch device 88% of cold applications restored sinus rhythm vs. 63.6% for placebo (P=0.05). The frequency of sinus restoration for cold ¾X¾, 1X1 and two ¾X¾ side by side devices was 86.7%, 83.3% and 70% respectively. Time to sinus restoration when achieved was within three minutes was also not significantly changed. Conclusion Placing a cool device in the oblique sinus can terminate AF and efficacy is not affected by the size of device. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MediCool Technologies

scholarly journals Changing behaviour, ‘more or less’: do implementation and de-implementation interventions include different behaviour change techniques?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Andrea M. Patey ◽  
Jeremy M. Grimshaw ◽  
Jill J. Francis
Keyword(s):  
Behaviour Change ◽  
Implicit Theories ◽  
Cochrane Library ◽  
Behaviour Change Techniques ◽  
Behaviour Change Technique ◽  
Exact Test ◽  
Continuity Correction ◽  
Chi Squared ◽  
Clinician Behaviour ◽  
The Cochrane Library

Abstract Background Decreasing ineffective or harmful healthcare practices (de-implementation) may require different approaches than those used to promote uptake of effective practices (implementation). Few psychological theories differentiate between processes involved in decreasing, versus increasing, behaviour. However, it is unknown whether implementation and de-implementation interventions already use different approaches. We used the behaviour change technique (BCT) taxonomy (version 1) (which includes 93 BCTs organised into 12 groupings) to investigate whether implementation and de-implementation interventions for clinician behaviour change use different BCTs. Methods Intervention descriptions in 181 articles from three systematic reviews in the Cochrane Library were coded for (a) implementation versus de-implementation and (b) intervention content (BCTs) using the BCT taxonomy (v1). BCT frequencies were calculated and compared using Pearson’s chi-squared (χ2), Yates’ continuity correction and Fisher’s exact test, where appropriate. Identified BCTs were ranked according to frequency and rankings for de-implementation versus implementation interventions were compared and described. Results Twenty-nine and 25 BCTs were identified in implementation and de-implementation interventions respectively. Feedback on behaviour was identified more frequently in implementation than de-implementation (Χ2(2, n=178) = 15.693, p = .000057). Three BCTs were identified more frequently in de-implementation than implementation: Behaviour substitution (Χ2(2, n=178) = 14.561, p = .0001; Yates’ continuity correction); Monitoring of behaviour by others without feedback (Χ2(2, n=178) = 16.187, p = .000057; Yates’ continuity correction); and Restructuring social environment (p = .000273; Fisher’s 2-sided exact test). Conclusions There were some significant differences between BCTs reported in implementation and de-implementation interventions suggesting that researchers may have implicit theories about different BCTs required for de-implementation and implementation. These findings do not imply that the BCTs identified as targeting implementation or de-implementation are effective, rather simply that they were more frequently used. These findings require replication for a wider range of clinical behaviours. The continued accumulation of additional knowledge and evidence into whether implementation and de-implementation is different will serve to better inform researchers and, subsequently, improve methods for intervention design.

scholarly journals Detrusor underactivity prevalence and risk factors according to different definitions in women attending urogynecology clinic

2021 ◽  
Author(s):  
Gloria D’Alessandro ◽  
Stefania Palmieri ◽  
Alice Cola ◽  
Marta Barba ◽  
Stefano Manodoro ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Menopausal Status ◽  
Maximum Flow ◽  
Primary Objective ◽  
Wilcoxon Test ◽  
Detrusor Underactivity ◽  
Chi Squared ◽  
Student’S T ◽  
Student’S T Test

Abstract Introduction and hypothesis There is still no consensus on definitions of detrusor underactivity; therefore, it is difficult to estimate the prevalence. The primary objective of the study was to evaluate the prevalence of detrusor underactivity in a cohort of patients with pelvic floor disorders according to different proposed urodynamics definitions. The secondary objectives were to estimate the association between detrusor underactivity and symptoms, anatomy and urodynamic findings and to build predictive models. Methods Patients who performed urodynamic evaluation for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Detrusor underactivity was evaluated according to Schafer’s detrusor factor, Abrams’ bladder contractility index and Jeong cut-offs. The degree of concordance between each method was measured with Cohenʼs kappa, and differences were tested using Student’s t test, Wilcoxon test and Pearson’s chi-squared test. Results The prevalence of detrusor underactivity among a cohort of 2092 women, concerning the three urodynamic definitions, was 33.7%, 37.0% and 4.1%, respectively. Age, menopausal status, voiding/bulging symptoms, anterior and central prolapse, first desire to void and positive postvoid residual were directly related to detrusor underactivity. Conversely, stress urinary incontinence, detrusor pressures during voiding and maximum flow were inversely associated. Final models for detrusor underactivity resulted in poor accuracy for all considered definitions. Conclusions The prevalence of detrusor underactivity varies depending on the definition considered. Although several clinical variables resulted as independent predictors of detrusor underactivity, instrumental evaluation still plays a key role in the diagnosis.

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

2021 ◽  
Author(s):  
Beniamino Brunetti ◽  
Rosa Salzillo ◽  
Stefania Tenna ◽  
Bruno Brunetti ◽  
Mario Alessandri Bonetti ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Locoregional Recurrence ◽  
Demographic Data ◽  
Exact Test ◽  
Significant Difference ◽  
Chi Squared ◽  
Group A ◽  
The Aesthetic ◽  
One Year ◽  
Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

scholarly journals Seroprevalence of Toxoplasma gondii in dogs of riverside communities of Mato Grosso Pantanal, Brazil

2016 ◽  
Vol 25 (4) ◽  
pp. 531-535 ◽  
Author(s):  
Juliana Yuki Rodrigues ◽  
Arleana do Bom Parto Ferreira de Almeida ◽  
Eveline da Cruz Boa Sorte ◽  
Naiani Domingos Gasparetto ◽  
Felipe Augusto Constantino Seabra da Cruz ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Antibody Test ◽  
Human Infection ◽  
Mato Grosso ◽  
Exact Test ◽  
Worldwide Distribution ◽  
Significant Difference ◽  
Chi Squared ◽  
Immunofluorescence Antibody Test ◽  
Immunofluorescence Antibody

Abstract Toxoplasma gondii is an intracellular protozoan with worldwide distribution and dogs act as sentinels of human infection. This search aimed to determine the occurrence of antibodies against T. gondii in dogs of the communities on the Cuiabá River, Mato Grosso and variables associated with infection. The dogs of the riverside communities in Cuiabá River, which includes Barranco Alto, Praia do Poço, Engenho Velho, Varginha, Bom Sucesso, Passagem da Conceição and São Gonçalo Beira Rio, were evaluated for the presence of T. gondii antibodies by indirect immunofluorescence antibody test (IFAT). The prevalence and factors associated with infection were calculated by chi-squared test (χ2) or Fisher’s exact test, and univariate and multiple analysis. Of the 248 dogs surveyed, 107 (43.1%) were seropositive for T. gondii. The seroprevalence ranged from 25.6% to 64.3%. There was no statistically significant difference between the communities studied (p > 0.05). As for the associated factors, the only statistically significant factor was that of dogs living with cats (p = 0.02), with approximately twice the risk of acquiring infection. In conclusion, the seroprevalence in dogs of riverside communities in the Baixada Cuiabana demonstrated that high rates of infection, being the factor associated with infection, contact with domestic cats.

Clinical manifestations in patients with acute and transient psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S363-S364
Author(s):  
Á. López Díaz ◽  
A. Soler Iborte ◽  
S. Galiano Rus ◽  
J.L. Fernández González ◽  
J.I. Aznarte López
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Exact Test ◽  
Chi Squared ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Competing Interest

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract TP308: Transitional Care in Stroke Certified and Non-certified Hospitals: The Comprehensive Post-Acute Stroke Services (COMPASS) Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Janet Prvu Bettger ◽  
Sara Jones ◽  
Anna Kucharska-Newton ◽  
Janet Freburger ◽  
Walter Ambrosius ◽  
...  
Keyword(s):  
Transitional Care ◽  
Discharge Planning ◽  
Care Transitions ◽  
Cluster Randomized Trial ◽  
Stroke Patients ◽  
Care Needs ◽  
Post Discharge ◽  
Exact Test ◽  
Chi Squared

Background: Greater than 50% of stroke patients are discharged home from the hospital, most with continuing care needs. In the absence of evidence-based transitional care interventions for stroke patients, procedures likely vary by hospital even among stroke-certified hospitals with requirements for transitional care protocols. We examined the standard of transitional care among NC hospitals enrolled in the COMPASS study comparing stroke-certified and non-certified hospitals. Methods: Hospitals completed an online, self-administered, web-based questionnaire to assess usual care related to hospitals’ transitional care strategy, stroke program structural components, discharge planning processes, and post-discharge patient management and follow-up. Response frequencies were compared between stroke certified versus non-certified hospitals using chi-squared statistics and Fisher’s exact test. Results: As of July 2016, the first 27 hospitals enrolled (of 40 expected) completed the survey (67% certified as a primary or comprehensive stroke center). On average, 54% of stroke patients were discharged home. Processes supporting hospital-to-home care transitions, such as timely follow-up calls and follow-up with neurology, were infrequent and overall less common for non-certified hospitals (Table). Assessment of post-discharge outcomes was particularly infrequent among non-certified sites (11%) compared with certified sites (56%). Uptake of transitional care management billing codes and quality metrics was low for both certified and non-certified hospitals. Conclusion: Significant variation exists in the infrastructure and processes supporting care transitions for stroke patients among COMPASS hospitals in NC. COMPASS as a pragmatic cluster-randomized trial will compare outcomes among hospitals that implement a CMS-directed model of transitional care with those hospitals that provide highly variable transitional care services.

scholarly journals 271. Fungal Diagnostic Studies in Histoplasmosis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S150-S150
Author(s):  
Gayathri Krishnan ◽  
Margaret Power ◽  
J Ryan Bariola ◽  
Ryan K Dare
Keyword(s):  
Fungal Pathogens ◽  
Cross Reaction ◽  
High Rate ◽  
Fungal Culture ◽  
Patient Demographics ◽  
Immunosuppressive Medications ◽  
Chi Squared ◽  
A Prospective Study ◽  
Disseminated Disease ◽  
Antigen Testing

Abstract Background Histoplasmosis (histo) is a common cause of invasive fungal infection in endemic regions and accurate diagnosis is difficult without direct tissue culture or pathology. Indirect fungal antigen testing for various fungal pathogens is typically performed to assist with diagnostic workup though cross-reaction can lead to difficulty interpreting results. We aimed to evaluate the prevalence of positive antigen testing for non-Histoplasma fungal pathogens in patients with proven invasive histo. Methods We performed a retrospective review of adult patients with proven invasive histo from 2010–2018 at our institution. For inclusion purposes, histo was confirmed by either fungal culture and/or cytology. Patient demographics, clinical characteristics and results of fungal antigen testing for Histoplasma, Blastomyces, Aspergillus, Cryptococcus and β-d-glucan were evaluated. Two different urine Histoplasma antigen assays were used during the study period. Results 57 (31%) of 182 patients diagnosed with histo during the study period had culture or cytology evidence of disease and were included in all further analysis. Thirty-two (56%) of these patients were male, 35 (61.4%) were Caucasian and the mean age was 50.1 years. HIV (20; 35%) and being on immunosuppressive medications (21, 37%) were common in this population. The majority of cases were classified as disseminated histo (40, 70%) followed by acute pulmonary (10; 18%) and chronic pulmonary (7, 12%) disease. Results of fungal antigen testing are documented in the table. Chi-squared analysis was performed. Conclusion There is a frequent cross reaction of non-Histoplasma fungal tests in patients with histo. In our review, there was a high rate of cross reaction with Blastomyces antigen, which can be confusing in regions where both pathogens coexist. Elevation of β-d-glucan was high in these patients. Urine Histoplasma antigen sensitivity was higher with MiraVista testing for disseminated disease in our review. While noninvasive fungal tests are helpful in diagnosis of these infrequent infections, clinicians must still maintain knowledge of the clinical differences between these fungal pathogens and be aware of the limitations of these tests. A prospective study is needed to better define differences between individual Histoplasma tests. Disclosures All authors: No reported disclosures.

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